When the health crisis caused by covid-19 broke out, voices started to be raised from the health sciences field alerting of the long-term repercussions that it would have on citizens’ mental health and well-being. Similarly, the importance of talking about suicide started to be addressed in public debates, while great social concern emerged about the way in which this problem was being handled in the political and social spheres. These debates led to the adopting of some prevention measures – such as the 024 suicidal behaviour hotline – and to the implementation of various awareness-raising campaigns on a local and state level. Although those studies conducted during the first months of the pandemic did not allow clear determination of whether suicidal behaviour had increased during this period, specialists predicted that problems could emerge in the following years (World Health Organisation, 2022). Some data suggest that following the pandemic, there is an increased risk of suicidal behaviour among young people, especially girls, therefore special attention has been paid to this group, and to minors (Dubé et al., 2021). 

With the aim of providing more information in this regard, this study includes the evolution of calls related with any type of suicidal behaviour (deaths, attempts, suicidal ideation, or suspicion of suicide) made to the 112 emergency service of the Valencian Community by adolescents and minors in the period 2018-2022. These calls were made by the minors themselves or by their relatives or other individuals present at the time of the suicidal behaviour, but did not necessarily result in consummated suicides. Rather, they contemplated any situation in which the caller considered that the minor’s safety was in danger and that support was required from an emergency service (police, firefighters, or health resources).  

Figure 1 shows the evolution over time of calls to 112 related with suicide among minors aged under 18 years. The month of March 2020 was set as the start of the pandemic, and two periods were established: the pre-covid period and the covid period. In the pre-covid period (between January 2018 and February 2020), monthly calls related with the suicide of minors were stabilised, ranging between 20 and 40 calls per month (33 calls on average), except for a small peak of calls in the months of April and July 2019. From lockdown, in March 2020 (start of the covid period, which lasted until the end of 2022), a clear upward trend can be observed, reaching its maximum peak in February 2022, with close to 100 calls per month, i.e., triple the calls registered in the pre-covid period. In total, during the covid period, an average of 61 calls per month were counted. In mid-2022, the trend pointed towards stabilisation, but the data remained very high in comparison with the period prior to the pandemic. 

In order to take into account the gender perspective, the tendency over time of calls related with the suicide of minors was analysed in a differentiated way. As shown in figure 2, from the start of the pandemic, calls relating to girls are the ones that register the greatest increase, increasing from an average of 20 calls per month to triple this figure in 2022. The maximum peaks of calls from girls are situated in the months of May and June 2021 – coinciding with the fifth wave, known as “the young wave”, as it mainly affected young people who were starting to return to social interactions; in the month of February 2022 – the point when the sixth wave, “or omicron wave”, which mainly affected children who were not yet vaccinated, ended; and in June and September 2022, a period corresponding to the seventh wave, which was milder. The number of calls relating to boys also increased, but with a less pronounced curve, rising from an average of 12 calls per month in the pre-covid period to over 20 calls per month in 2022, with the maximum peaks in February of that same year (also coinciding with the sixth wave) and in October 2022.

Figure 3 shows the distribution of calls during the pre-covid and covid periods according to the age of minors concerned. In the case of boys, an exponential distribution is observed, with a higher number of calls as age increases, so that 17-year-old boys are the ones who concentrate the largest number of calls. In the case of girls, the distribution of ages is more even and most of the calls correspond to girls aged between 14 and 17 years old. This distribution remained stable over the two periods, with an average age of 15 years. In the case of minors aged between 15 and 17 years, 13.5% of the calls showed that the minor suffered from some type of depression or anxiety disorder.

To understand the psychosocial characteristics of each of the calls, the description provided by the caller was analysed, enabling a brief definition of the case and highlighting of the most significant aspects. The description included the data considered of interest to define what was happening during the emergency, i.e., the minor’s psychological characteristics (e.g., whether he or she suffered from a psychiatric disorder or was in treatment for a psychological reason), or characteristics of the suicidal behaviour (e.g., whether it was a suicide attempt, suicidal ideation, or whether the minor was threatening suicide, and whether there was any evidence of previous attempts).

