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).
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)
While pediatric societies & "hospital organizations" did "science by press release," breathlessly discussing a correlation on a parent survey or releasing a statement about 1 month of admissions in May 2021, I knew we would get REAL DATA.
/2 This day has arrived. We have the incredible article by Ray et al, showing that during the first 15 months of the pandemic, youth ER presentations of self harm, overdose, and hospital admissions of both decreased by ~18% in Ontario.
/3 There is OTHER data out of Ontario showing that acute mental health ER and admission levels DID NOT INCREASE during the first 12 months of the pandemic. (broken down by age group)
My anger is so high. all I wanted when @CHEO and @SickKidsNews announced these breathless claims about skyrocketing admissions and self harm was DATA RELEASES.
Now, a large study shows that ON 14-24 admissions for self harm, OD, and deaths for same decreased by 20% to mid '21.
Among adolescents and young adults, the initial 15-month period of the COVID-19 pandemic was associated with a relative decline in hospital care for self-harm or overdose.
After 4M person-years of follow-up, 6224 14-24 experienced self-harm/ overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an HR of 0.78 (95% CI 0.75-0.80)
/1 Critically reading a paper
REMOTE/IN SCHOOL & KIDS BEHAVIOUR
*******
It took me ~40 (!!!) tweets to go through a paper critically and explain it and its strengths & limitations. This is how much work reading evidence is. Read (if you dare).
/2 But more importantly, look how much effort I put into it. I really wanted to show you what is required to read, integrate, extract, and analyze primary research.
/3 40 tweets was hard. I could have written MUCH more, and I did much more (like counting unlabelled n's, estimating cohen's d which is VERY challenging for in-person effects, etc)
THREAD: A look at a new study looking at school setting, pandemic, and behaviours in kids.
@JAMA_current article using a cohort design to look at the effects of the pandemic over time. They have an interesting statistical manipulation which I'll describe in a moment!
/1
Now very importantly, the authors acknowledge that the statistical manipulation wasnt enough! It falls short in a number of ways, so they caution very strongly against interpreting this as "causal evidence"
Let's look at what it shows and what its limitations are.
/2
First: what is this?
It is an ongoing survey that is being done of early learning that's been going since 2017. During the 2020-2021 school year, for kids 6-8, 405 parents were surveyed in 4 monthly surveys.
/3
Hey, is your BMI 20? congratulations. You have the same risk of dying as someone with a BMI of 35. BMI is a very imperfect, unscientific, pseudoscientific measure created by a Belgian astronomer. Pretty much everything most doctors know about BMI is wrong.
/1
BMI mortality depends very much on the thing that you are considering.
Many causes of death are associated with lower BMIs many with higher BMIs
/2
The use of archaic BMI's as a measure of health is unscientific and contributes to fatphobia, discrimination, and leads to people who should seek health care to avoiding health care.
/3