Study finds ‘huge’ increase in children going to the emergency room with suicidal thoughts

Editor’s note: If you or someone you know is struggling with suicidal thoughts or mental health issues, please call 988 Suicide and Crisis Lifeline or visit the hotline’s website.


There has been a steady rise in the number of children being seen in emergency rooms for suicidal thoughts, according to a new study – and the increase began even before the Covid-19 pandemic brought record high demand for children’s psychological services.

The effects of the pandemic have drawn renewed attention to suicide among teenagers and young children. In June, the Biden administration called the recent rise in rates of depression, anxiety and suicidal thoughts among children an “unprecedented mental health crisis.”

The study, published Monday in the journal Pediatrics, used data from hospitals in Illinois. Researchers looked at the number of children ages 5 to 19 who sought help for suicide in emergency departments between January 2016 and June 2021.

During that period, there were 81,051 visits to the Emergency Department by young people which were coded for suicidal ideation. About a quarter of those visits turned into hospital stays.

The study found that ER visits with suicidal thoughts increased 59% from 2016-17 to 2019-21. There was a corresponding increase in cases in which suicidal ideation was the main diagnosis, rising from 34.6% to 44.3%.

Hospitalizations due to suicidal thoughts increased by 57% between fall 2019 and fall 2020.

“It just really highlights how mental health issues were really a problem before the pandemic. I mean, we’ve seen this huge increase in [emergency department] visits for children of all ages, frankly, in 2019, and that’s very concerning,” said study co-author Audrey Brewer, MD, an advanced general pediatrics and primary care physician at Ann & Robert H. Children’s Hospital. Lurie in Chicago. “We’ve seen more kids than we normally do, so … we don’t necessarily think we’re going to have problems with suicidal ideation.” We saw 5-year-old children.

“Seeing them come to emergency departments for mental health or suicide-related visits is very concerning.”

Brewer thinks the true numbers are likely much higher than what the study found, because not all children struggling with suicidal thoughts go to the emergency room.

Experts say it is not a problem unique to any country.

Dr. Nicholas Holmes, senior vice president and chief operating officer at Rady Children’s Hospital in San Diego, said the increase in the number of children seeking help in his health system is “profound.”

“Over the last nine years, where we used to see about one to two patients a day who had a behavioral health crisis, now we’re seeing more than 20 a day,” said Holmes, who was not involved in the new research.

He said Rady, the largest pediatric hospital on the West Coast, is fortunate to have an inpatient child and adolescent psychiatric unit.

To help more of these children, Holmes Hospital System is working with County Health and Human Services to help create a pediatric-focused mental and behavioral health campus. That would double the size of Reidy’s inpatient behavioral ward, in addition to boosting services for children who need therapy but don’t need to be hospitalized.

Other places in the US are not so lucky. There is a nationwide shortage of beds for children who need mental health help, research shows. A 2020 federal survey found that the number of residential treatment facilities for children had fallen 30% from where it was in 2012.

The lack of care has come along with a significant increase in the prevalence of mental health challenges that can lead to suicide. In 2019, 1 in 3 high school girls and half of all female students reported persistent feelings of hopelessness and sadness, up from 40% in 2009. And, according to the US Centers for Disease Control and Prevention.

The new study can’t pinpoint why so many young people are still going to the hospital with suicidal thoughts, but Brewer thinks it could be a combination of factors.

Many of the children who were hospitalized with suicidal thoughts had other mental health problems such as anxiety, depression and substance use, she said.

Children also respond to trauma in their lives and social influences on their health, such as poverty, historical trauma and marginalization, problems at school, online bullying and pressures brought about by social media, in addition to lack of access to counseling and therapy.

Brewer said adults can intervene when a child is thinking about suicide. She advises caregivers to be on the lookout for problems at school or among friends, and to be on the lookout for a child who is isolating or showing signs of more anxiety or aggression than usual.

“They may act out or have trouble sleeping.” Irritability and being more withdrawn and isolated are a lot of things that we often think about,” Brewer said.

It never hurts to ask a pediatrician for help on how to help a struggling child.

“It’s important that parents feel empowered to really sit back and listen to their children and talk to them. “Really try to connect and understand what’s going on with them and help promote positive relationships,” Brewer said.

She said she hopes mental health care will become less stigmatized and more accessible to children.

“We really need to develop more of a strategy to help support all kinds of different ways and really focus on some of those trauma and societal impacts on health,” Brewer said. “We need to make sure more kids have safe places to grow and thrive.”


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