Background Suicide is a leading cause of death among children in the United States (US). The COVID-19 pandemic raised concerns that suicide rates will increase. Multidisciplinary child death review (CDR) teams examine the circumstances of child deaths, identifying risk and protective factors and recommending prevention strategies.

Aims Identify factors associated with suicides during the COVID-19 pandemic.

Methods The National Fatality Review Case Reporting System (NFR-CRS) is a web-based platform documenting circumstances of child deaths reviewed by CDR teams. In April 2021 a COVID-19 question that asked whether COVID-19 directly or indirectly impacted the death was added. Suicides among children ages 10–17 occurring during 2020–2021 were studied. Demographic characteristics, life stressors, and social/mental health histories were compared for COVID-19 impacted suicides and non-COVID-19 impacted suicides using descriptive statistics; chi-squared statistics assessed statistical significance.

Results 550 suicides were included for study. Youth whose suicide was impacted by COVID-19 (n=142) experienced significantly more isolation (61% vs 14%), school problems (42% vs 19%), and witnessing violence (14% vs 3%) compared to non-COVID-19 impacted suicides (n=408). Significantly more COVID-19 impacted youth had depression (43% vs 24%) and/or anxiety disorder (23% vs 12%) diagnoses.

Conclusions Flexibility within the NFR-CRS permitted the rapid addition of pandemic-related questions, thereby, providing opportunities to examine the pandemic’s impact on children’s deaths. Although suicide rates cannot be calculated using NFR-CRS data, significant factors associated with suicide are identified that can facilitate screening and mental health delivery.

Learning Outcomes Understand the impact of the COVID-19 pandemic on youth suicide in the US.