(1757) Suicide and Abuse Admissions to PICUs in California and Wisconsin During the COVID-19 Pandemic

Introduction: It was unclear if rates of life-threatening pediatric suicide and child abuse changed during the COVID-19 pandemic. We set out to determine if PICU admission rates for suicide and abuse changed in California (CA) and Wisconsin (WI) during the pandemic, considering both states as a whole and each state independently. Since rural children have higher mortality from suicide, we also separately considered the rural and nonrural subpopulations of both states.

Methods: Using population-level data from Virtual Pediatric Systems, we captured virtually all PICU admissions in both states during the study. We compared PICU admission rates (admissions per week) for suicide and child abuse during the pandemic (March 2020 - December 2022) to rates in seasonally matched projections from time series analysis of PICU admissions in the previous four years (March 2016 - February 2020), stratifying outcomes separately by state and rurality. We defined rural admissions using USDA Rural and Urban Commuting Area Codes, and we defined nonrural admissions as all other admissions.

Results: There were 207,272 unique admissions from 35 PICUs in the seven-year study. Considering CA and WI together, suicide admissions were 33% more frequent during the pandemic [14 ± 5 vs. 11, RR 1.33 (1.23-1.44), p< 0.001]. More frequent suicide was observed in both CA (+42%, p< 0.001) and WI (+17%, p=0.009) and from both the rural (+31%, p=0.007) and nonrural (+28%, p< 0.001) areas of both states. Overall, child abuse admissions were 25% more frequent during the pandemic [3.3 ± 1.8 vs. 2.7, RR 1.25 (1.11-1.41), p< 0.001]. Abuse admissions increased in CA (+58%, p< 0.001), decreased in WI (-35%, p=0.001), and increased in the nonrural areas of both states (+24%, p=0.002). There was no significant change in abuse admissions from the rural areas of both states.

Conclusions: Suicide admissions were 33% more frequent during the pandemic with findings directionally consistent though of variable magnitude in each state and in the rural and nonrural subgroups. A 25% overall increase in child abuse admissions was, again, inconsistent across our sociodemographic analyses. Thus, both state- and population density-related factors likely influenced the changing rates of pediatric suicide and child abuse during the pandemic.