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 matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.

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

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

The study, published Monday in the journal Pediatrics, used data from hospitals in Illinois. The 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.

In that period, there were 81,051 emergency department visits by young people that were coded for suicidal ideation. About a quarter of those visits turned into hospital stays.

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

Hospitalizations for suicidal thoughts increased 57% between fall 2019 and fall 2020.

“It just really highlights how mental health concerns were really a problem before the pandemic. I mean, we saw this huge increase in [emergency department] visits for kids of all ages, honestly, in 2019, and it’s very concerning,” said study co-author Dr. Audrey Brewer, an attending physician in advanced general pediatrics and primary care at Ann & Robert H. Lurie Children’s Hospital of Chicago and a researcher in the Department of Pediatrics at Northwestern University Feinberg School of Medicine. “We saw more kids than we typically do that we … wouldn’t necessarily have thought would have problems about suicidal ideation. We saw 5-year-olds.

“To see them presenting to emergency departments for mental health or for suicide-ideation-related visits is very concerning.”

Brewer thinks the true numbers are probably much higher than what the study found, because not all children who struggle with thoughts of suicide go to the emergency room.

Experts say it’s not a problem unique to any one state.

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 kids seeking help in his health care system has been “profound.”

“Over the last nine years, where we would see about anywhere from one to two patients a day that were having a behavioral health crisis, now we’re seeing 20-plus 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. It will double the size of Rady’s inpatient behavioral health unit, in addition to beefing up services for children who need therapy but don’t need to be hospitalized.

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

The care shortage has come alongside a significant increase in the prevalence of mental health challenges that can lead to suicide. In 2019, 1 in 3 high school students and half of all female students reported persistent feelings of hopelessness and sadness, up from 40% in 2009. And there was a 36% increase in students who reported considering suicide, according to the US Centers for Disease Control and Prevention.

The new study cannot determine exactly why so many more young people are going to a hospital with thoughts of suicide, but Brewer thinks it may be a combination of factors.

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

Children also are responding to trauma in their lives and social influences on their health like poverty, historical trauma and marginalization, trouble at school, online bullying and the pressures brought by social media, in addition to a 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 watch for a child who is isolating themselves or showing signs of more anxiety or aggression than usual.

“They may act out or have problems sleeping. Irritability and being more withdrawn and isolating themselves are a lot of things that we oftentimes will think about,” Brewer said.

It never hurts to seek help from a pediatrician about how to help a child who’s struggling.

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

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

“We really need to develop more of a strategy to help support all kinds in different ways and really focus on some of those traumas and social influences of health,” Brewer said. “We need to make sure more children will have safe places to grow and thrive.”