Increased suicide-related behaviors, challenging behaviors, and anxiety symptoms in elementary and junior high school students after the coronavirus disease 2019 pandemic: A single-center case-control study

PCN Rep. 2025 Dec 2;4(4):e70263. doi: 10.1002/pcn5.70263. eCollection 2025 Dec.

ABSTRACT

AIM: The coronavirus disease 2019 (COVID-19) pandemic has had a significant psychological impact on children and adolescents, increasing depression, anxiety, and suicide-related behaviors. In Japan, suicide remained the leading cause of death among individuals aged 10-19 years, with rates rising after the pandemic onset. However, few studies have examined these changes in psychiatric outpatient settings. We aimed to determine whether the prevalence of suicide-related behaviors and associated psychiatric symptoms-depression and anxiety-differed pre- and post-pandemic among elementary and junior high school students attending psychiatric outpatient clinics.

METHODS: In this retrospective case–control study, we analyzed registry data from a child and adolescent psychiatric outpatient clinic in Japan. Patients were classified into pre- and post-COVID-19 groups based on the visit date (cutoff: March 2, 2020). Clinical characteristics were assessed at the initial visit through interviews and standardized rating scales: Depression Self-Rating Scale for Children, Spence Children’s Anxiety Scale, and Attention-Deficit/Hyperactivity Disorder Rating Scale-IV. Group differences were examined using univariate and multivariate logistic regression analyses.

RESULTS: Between 2016 and 2022, 2878 patients were included. The prevalence of suicide-related behaviors increased post-pandemic, from 3.0% to 6.9% among elementary school students and from 15.5% to 21.2% among junior high school students. In the post-COVID-19 group, elementary students more often exhibited antisocial behaviors and hyperactivity/conduct disorder diagnoses. Junior high students more often exhibited anxiety symptoms, particularly social anxiety, panic, and trauma-related fear.

CONCLUSION: Suicide-related behaviors significantly increased after the COVID-19 pandemic, with distinct clinical characteristics observed across age groups.

PMID:41341485 | PMC:PMC12670963 | DOI:10.1002/pcn5.70263