More and more kids are ending up in emergency rooms because they are contemplating suicide, a new study finds.
An analysis of Illinois emergency department data with national implications revealed that in fall 2019, there was a spike in visits from teens and younger children who were diagnosed as experiencing suicidal ideation. Researchers found another spike in fall 2020, according to the report published in Pediatrics on Nov. 14.
“One thing I want people to understand is that suicidal-ideation related emergency department visits were increasing before the pandemic,” said the study’s lead author, Dr. Audrey Brewer, an attending pediatrician at the Ann and Robert H. Lurie Children’s Hospital of Chicago.
Another important point, Brewer said, is that “during the pandemic we saw an influx of kids from all age groups. We tend to think about anxiety and depression as being common in older kids, but a lot of those who presented to the emergency department during the pandemic were between 5 and 13.”
Currently, suicide is the second-leading cause of death in American kids aged 10 to 19, Brewer and her colleagues noted, adding that “suicide death rates among children have increased by more than 50% over the past two decades."
Making matters worse, Brewer said, is an ongoing shortage of mental health care providers. “We know that there are not enough psychiatrists and therapists available to kids,” she explained. “For me, as a general pediatrician, that means we all have to feel more comfortable taking care of kids presenting with mental health concerns.”
No one knows exactly why, prepandemic, there were more and more kids thinking about suicide. “So many different factors play a role in why kids might be contemplating suicide,” Brewer said. “There may not be one specific reason.”
To take a closer look at trends in emergency room visits for suicidal ideation, Brewer and her colleagues turned to the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database. The researchers analyzed data on pediatric ER visits coded for suicidal ideation between January 2016 and June 2021 for 205 nonfederal hospitals in the state.
Overall, there were 81,051 ER visits for suicidal ideation during the 66 months covered by the study, which the authors analyzed as three 22-month periods. Visits increased by 59% from the 2016-2017 period compared to the 2019-2021 period. Hospitalizations increased 57% between the fall of 2019 and the fall of 2020.
Brewer and her colleagues found that visits for suicidal ideation were consistently higher among all age groups during fall and winter months. While visits increased modestly between 2016 and 2018, there was a sharp spike in 2019, followed by a similar spike during the fall of 2020, with the highest number of visits per month in October 2020.
More than half of the children visiting the ER for suicidal thoughts, were either uninsured (4.4%) or covered by Medicaid (47.7%).
“What’s interesting about the hospital data for the state of Illinois that we used for the study is that it can be generalizable at the national level,” Brewer said. “From a sociodemographic perspective, our data are representative of the racial and ethnic makeup of our country.”
The new study shines a light on the silent epidemic of children with mental health issues that's been growing for decades and has been only getting worse, said Dr. Warren Ng, director of clinical services for child and adolescent psychiatry at Columbia University and president of the American Academy of Child and Adolescent Psychiatry.
“The pandemic highlighted what could no longer be ignored: the suffering of young people,” Ng said. “If people can take away one fact, it’s that we are in a crisis.”
Unfortunately, “we haven’t invested in the infrastructure to support young people,” Ng said. “There is no quick fix.”
To help their children, parents need to pay close attention to their kids’ mental health, said Dr. Eleni Maloutas, assistant professor of psychiatry at Mount Sinai in New York.
“When parents come into my office, I tell them they are the experts in their own children,” Maloutas said. “They need to be checking in with their children and keeping the lines of communication open — that is really the most important thing.”
There are signs that a child might be struggling, Maloutas said. “With any mental illness you want to identify it early on,” she said. “So what you would typically see might be sadness, but in some children it could be irritability.”
Other signs, Maloutas said, include: withdrawal, boredom, changes in sleeping patterns, a lack of interest in things they once enjoyed, feelings of hopelessness or worthlessness and feelings that life is not worth living. “These are the big things to look out for,” she added.
In general, Maloutas said, “Aside from what you might observe, you want to make sure you are communicating with your child.”