Side view of a sad woman sitting on the floor in a dark room

Suicide-Related Visits Rose Sharply During Pandemic

By on 07/08/2021

The patients had no breathing problems, no loss of smell or taste, no fever, weakness or fatigue. But they came in droves to the Emergency Departments throughout Einstein Healthcare Network during the COVID pandemic, too: they were suicidal.

“We have had a huge increase in the number of adolescents or adults with depression and anxiety, thoughts of suicide, and it’s absolutely pandemic related,” says Bob Czincila, MD, director of Emergency Medicine at Einstein Medical Center Montgomery. “We see kids as young as 8 or 10, up to 16, 17, 18, and young adults.”

A study recently completed by Joseph Herres, DO, director of research in the Emergency Department at Einstein Medical Center Philadelphia, confirms the dramatic increase in suicide-related ED visits during the pandemic. Suicide-related visits include those by people who had thoughts of suicide as well as those who attempted suicide.

The research, a joint project with the Department of Emergency Medicine  and the Department of Psychiatry, also reflects the paradoxical impact COVID has had on mental health: dramatically increased visits to the ED, but not suicide attempts.

“There were more suicide attempts, but not statistically significant enough to attribute to the pandemic. It could just be random deviation,” Dr. Herres says.

And despite anecdotal impressions and national reports, the Einstein study found “no significant difference in age groups, gender or race,” he says.

More Suicidal Thoughts

David Greenspan, MD, Chair of the Department of Psychiatry, initiated the study. He says he read reports from the Centers for Disease Control and Prevention (CDC) that showed a national increase in suicidal thoughts during COVID, and wanted to see if Einstein’s patients reflected the same pattern. They did.

Many Einstein patients who already endure health disparities due to socio-economic inequities lost the “social support and human connection” that mitigates these circumstances, Dr. Greenspan says.

“Many who find solace in family, or community gathering places such as churches, clubs, sports venues, restaurants and taverns, lost these to the public health effort to save lives,”  he says.

Dr. Herres looked at 819 ED visits in 2019 and 887 visits in 2020 over the same time span and found that the proportion of suicide-related visits – compared with the total number of visits – increased significantly, “with 68% greater after the start of the COVID-19 pandemic.”

Excluding actual suicide attempts, the proportion of ED visits related to thoughts of suicide increased even more, rising 103% during the pandemic.

Increased Resources for People in Crisis

Einstein Montgomery’s Emergency Department staff were so besieged by suicide-related patients that they partnered with the Montgomery County Division of Emergency Medical Services to provide a crisis worker in the ED on Tuesdays and Thursdays, four hours a day.

“There are days of the week when we can have seven to eight patients waiting for facilities, taking up an entire pod in the ED,” Dr. Czincila says.

Patients who are ineligible for discharge after an evaluation by a telehealth psychiatrist receive one-on-one care by technicians in the ED while they await placement. That strains resources as techs are unable to perform their other duties, and patients can wait for days in the ED because of an inadequate number of psychiatric facilities, he says.  

Dr. Herres’ research report is undergoing final review before it is submitted to a professional journal of psychiatry or emergency medicine.

“COVID has added a variety of stresses on the general population and has particularly impacted the population in our ED,” the study concluded.

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