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

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.