Addressing the Suicide Epidemic Among American Youth
New research published in JAMA Pediatrics shows that the rate of suicides among American youth has accelerated at an alarming pace.
The study, which assessed data from the CDC’s annual National Hospital Ambulatory Medical Care Survey, indicated that emergency department (ED) visits for suicidal attempts and ideations nearly doubled among pediatric patients between 2007 and 2015, increasing from an estimated 580,000 (2.17%) to 1.12 million (3.50%) visits nationally during this time period.1
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Suicide is already known to be a major public health concern and the second leading cause of death among children and adults aged 10 to 18 years, according to the National Institutes of Mental Health.2 However, the new study found that these trends actually apply to much younger children, too.
“In a study published in Pediatrics last year, it was found that more than 50% of patients presenting to EDs with suicidal behavior were between the ages of 15 and 18, and that group has classically been regarded as the higher-risk group. However, the largest patient demographic for suicidal behavior in our study was much younger actually. We found that 43.1% of patients were between the ages of 5 and 11,” said lead study author Brett Burstein, MDCM, PhD, MPH, from Montreal Children’s Hospital in Quebec, Canada, in an interview with Consultant360.
The 2018 study Dr Burstein refers to was performed by Gregory Plemmons, MD, from the Vanderbilt University School of Medicine, and colleagues.3 Plemmons et al took into account trends in ED visits and inpatient encounters specifically in children’s hospitals across the United States from 2008 to 2015, whereas the present study performed by Burstein et al examined all suicide-related presentations by US youth to any ED across the nation, including general EDs.
The trends reported by Plemmons et al were similar to those presented in Dr Burstein’s study in that visits for suicidal ideations and attempts among American youth were shown to have nearly doubled in both studies. However, comparing these studies yielded another concerning finding: the vast majority of youth who presented with suicide-related concerns had presented to a general ED which, according to Dr Burstein, are not equipped to properly treat these patients.
Perhaps more concerning: the vast majority of pediatric patients who present to a general ED for a suicide-related concern are not admitted, data show.
“Approximately 90% of patients who presented for a suicidal attempt or ideations had presented to general EDs, which do not have specialized pediatric care. They don’t have inpatient psychiatric services where these patients can be admitted,” Dr Burstein explained.
In the study performed by Plemmons et al, approximately half of patients who presented to pediatric EDs in particular for suicide attempts and ideations were admitted, Dr Burstein told Consultant360. However, when accounting for all pediatric visits to any ED for a suicide-related concern across the country, Dr Burstein and colleagues found only 2.1% were hospitalized.
Of this finding, Dr Burstein said, “It would be reasonable to assume that the 2.1% being admitted are either those that present to pediatric centers or those who present very medically unwell from their suicide attempt and require stabilization.”
That youth with suicidal attempts or ideations receive the proper care is of utmost importance, as any individual with a prior suicide attempt has an increased risk of completing a suicide, Dr Burstein told Consultant360. Although his study did not identify the specific factors influencing rising suicide rates among US youth, it shines a light on the need to increase availability and access to the right resources to youth with suicidal ideations or attempts.
In addition to a prior suicide attempt, the National Institutes of Mental Health names depression and other mental disorders, family history of suicide, substance abuse disorder, family violence, and having guns or other firearms in the home, among others, as top risk factors for suicide.2
Connecting youth with an increased risk of suicide to the right resources is paramount, Dr Burstein told Consultant360. “From here, I think one of the most important interventions is augmenting emergency department resources to handle this increase in suicide-related ED visits among youth observed in our study,” Dr Burstein said. “We need to increase our preparedness for dealing with this problem, the resources available broadly, and our ability to then support those patients who present with this problem. I think those are the most important areas for targeted interventions,” he added.
—Christina Vogt
References:
1. Burstein B, Agostino H, Greenfield B. Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015 [Published online April 8, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0464.
2. Suicide in America: Frequently asked questions. National Institutes of Mental Health. https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml. Accessed on April 8, 2019.
3. Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics. 2018;141(6). doi: 10.1542/peds.2017-2426.