Thread by @tylerblack32

1/ THREAD: Actual data (not claims):
Presentations of pediatric suicide attempts during the pandemic

A study out of Paris looking at suicide attempts in kids <16y, presenting to the Robert Debré. It has unsurprising (to me) results, but demonstrates some interesting things.

2/ Some context from a child emergency expert:

Children often present with suicide attempts when they are under duress. A surprising number of kids (5-8% per year) attempt suicide (by report), fortunately a much smaller fraction of kids (<0.01%) die of suicide.

3/ I couldn't find French data, but its neighbour Germany has an article out that shows the rate of suicide attempts in youth at 6.7% (no migration background) or 10% (with migration background).

bmcpediatr.biomedcentral.com/articles/10.11…

4/ Also, some France Background.

They had three major lockdowns:
16 Mar to 11 May 2020
28 Oct to 14 Dec 2020
26 Feb to 2 May 2021

School closures:
17 Mar to 10 May 2020
5 April to 3 May 2021

School opening:
Sep 2020
(School did not close during the 2nd lockdown period)

5/ All this to say, suicide presentations to hospital is a good OBJECTIVE MARKER of childhood distress. Surveys are good of course too, and we should listen to what kids have to say! I much prefer child surveys over parent surveys. Most parents don't know about SI/SA until after.

6/ Lets look at this study and see what it shows. First: Boom!

There was a spike in suicide attempts during the pandemic. This is consistent with pretty much every bit of data we have coming out of many jurisdictions: the pandemic has massive distress implications for kids.

7/ Why did I have to draw on the actual pandemic/times? because the authors made a mistake in the graph. the pandemic started in march 2020, and their numbers have a bizarre shift in this graph, and the date axes don't line up.

I'm pretty sure my version is correct.

8/ Lets closely look at this though (The authors make it very helpful by including this graph, though, again, its axes and plots are off, and the pandemic not properly plotted).

The TREND WAS INCREASING (We will calculate later) PRIOR to the pandemic.

9/ Clearly, there was an increase that was beyond the trend in 2020. However, please remember that trends are NOT predictive. IE 2015's "5 year trend" did not predict 2016-2019. Trends are RETROSPECTIVE NOT PREDICTIVE in suicide.

10/ By eyeballing the trend, it looks like yearly there was an increase of about 5 patients per 2 months. By looking these author's january numbers, Jan/Feb 2019-2020, the difference was ~5. This is a 30.8% increase over the previous year, PREPANDEMIC.

11/ So lets look at the numbers.
They helpfully include this table

(Which allowed me to do a number of calculations as well as correct their errored graphs, and this table is also why I am certain that their graphs have serious plot errors).

12/ How seriously do I take stats? THIS SERIOUSLY. I really wish that people would take time and care to represent data. The errors on the graphs in the original paper mean that people will be misreading it when they lazily skim/graph hunt.

13/ The lockdown WITH school closures AT beginning of COVID was associated with least number of SA even c/t PREPANDEMIC, and represents both a huge drop from the previous 2 months, but also an unprecedented drop in May-June generally (school year ending, typically MORE distress)

14/ There was certainly a spike in suicide attempts in the pandemic, but it wasn't until the September school year started again in 2020 with OPEN schools, & NO lockdowns that we saw a TREMENDOUS spike in suicide attempts.

***Note: lockdowns lifted for 4 months by this point***

15/ The addition of **lockdown** and **school closures** did not significantly change the number of attempts, nor did it change a lot when lockdown was lifted again.

16/ Due to the way they bifurcated the Months, I have to ignore Mar/April 2021, despite there being a tantalizing knowledge that in April schools were closed or a month and there was a lockdown. Would love to know the Mar/April diference.

17/ Here's the raw #'s (no math to remove the "seasonal effect") with the prepandemic year in the blue bars (and one estimated imaginary month where COVID didn't happen), and the pandemic dot/lines coloured per "lockdown" condition.

18/ Please note I painstakingly measured the graph presented by the authors to establish these raw numbers. if the graph Y axis is accurate (x wasnt!) I am no more than +/- 1 on these numbers.

19/ Takeaway:
This study shows us:
* In Paris, pandemic resulted in more suicide attempts in kids
* BUT, there does not seem to be a substantial effect of "locking things down." In fact, its minor, and the first lockdown a significant decrease.

20/ Before we take this as huge proof, the data is noisy, its low numbers, it can't be divided by gender due to the low numbers. BUT. It's data. Unlike sensationalistic claims by some hospitals/advocates, this is raw data. It's what we need more of.

21/ Other limitation: Do suicide attempt presentations decrease during lockdown due to access? (I can never know, but I would bet an awful lot on this not being the case. Both clinically & in common sense, it is difficult to imagine not going to hospital after suicide attempt)

22/ Article:
jamanetwork.com/journals/jaman…