"You Just Try to Hang in There...": Experiences of Parents with a Child in Suicidal Crisis during the COVID-19 Pandemic

Background: Suicide is currently the 2^nd leading cause of death among youth ages 10-24, with rates continuing to rise exponentially. An emerging--yet substantial--body of research indicates that the COVID-19 pandemic only exacerbated this crisis, particularly among youth of color. While parental support has been shown to buffer against suicide risk and parent-child communication has been shown to be protective against youth anxiety and depression during the COVID-19 pandemic specifically, little is known about the ways in which the COVID-19 pandemic affected parents/caregivers and their capacity to support their children who experienced a suicidal crisis during COVID-19.

Methods: As part of a larger intervention development study, semi-structured interviews were conducted with 15 parents/caregivers whose child had been psychiatrically hospitalized for a suicide attempt within the previous six months. All data collection occurred between November 2021 and June 2022. Interviews were designed to elicit perspectives on the ways in which COVID-19 impacted their family, their child’s mental health, precipitants to the hospitalization, and their experiences of inpatient psychiatric care. Data were analyzed in Atlas.ti using reflective thematic analysis.

Results: Analyses produced several salient themes related to isolation, distress, and uncertainty. In general, parents reported that pandemic-related distress (e.g., school closures, discontinuation of activities, inability to see family/friends) functioned to exacerbate their children’s mental health symptoms, with isolation due to pandemic-related public health precautions identified as a main trigger. Although a few parents indicated that COVID-19 had a positive impact on their relationships with their child, as it bolstered a sense of connection, most parents described a pervasive sense of loss that spanned multiple domains, including loss of financial stability, loss of predictability/normalcy, loss of support networks and school-based resources, and deaths of family members due to COVID-19. These losses, and the associated grief experienced, generally increased global family distress, with parents reporting exhaustion and fear, which invariably affected their abilities to support their children. Navigating changes in health care delivery systems (e.g., hospitals with different visitation policies, deciding between virtual and in-person outpatient treatment options), both on the unit itself and when securing post-hospitalization follow up care, also contributed to pandemic-related fatigue experienced by parents/caregivers in this sample.

Conclusions: Findings from this study indicate that the COVID-19 pandemic impacted parents and caregivers tasked with supporting youth in suicidal crises. Parents and caregivers described experiencing increased feelings of isolation and distress due to the pandemic, and in that context dealt with finding help for a child in suicidal crisis. With public health precautions designed to mitigate spread of COVID-19 diminishing external support networks such as family, friends, and school resources, additional responsibilities were placed on parents. Implications for supporting parents and caregivers of youth in suicidal crisis will be discussed, including ways the health care system can enhance parental and caregiver capacity for supporting suicidal youth during COVID-19 and beyond.