Child and Adolescent Psychiatry, Kings College London, London, UK.
South London and Maudsley Mental Health NHS Trust, London, UK.
Eur Child Adolesc Psychiatry. 2022 Jul;31(7):1-13. doi: 10.1007/s00787-021-01741-6. Epub 2021 Mar 7.
To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62-0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07-1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06-2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28-0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.
为了研究与 2019 年同期相比，2020 年 3 月至 4 月 COVID-19 封锁期间儿童和青少年因自残到医院急诊就诊的差异。这是一项回顾性队列研究。我们使用了来自 10 个国家的 23 个医院急诊部的电子患者记录，这些记录被分为 14 个区域。我们通过年龄 18 岁以下的 1795 名独特儿童和青少年检查了 2073 例急性医院就诊的数据。我们将紧急精神病院就诊的总人数和出现严重自残的儿童和青少年比例作为我们的两个主要结果衡量标准。此外，我们还检查了那些出现自残的儿童和青少年的社会人口学和临床特征以及临床管理变量。为了比较 2020 年和 2019 年的就诊人数，我们使用了负二项模型。对于其他变量，我们进行了个体参与者数据（IPD）荟萃分析。2020 年紧急精神病院就诊人数从 2019 年的 1239 例减少到 2020 年的 834 例，发病率比为 0.67，95%置信区间为 0.62-0.73；p<0.001。出现自残的儿童和青少年的比例从 2019 年的 50%增加到 2020 年的 57%，优势比为 1.33，1.07-1.64；p=0.009，但出现严重自残的比例没有差异。在出现自残的亚人群中，出现情绪障碍的儿童和青少年的比例从 58%增加到 66%，优势比为 1.58，1.06-2.36；p=0.025。2020 年，被收治到观察病房的儿童和青少年的比例也从 13%降至 9%，优势比为 0.52，0.28-0.96；p=0.036。服务规划者应考虑到，在封锁期间，紧急精神病院就诊的人数可能会减少。许多有精神科急症的儿童和青少年可能得不到任何服务。应优先考虑发展具有外展能力的强化社区护理服务。
