Q: My son’s pediatrician says it is important to screen for depression and for suicide risk. How much of an issue is teen suicide, and has it become worse in the COVID era?
A: Thank you for this question. Suicide attempts, whether successful or not, are a delicate and painful subject.
Anecdotally, I can tell you that suicide attempts resulting in children being admitted to the pediatric ICU occur on a fairly frequent basis. As a hospital-based clinician, I was accustomed to seeing two-to-three children per month, at a ratio of about 2:1, girls to boys.
These children were usually teenagers, and the trigger for their act was often a fight with a boyfriend or bullying in school. Most of the time, thankfully, these attempts were not successful.
The kids would either be found by a family member, call a friend who then called for help, post something online which led friends to call for help or occasionally the child would themselves come ask for help. Some of these acts are impulsive and immediately regretted. The most common method used seems to be overdosing on 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 through hanging and occasionally by self-inflicted gun violence. Many of these children do suffer from depression and anxiety, and have expressed suicidal thoughts or attempted suicide before.
In response to the second half of your question – it does seem that we are seeing approximately double the incidence of suicide attempts in the pediatric intensive care unit. We are seeing more boys than I am used to seeing, and we are seeing younger children, as young as 11 years old.
And, there seems to be more family squabbles cited as a trigger for the attempt. That makes sense, considering most kids have been at home, and not in school, for much of the past year.
Our pediatric psychiatry and psychology colleagues are overrun with providing consultation to those children while admitted, providing support for their families, managing inpatient admissions to the Children’s Psychiatric Hospital and arranging for follow up care.
The American Academy of Pediatrics (AAP) has made youth suicide a focus. AAP President Dr. Lee Savio Beers called on policymakers to invest in a comprehensive approach to mental health that addresses prevention and early treatment, as well as crisis response.
There was a recent Virtual Summit on Youth Suicide Prevention, which reported the most recently available statistics, from 2019. 8.9% of high school students attempted suicide.
There were over 6,000 deaths in young people between ages 10 to 24 years. A survey of pediatricians found that 44% had a patient either attempt or die from suicide.
Going forward, we must ensure that suicide prevention efforts involve at risk populations such as Black, Indigenous and people of color.
Children under 10 who show warning signs should be assessed for suicide risk. It is necessary to reduce youth access to lethal means like firearms. Experts must work with the media to help portray resilient behavior.
And more funding is needed for research and for inpatient care.
The recently passed $1.9 trillion Covid-19 relief legislation called the American Rescue Plan includes $80 million for a program that increases access to mental health services for children and adolescents.
While this is a huge gain, and desperately needed, doctors and families are asking what can be done now?
The first task is to encourage youth to speak about the suicidal impulse. Talking about suicide does not cause suicide.
If alerted that a youth is considering suicide, the first step is to reach out and engage them, and then waste no time in seeking medical care. It is okay to take a suicidal youth to the emergency department.
While in the hospital, they will be in a safe, monitored environment and be evaluated by pediatric psychiatry 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 jokingly); giving away prized possessions; and doing worse in school.
More information on recognizing the warning signs can be found at stanfordchildrens.org.
This is a serious topic and a heartbreaking reality.
Thank you for starting a conversation about it.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to email@example.com.