Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study

Dennis Ougrin, Ben Hoi ching Wong*, Mehrak Vaezinejad, Paul L. Plener, Tauseef Mehdi, Liana Romaniuk, Elizabeth Barrett, Haseena Hussain, Alexandra Lloyd, Jovanka Tolmac, Manish Rao, Sulagna Chakrabarti, Sara Carucci, Omer S. Moghraby, Rachel Elvins, Farah Rozali, Ereni Skouta, Fiona McNicholas, Natalie Kuruppuaracchi, Dejan StevanovicPeter Nagy, Chiara Davico, Hassan Mirza, Evren Tufan, Fatima Youssef, Ben Meadowcroft, Sabine Landau

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

85 Citations (Scopus)


To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62–0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07–1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06–2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28–0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalEuropean Child and Adolescent Psychiatry
Issue number7
Publication statusPublished - Jul 2022


  • Adolescents
  • COVID-19
  • Children
  • Emergency presentation
  • Pandemic
  • Self-harm

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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