As for the psychological factors that might have triggered the emergency call, in the case of females there were increased references to depression and anxiety, while among males these references did not experience any variation, but there was a greater increase in mentions of other psychiatric disorders, as well as a higher incidence of calls in which it was highlighted that the minors were in treatment at the time the suicidal behaviour occurred. In both cases, in the covid period there was also a significant increase in self-harming. With respect to the degree of suicidal intent, there was a substantial reduction in references to threats and a slight reduction in references to suicide attempts, among males and females alike. However, there was a considerable increase in the number of calls in which mention was made of suicidal ideation. Finally, calls indicating that it was not the first time that the minor in question had attempted suicide doubled. 

The results indicate that, during lockdown, the Valencian Community registered a drastic increase in calls to 112 related with the suicide of minors. However, the data suggest that “the new normality” may be weakening this upward curve, despite the figures continuing to be very high. The increase has been especially pronounced among females, given that the figures have tripled in barely four years. 
Moreover, the results show an increase in cases in which reference is made to aspects related with mental health, as well as to suicidal ideation. It is possible that the social isolation, uncertainty, fear of the unknown and other psychological effects that accompanied this health crisis affected minors – who were at a vital stage in their psychosocial development – to a greater extent. 

However, it is important to take into account that the calls recorded cover all types of suicidal behaviour (ideation, attempt, or death by suicide) and not only consummated suicides. These results do not allow us to determine precisely what was the cause leading to the increase in calls, but they do give a snapshot of what is occurring, which is very useful for continuing to advance in the fight against mental health problems in young people. Thus, on the one hand, they may suggest a higher prevalence of suicidal behaviour after the covid-19 pandemic and, on the other, that the increase may also be due to greater awareness and social sensitivity towards this problem, as well as greater knowledge and use of the 112 emergency number. 

Furthermore, it is worth clarifying that in all cases these are emergency calls, and not another type of data such as, for example, those corresponding to hospitalisations or deaths. In these calls, where the aim is to quickly collect the information necessary to deal with the emergency in the most effective way possible, individual information on suicidal behaviour is not very relevant and the causes behind it are not studied in great depth, nor is information obtained a posteriori – in other words, once the call has finished – on the state of (physical and mental) health of the minor affected. To better understand this phenomenon, it would be essential to make a comparison between the emergency calls used in this study and other types of suicide data originating from other sources. Similarly, it is important that in coming years a longitudinal analysis is conducted of the evolution of calls relating to suicide in minors to assess whether the trend stabilises after the World Health Organisation declared, in May 2023, the end of the international health emergency due to covid-19. 

In any event, it is essential to continue working and analysing this problem with such serious consequences for minors, their environment and society as a whole, so that as much information as possible can be provided on what is happening and the factors related to the increase in suicidal behaviours, as well as being able to predict what will happen in the future, in both the short and the long term. This information will be essential when designing preventive protocols, intervention programs and improvements in the management of emergency services with a view to achieving a positive impact on the mental health of minors and on their quality of life (Marco et al., 2017; 2018).
The authors of this study would like to express their thanks to the Valencian Community 1·1·2 Service (Valencian Agency for Security and Response to Emergencies of the Valencian Government) for the data provided. 

DUBE, J. P., et al. (2021): «Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies», Psychiatry Research, 301, 113998. 

MARCO, M., et al. (2017): «Spatio-Temporal Analysis of Suicide-Related Emergency Calls», International Journal of Environmental Research and Public Health, 14(7), 735. 

MARCO, M., et al. (2018): «What calls for service tell us about suicide: A 7-year spatio-temporal analysis of neighborhood correlates of suicide-related calls», Scientific Reports, 8, 6746. 

ORGANIZACIÓN MUNDIAL DE LA SALUD (2 March 2022): «Mental Health and COVID-19: Early evidence of the pandemic’s impact».