Return-to-school effects on suicide attempts in adolescents: a cross-sectional comparison between COVID-19 pre-pandemic and pandemic school semesters.

Abstract Background The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year. Methods A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of suicide attempts of adolescents occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4). Results The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of suicide attempts in girls in period 4 (Sept 2020-Mar 2021) compared to the rest of periods ( p = 0.026). The multinomial regression models showed a significant increase in the frequency of suicide attempts in the first semester of the pandemic academic year compared to the second semester of the pre-pandemic year, with depressive symptoms being a significant contributing factor (p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year compared to the same semester of the pre-pandemic year (p = 0.006 and p = 0.01, respectively). Conclusions During the pandemic, suicide attempts in girls increased more significantly in the first semester than in the previous year, and it was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown was a relevant trigger of suicide attempts in adolescents.