Visits to an emergency department (ED) for suicidal ideation have spiked in recent years among children and teens in Illinois, a new study found.
“Rapidly rising hospital use may reflect worsening mental illness and continued difficulty in accessing low cost, high-quality outpatient mental health services,” authors from the Northwestern University Feinberg School of Medicine wrote in “Trends in Suicidal Ideation-Related Emergency Department Visits for Youth in Illinois: 2016 — 2021” (Brewer AG, et al. Pediatrics. Nov. 14, 2022).
Researchers analyzed data on 205 Illinois hospitals from January 2016 to June 2021, zeroing in on ED visits for suicidal ideation among children ages 5-19 years. They found just over 81,000 such visits, about one-quarter of which resulted in hospitalization. Teens ages 14-17 years had far higher frequency of these visits than any other age group, and about two-thirds of visits were among females. About 48% were covered by Medicaid, and just over 4% were uninsured.
ED visits for suicidal ideation rose 59% when looking at a 22-month period in 2019-’21 compared to the same amount of time in 2016-’17, with sharp spikes in the fall of 2019 and fall of 2020. In those later years, suicidal ideation was more likely to be patients’ principal diagnosis.
From the fall of 2019 to the fall of 2020, monthly inpatient hospitalization among youths reporting suicidal ideation rose 57%. Authors said this may have been due to patients delaying care early in the COVID-19 pandemic.
Youths were more likely to be hospitalized if their principal diagnosis was severe mental illness, substance use, anxiety or depression than if it was suicidal ideation. About three-quarters of patients presenting to the ED with suicidal ideation during the pandemic also had one of these diagnoses. Hospitalization also was more likely for those at a children’s hospital or psychiatric hospital than at a community hospital, likely due to more beds being available, according to the study.
The study adds to research showing youths were struggling with mental health before the pandemic, which then exacerbated these challenges. Authors noted youths face stressors such as toxic online environments, academic pressures, economic anxiety and social isolation.
The AAP has been vocal about addressing the youth mental health crisis. Last month, the AAP led a letter to President Joe Biden with more than 140 state and national organizations urging the administration to declare the crisis a federal national emergency.
The study laid out grim statistics on suicide, noting is it the second leading cause of death for youths ages 10-19 years and that about one-third with suicidal ideation will attempt suicide within a year.
The AAP recommends screening all patients ages 12 years and older for suicide risk and screening those ages 8-11 years when clinically indicated.
Authors of the study stressed the need to address the shortage of pediatric psychiatrists and improve Medicaid coverage of mental health services.
“Specific community-based mental health strategies targeting most at risk youth may help improve health outcomes among youth and decrease the burden of mental health care utilization in ED and inpatient settings, as we continue to face pandemic-related challenges, such as social isolation and exposure to socioeconomic adversities,” they wrote.
Resources
- Related commentary “Upstream Prevention Strategies to Prevent Suicidal Ideation-Related ED Visits”
- AAP’s Blueprint for Youth Suicide Prevention
- AAP mental health initiatives
- AAP interim guidance on children’s emotional and behavioral health during the pandemic
- Information for parents from HealthyChildren.org on mental health during the pandemic
- CDC’s What Works in Schools program
- COVID-19 parental resources toolkit on mental health from the CDC
- Surgeon general advisory “Protecting Youth Mental Health”
- Information from the American Medical Association on integrating behavioral health care into a clinical practice
