This past fall, the American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatry (AACAP) declared a nationwide pediatric mental health emergency. The reasons for this are likely self-evident if you are actively practicing pediatrics, especially if you add in the stress of the pandemic to an already concerning prevalence of mental health disorders in children and adolescents. That is why I am calling your attention to a concerning article by Lantos et al (10.1542/peds.2021-053486) we are early releasing this week that describes an uptick in suicide risk in youth in the setting of the current pandemic.
This study builds on prior studies outlining the changes in suicidal ideation in the early months of the COVID-19 pandemic (REF). Lantos et al compared universal screening (utilizing the four-item Ask Suicide-Screening Questions (ASQ)) data among 12 to 24-year-olds in the spring of 2019 (T1) and 2020 (T2) in Kansas City’s Children’s Mercy hospital inpatient, emergency department, and outpatient settings. Among the more than 32,000 ASQ screens included, the authors observed an increase in positive screens at the later stages (T2) of the ongoing pandemic. Positive screens were more likely among females, those less than 16-years-old, patients screened in person (as opposed to those via telemedicine), and those with public insurance. Interestingly, the reported positive screens were lower among Black patients which may be somewhat counterintuitive when considering studies finding that that Black children (ages 5-11) are twice as likely to die by suicide as their White counterparts. Of note, White patients and patients with private insurance were overrepresented in the T2 cohort. The authors acknowledge that the ASQ screen was not validated on a telemedicine format and speculate about what may have generated the difference in positive screens observed in face to face relative to virtual encounters.
This article and the current flare of the Omicron COVID-19 variant should be viewed as a call to action for us to redouble our efforts to screen, diagnose, and treat our patients for mental health disorders. Recognizing that there are not enough mental health providers to provide services for our patients, it is incumbent that we get the appropriate training (e.g. the AAP’s mental health toolkit), so that we can comfortably manage our patients and triage those who have more complicated and/or severe conditions to our mental health colleagues. In addition to our patient care and continuing educational responsibilities, we must continue advocating for federal and state funding to address the aforementioned provider shortages. The authors appropriately remind us that, “the best way to prevent suicide is to identify people who are at increased risk and link them to care.” Let’s get to work.