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{ "pk": 47097, "title": "Intersectional Analysis of Suicide-related Emergency Department Visits in Youth in California, 2018–2021", "subtitle": null, "abstract": "<p><strong>Introduction:</strong> The COVID-19 pandemic and related anti-Asian political rhetoric had a detrimental impact on the mental health of Asian American and Pacific Islander (AAPI) youth in the United States. Our objective was to quantify trends in suicide-related emergency department (ED) encounters among AAPI youth before and during the COVID-19 pandemic, using an intersectional lens of race and sex and to contextualize these trends on a timeline of political and social events (such as anti-Asian hate crimes) occurring during the same period in California.</p>\n<p><strong>Methods: </strong>Using data from the California State Emergency Department Database (SEDD) from 2018–2021, we evaluated changes in quarterly proportions of suicide-related ED encounters by age, race, and sex subgroups by comparing mean percentage change in proportions before and during the pandemic among patients 8-21 years of age. We evaluated changes in quarterly proportions of suicide-related ED encounters by age, race, and sex subgroups by comparing mean percentage changes as they related to events around the pandemic and spikes in anti-Asian hate crimes. To compare relative disparities during the periods, we used stratified adjusted mixed multilevel logistic regression, with White males as the reference group.</p>\n<p><strong>Results:</strong> The overall increase in suicide-related ED visits for all youth during this period was 49.5% (95% CI 46.7-52.2%), representing 2,637 more suicide-related ED visits in 2021 than 2018. The graphical observational analysis of changes in quarterly proportions of suicide-related ED visits showed some temporal correlation between spikes in rates among AAPI and American Indian and Alaska Native (AI/AN) females and specific events, such as anti-Asian hate crimes and school closings. The largest percentage increase was seen among females of all races, and in particular, AI/AN females (+58.1%, representing 471 more suicide-related ED visits in 2021 than 2018) and AAPI females (+57.5%, representing 1,545 more suicide-related ED visits in 2021 than 2018). During the pandemic, the adjusted odds of a suicide-related ED visit among AAPI females 13-17 years of age compared to White males was 2.01 (95% CI, 1.91-2.13). A total of 131 in-ED deaths occurred during the study period, with no significant year-to-year variation in the number of deaths.</p>\n<p><strong>Conclusion: </strong>Suicide-related ED visits increased for all youth during COVID-19, with the sharpest rise among AAPI and AI/AN females. Asian American and Pacific Islander females 8-12 and 13-17 years of age showed especially large increases. While causality cannot be inferred, patterns aligned with pandemic disruptions and anti-Asian hate crimes. Findings highlight the value of intersectional analysis to identify disproportionately impacted subgroups and inform future, culturally responsive suicide prevention efforts. </p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "pediatric" }, { "word": "Suicide" }, { "word": "intersectional" }, { "word": "gender" }, { "word": "Race" } ], "section": "Original Research (Limit 4000 words)", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3pg4f5c5", "frozenauthors": [ { "first_name": "Laura", "middle_name": "M", "last_name": "Prichett", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Pediatrics, Division of General Pediatrics, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Center for Suicide Prevention, Baltimore, Maryland", "department": "" }, { "first_name": "Annie", "middle_name": "", "last_name": "Na", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Pediatrics, Division of General Pediatrics, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland", "department": "" }, { "first_name": "Hanae", "middle_name": "", "last_name": "Fujii-Rios", "name_suffix": "", "institution": "Johns Hopkins Bloomberg School of Public Health, Center for Suicide Prevention, Baltimore, Maryland; Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland", "department": "" }, { "first_name": "Emily", "middle_name": "E", "last_name": "Haroz", "name_suffix": "", "institution": "Johns Hopkins Bloomberg School of Public Health, Center for Suicide Prevention, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Health Program, Center for Indigenous Health, Baltimore, Maryland", "department": "" } ], "date_submitted": "2025-03-28T20:02:40.966000+03:00", "date_accepted": "2025-07-27T16:41:51.708000+03:00", "date_published": "2025-11-27T07:56:00+03:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/47097/galley/43186/download/" } ] }