Bersia Michela, Koumantakis Emanuele, Berchialla Paola, Charrier Lorena, Ricotti Andrea, Grimaldi Piercesare, Dalmasso Paola, Comoretto Rosanna I
Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy.
Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 43, 10043, Orbassano, Italy.
EClinicalMedicine. 2022 Dec;54:101705. doi: 10.1016/j.eclinm.2022.101705. Epub 2022 Oct 31.
There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic.
A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included. Random-effects meta-analyses were conducted, and the intra-study risk of bias was assessed. When pre-COVID-19 data were available, incidence rate ratio (IRR) and prevalence ratio (PR) estimates were calculated between the two periods. All the analyses were performed according to the setting explored: general population, emergency department (ED), and psychiatric services. The review protocol was registered on PROSPERO (CRD42022308014).
Forty-seven observational studies were selected for more than 65 million subjects. The results of the meta-analysis showed a pooled annual incidence rate of suicides of 4.9 cases/100,000 during 2020, accounting for a non-statistically significant increase of 10% compared to 2019 (IRR 1.10, 95% CI: 0.94-1.29). The suicidal behaviors pooled prevalence during the COVID-19 pandemic was higher in the psychiatric setting (25%; 95% CI: 17-36%) than in the general population (3%; 1-13%) and ED (1%; 0-9%). The pooled rate of suicidal ideation was 17% in the general population (11-25%), 36% in psychiatric setting (20-56%) and 2% in ED (0-12%). The heterogeneity level was over 97% for both outcomes in all settings considered. The comparison between before and during COVID-19 periods highlighted a non-statistically significant upward trend in suicidal behaviors among the general population and in ED setting. The only significant increase was found for suicidal ideation in psychiatric setting among studies conducted in 2021 (PR 1.15; 95% CI: 1.04-1.27), not observed exploring 2020 alone.
During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks.
The present study was funded by the University of Torino (CHAL_RILO_21_01).
人们担心青少年中出现自杀行为。新冠疫情可能使情况恶化，然而，关于这一主题的研究报告了相互矛盾的结果。这项工作旨在总结全球新兴文献中关于新冠疫情期间年轻人自杀率的研究结果。
进行了一项系统综述和荟萃分析，在五个电子数据库中搜索2020年1月1日至2022年7月27日发表的研究。纳入了报告新冠疫情期间19岁以下年轻人三种考虑结果（自杀、自杀行为和自杀意念）发生率的研究。进行了随机效应荟萃分析，并评估了研究内的偏倚风险。当有新冠疫情前的数据时，计算两个时期之间的发病率比（IRR）和患病率比（PR）估计值。所有分析均根据所探索的环境进行：普通人群、急诊科（ED）和精神科服务。该综述方案已在PROSPERO上注册（CRD42022308014）。
为超过6500万受试者选择了47项观察性研究。荟萃分析结果显示，2020年自杀的合并年发病率为4.9例/10万，与2019年相比，无统计学意义的10%增长（IRR 1.10，95% CI：0.94 - 1.29）。新冠疫情期间，精神科环境中自杀行为的合并患病率（25%；95% CI：17 - 36%）高于普通人群（3%；1 - 13%）和急诊科（1%；0 - 9%）。普通人群中自杀意念的合并率为17%（11 - 25%），精神科环境中为36%（20 - 56%），急诊科为2%（0 - 12%）。在所有考虑的环境中，两种结果的异质性水平均超过97%。新冠疫情之前和期间的比较突出了普通人群和急诊科环境中自杀行为无统计学意义的上升趋势。在2021年进行的研究中，仅在精神科环境中发现自杀意念有显著增加（PR 1.15；95% CI：1.04 - 1.27），单独研究2020年时未观察到。
在疫情期间，自杀谱问题似乎遵循先前研究中描述的已知模式，自杀意念的发生率高于自杀行为和自杀事件。政府和其他利益相关者应注意，在像新冠疫情这样的重大灾难开始时，年轻人可能面临独特风险，采取积极措施满足年轻人的需求以减轻这些风险是必要的。
本研究由都灵大学资助（CHAL_RILO_21_01）。
