Analysis of the dynamics of suicidal tendencies in adolescence against the background of pandemic restrictions and the contribution of emergency medical services to the development of crisis intervention protocols to minimize deaths

Abstract

The study analyzes the dynamics of adolescent suicidal behavior during pandemic restrictions and evaluates the contribution of emergency medical services to the development of crisis intervention protocols aimed at reducing mortality. The relevance is driven by the increased burden on the emergency care system and the need for early identification of vulnerable groups. The objective is to provide a quantitative assessment of changes in service utilization and outcomes, compare the effectiveness of standard, extended, and integrated prehospital protocols, and identify demographic risk factors. The novelty lies in combining population-level analysis with the evaluation of tactical decisions made by emergency crews, including telemedicine support. Materials and methods included a retrospective comparative analysis of 11,482 calls by adolescents aged 13-18 in three metropolitan areas of the Russian Federation: the pre-pandemic period (2018-02.2020) and the pandemic period (03.2020-12.2022). Descriptive statistics, Mann-Whitney U-test, Pearson's chi-squared test, and Spearman correlation were used. Three protocols were evaluated: standard (somatic stabilization and transportation), extended (with added elements of primary psychological support), and integrated (involving psychologist or psychiatrist consultation via telemedicine). Variables analyzed included sex, age, type of residence, and emergency team response time ( 10, 10-20, 20 minutes). Results showed a statistically significant increase across all categories: suicidal ideation +62,05%, non-suicidal self-injury +31,18%, and suicide attempts +60,21%. The integrated protocol provided the highest rate of on-site stabilization (45,19%) and the lowest proportion of ICU hospitalizations (3,47%); the extended approach held intermediate positions, while the standard protocol was the least effective. High-risk groups included females, adolescents aged 16-18, and urban residents. Response time was strongly associated with outcomes: arrival within 10 minutes correlated with 2,21% mortality compared to 14,95% when delays exceeded 20 minutes, along with reduced need for intensive care. Discussion interprets pandemic restrictions as a systemic stressor that exacerbated self-aggressive tendencies and increased demands on emergency care. Practical measures include prioritizing calls with suicidal risk, widespread implementation of integrated protocols with telemedicine, training crews in crisis communication, optimizing logistics to achieve response times under 10 minutes, and developing targeted school-based and online programs for high-risk groups. Limitations include the retrospective design, potential coding bias, and urban-focused samples; future directions involve longitudinal causal studies and interregional replications.