Risk Factors for Suicidal Behavior in Youth and the Impact of SARS-CoV-2 Infection: A Retrospective Case-Control Study

ABSTRACT Background Suicide and self-harm remain critical concerns in youth. This study compares patients with and without suicidality or self-harm (SOSH), suicidality (SI/SA), and COVID-19 to investigate 53 pre-existing risk factors associated with suicidality in patients with and without COVID-19. Methods A retrospective case-control study was conducted using TriNetX data from 111,631,250 patients across 78 healthcare networks. This study included patients aged 0-21 with any healthcare visit between January 20, 2020, and May 11, 2023. Outcomes Comparison groups shared many risk factors, with specific differences. Children with SOSH and COVID-19 had higher odds of support group problems, personality disorder, thyroid disorders, and insomnia; children with SOSH without COVID-19 had higher odds of upbringing problems, anxiety and nonpsychotic disorders, sleep disorders, and autism. Adolescents with SOSH and COVID-19 had higher odds of parent-child conflict; adolescents with SOSH without COVID-19 had higher odds of education and literacy problems. Children with SI/SA and COVID-19 had higher odds of support group problems, personality disorders, and asthma; children with SI/SA without COVID-19 had higher odds of autism. Adolescents with SI/SA and COVID-19 had higher odds of asthma. The effect size of COVID-19 was not significant. SOSH was associated with increased odds of prior SARS-CoV-2 infection in children (OR 2.42) and adolescents (OR 1.88). Interpretation This study confirms known SOSH risk factors and demonstrates their association with suicidality. We observed a significant association between SOSH and preceding SARS-CoV-2 infection. This underscores the need to focus on suicide risk in youth affected by COVID-19.