Trends of the incidence and clinical outcomes of suicide-related out-of-hospital cardiac arrest in Korea: A 10-year nationwide observational study

Association of the COVID-19 pandemic with the incidence of suicidal/self-harm emergencies in Japan: dependence of trend on the regional length of movement restriction

OBJECTIVES

Reportedly, coronavirus disease pandemic 2019 (COVID 19) was associated with an increased rate of emergency department visits related to suicide in youth. This study analyzed the influence of the pandemic on the incidence of emergency transportation associated with suicide attempts and self-harm.

METHODS

This retrospective cohort study used the Nationwide Emergency Medical Services Transportation Database between 2016 and 2021 for main analyses and extended database for resuscitation-attempted out-of-hospital cardiac arrests cases for secondary analyses.

RESULTS

We analyzed 204,081 cases with suicidal/self-harm emergencies. Compared with corresponding periods of 4 pre-pandemic years, the incidence of suicidal/self-harm emergencies increased after the end of the first nationwide declaration of emergency and remained high in youth (incidence rate ratio; 95% lower/upper interval, 1.29; 1.22-1.37 and 1.33; 1.28-1.39,), particularly in females (1.35; 1.27-1.46 and 1.40; 1.33-1.48) during the remaining pandemic period (Phase I (June 2020 to December 2020) and Phase II (2021), respectively). Compared with other emergencies, suicidal/self-harm emergencies were associated with a much higher proportion of outpatient deaths regardless of the pandemic. Suicidal out-of-hospital cardiac arrests cases were associated with much poorer outcomes.

CONCLUSION

The incidence of suicidal/self-harm emergency transportation in youth considerably increased during COVID 19 after the end of the first state of emergency declaration in Japan. This pandemic's impact varied among sex and region, appearing most prominently in young females. Rapid accumulation of suicidal/self-harm emergency transportation incidences may serve as an early warning sign for mental health problems and suicidality in Japan.

Association between suicide attempts and pediatric OHCA survival during the COVID-19 pandemic: Japanese cohort study

BACKGROUND

Suicide is a leading cause of death in children. The COVID-19 pandemic might change the characteristics, causes (medical, suicidal, accidental, and other non-medical), and outcomes of pediatric OHCA. This study aimed to investigate the impact of pediatric OHCA in age, location, and quarantine-related movement restriction subgroups.

METHODS

Combining the nationwide OHCA registry with the emergency medical service transportation database, we created a database with detailed information on 7657 non-neonatal, pediatric OHCA cases.

RESULTS

The pandemic period did not significantly alter neurologically favorable 1-month survival compared to pre-pandemic 4 years (95% confidence interval 0.73-1.00). However, the survival rate significantly decreased in the following subgroups of OHCA: school-age (0.62-0.96), outside of school or home (0.52-0.96), and cases where no quarantine-related movement restrictions were applied (0.68-0.97). There was a prominent increase in the proportion of suicide-related OHCA in these subgroups: from 30.3 to 38.1% (1.22-1.64), from 10.2 to 15.9% (1.21-2.28), and from 12.5 to 17.8% (1.30-1.77), respectively.

CONCLUSION

The COVID-19 pandemic did not significantly alter neurologically favorable 1-month survival. However, it led to worsened survival in subgroups with higher suicide attempt rates. Prevention of suicide is likely essential in the assurance of children's lives during the pandemic.

IMPACT

This cohort study found that during the 2020/2021 pandemic, neurologically favorable survival decreased in school-age out-of-hospital cardiac arrest (OHCA) cases, those not subject to quarantine-related movement restrictions, and those in locations outside of school or home. Within these three subgroups, there was a notable rise in OHCA cases related to suicide, historically known to be more challenging to manage successfully. However, survival rates for overall OHCA and medically related OHCA cases remained unchanged throughout the pandemic. Preventive measures for suicide attempts may be necessary to improve the overall survival of pediatric OHCA during the pandemic.

Suicide-Related Out-of-Hospital Cardiac Arrests in Queensland, Australia: Temporal Trends of Characteristics and Outcomes over 14 Years

BACKGROUND

Research into suicide-related out-of-hospital cardiac arrests (OHCA) using OHCA registries is scant. A more complete understanding of methods, patient characteristics, and outcomes is essential to inform prehospital management strategies and public health interventions.

METHODS

Included were all OHCA attended by Queensland Ambulance Service (Australia) paramedics between 1 January 2007 and 31 December 2020, where suicide-related causes could be identified. Age- and sex-standardized incidence rates were calculated. Suicide methods, patient characteristics, and survival outcomes were described. Factors associated with survival outcomes were investigated.

RESULTS

Seven thousand three hundred and fifty-six suicide-related OHCA cases were included. The incidence rates increased from 9.0 per 100,000 population in 2007 to 12.4 in 2020. The incidence rates for males were four times those for females; however, incidence rates for females have increased faster than for males. Hanging was the most common suicide method (63%). Twenty-three percent of patients received resuscitation attempts by paramedics. Among those, the rates of return of spontaneous circulation (ROSC) sustained to hospital arrival, survival to hospital discharge, and survival to 30 days were 28.6, 8.5, and 8.0%, respectively. Over time, the rates of ROSC upon hospital arrival increased, whereas the rates of survival to discharge and 30-day survival remained stable.

CONCLUSION

The incidence of prehospital-identified suicide-related OHCA in Queensland has increased over time. The prognosis of suicide-related OHCA is poor. Prevention measures should focus on early identification and treatment of individuals having a high risk of suicide. Emergency medical services need to have sufficient training for telecommunicators and paramedics in suicide risk assessment and identification.

Temporal trends of suicide-related non-traumatic out-of-hospital cardiac arrest characteristics and outcomes with the COVID-19 pandemic

Background

Jurisdictions have reported COVID-19-related increases in the incidence and mortality of non-traumatic out-of-hospital cardiac arrest (OHCA). We hypothesized that changes in suicide incidence during the COVID-19 pandemic may have contributed to these changes. We investigated whether the COVID-19 pandemic was associated with changes in the: (1) incidence of suicide-related OHCA, and (2) characteristics and outcomes of such cases.

Methods

We used the provincial British Columbia Cardiac Arrest Registry, including non-traumatic emergency medical system (EMS)-assessed OHCA, to compare suicide-related OHCA (defined as clear self-harm or a priori communication of intent) one-year prior to, and one year after, the start of the COVID-19 pandemic (March 15, 2020). We calculated differences in incidence (with 95% CI), overall and within subgroups of mechanism (hanging, suffocation, poisoning, or unclear mechanism), and in case characteristics and hospital-discharge favourable neurological outcomes (CPC 1–2).

Results

Of 13,785 EMS-assessed OHCA, we included 274/6430 (4.3%) pre-pandemic and 221/7355 (3.0%) pandemic-period suicide-related cases. The median age was 43 years (IQR 30–57), 157 (32%) were female, and 7 (1.4%) survived with favourable neurological status. Suicide-related OHCA incidence decreased from 5.4 pre-pandemic to 4.3 per 100 000 person-years (-1.1, 95% CI −2.0 to −0.28). Hanging-related OHCA incidence also decreased. Patient characteristics and hospital discharge outcomes between periods were similar.

Conclusion

Suicide-related OHCA incidence decreased with the COVID-19 pandemic and we did not detect changes in patient characteristics or outcomes, suggesting that suicide is not a contributor to increases in COVID-related OHCA incidence or mortality. Overall suicide-related OHCA outcomes in both time periods were poor.