Q: My son’s pediatrician says it’s important to screen for depression and suicide risk. How much of a problem is teen suicide, and has it gotten worse in the COVID era?
A: Thank you for this question. Suicide attempts, whether successful or not, are a delicate and painful topic.
Anecdotally, I can tell you that suicide attempts that result in children being admitted to children’s ICU are quite frequent. As a hospital doctor, I was used to seeing two to three children a month, at a ratio of about 2: 1, girls to boys.
These children were mostly teenagers, and the trigger for their act was often an argument with a boyfriend or bullying at school. Fortunately, these attempts were mostly unsuccessful.
The children were either found by a family member, called a friend who then called for help, posted something online that caused friends to call for help, or occasionally the child came to ask for help. Some of these actions are impulsive and immediately regret. The most commonly used method appears to be an overdose of pills – either prescribed to the child for underlying mood disorders belonging to other members of the household, or over-the-counter medications.
We also see children who have attempted suicide by hanging and sometimes suicide. Many of these children suffer from depression and anxiety and have previously expressed suicidal thoughts or attempted suicide.
In response to the second half of your question, it appears that we are seeing about double the number of suicide attempts in the pediatric intensive care unit. We see more boys than I am used to, and we see younger children, as young as 11 years old.
And there seem to be more family arguments cited as the trigger for the attempt. That makes sense, given that most of the kids have spent most of the past year at home and not at school.
Our child psychiatry and psychology colleagues are inundated with providing consultation to those children during admission, providing support to their families, managing clinical admissions to the child psychiatric hospital and arranging follow-up care.
The American Academy of Pediatrics (AAP) has made suicide among young people a concern. AAP president Dr. Lee Savio Beers called on policymakers to invest in a comprehensive approach to mental health that focuses on prevention and early treatment as well as crisis response.
There was a virtual summit on youth suicide prevention recently, which reported the most recently available statistics from 2019. 8.9% of high school students attempted suicide.
There were more than 6,000 deaths in young people between the ages of 10 and 24. A survey of pediatricians found that 44% had a patient who attempted or died of suicide.
In the future, we must ensure that suicide prevention efforts involve at-risk populations such as black, indigenous, and colored people.
Children under 10 showing warning signs should be assessed for suicide risk. It is necessary to reduce young people’s access to lethal means such as firearms. Experts need to work with the media to portray resilient behavior.
And more money is needed for research and hospital care.
The recently passed $ 1.9 trillion Covid-19 emergency bill called the American Rescue Plan includes $ 80 million for a program that increases access to mental health care for children and adolescents.
While this is a huge profit and much needed, doctors and families are wondering what can be done now?
The first task is to encourage young people to talk about the suicide impulse. Talking about suicide does not lead to suicide.
If you are warned that a young person is considering suicide, the first step is to contact and involve them, and then not waste time seeking medical care. It’s okay to take a suicidal young person to the emergency room.
While in the hospital, they are in a safe, monitored environment and are being evaluated by child psychiatric services. Some warning signs may include noticeable changes in eating or sleeping habits; withdrawal from family or friends; sexual promiscuity / truancy / vandalism; talking or writing about committing suicide (even as a joke); give away precious possessions; and doing worse at school.
More information on recognizing warning signs can be found at stanfordchildrens.org.
This is a serious topic and a heartbreaking reality.
Thank you for starting a conversation about this.
Anjali Subbaswamy is a pediatrician in the Intensive Care Unit at UNM. Send your questions to email@example.com.