"The findings in this report are subject to at least nine limitations. First, these data are not nationally representative. Second, facility participation varies within and across states; however, data were only analyzed from facilities that reported consistently over the study period, thus minimizing the impact of reporting fluctuations on resultant trends. Third, differences in availability, coding practices, and reporting of chief complaints and discharge diagnoses from facilities might influence results returned by the syndrome definition. Fourth, distinguishing initial visits from follow-up visits for the same event was not possible, so the number of ED visits for suspected suicide attempts might be lower than presented. Fifth, NSSP race and ethnicity data were not available at the national level for this analysis at the time it was conducted, so analyses of differences among racial/ethnic groups was not possible. Sixth, these data likely underrepresent the true prevalence of suspected suicide attempts because persons with less severe injuries might be less likely to seek emergency care during the pandemic when many persons avoided medical settings to reduce the risk for contracting COVID-19. Seventh, the suspected suicide attempt syndrome definition excludes some, but not all, visits for nonsuicidal self-harm. Eighth, the sharp decline in all ED visits during the pandemic likely affected the number and proportion of visits for suspected suicide attempts (6). Finally, this analysis was not designed to determine whether a causal link existed between these trends and the COVID-19 pandemic."