Suicide and Self-Harm in Youth Presenting to a US Rural Hospital During COVID-19.

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Rural-residing children in the United States experience higher suicide mortality than urban-residing children but are underrepresented in research. We examined changes in emergency department (ED) utilization and subsequent hospitalization for suicide or self-harm in a rural hospital after the coronavirus disease 2019 pandemic onset. This retrospective cohort study involved children aged 5 to 17 years visiting a rural, Northeastern hospital from January 1, 2017 to May 31, 2021. We used autoregressive integrated moving average modeling, an interrupted time series analysis, to examine monthly changes after the pandemic onset (March 2020) in ED visits with a primary mental health diagnosis, number of mental health visits with a suicide or self-harm diagnosis, proportion of patients with suicide or self-harm admitted to hospital, and length of stay for suicide or self-harm. Prepandemic, there was an average of 20.6 visits per month for mental health conditions, with 23.3 visits per month postpandemic (P = .16). Monthly visits for suicide or self-harm were greater in the postpandemic (15.6 visits per month) versus prepandemic months (11.4 visits per month, P < .01). In autoregressive integrated moving average modeling, pandemic onset related to an additional 0.83 (95% confidence interval: 0.31 to 1.36) primary mental health visits with suicide or self-harm diagnoses per month. Of these visits, there was an immediate, absolute increase of 39.6% (95% confidence interval: 26.0% to 53.1%) in the proportion resulting in admission; admission rates declined in subsequent months. Pandemic onset was not associated with significant changes in the number of visits for mental health conditions or length of stay. Pediatric ED visits for suicide or self-harm increased at a significant rate during the coronavirus disease 2019 pandemic and a greater proportion resulted in hospitalization, highlighting the acute mental health needs of rural-residing children.