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Increasing Emergency Visits for Suicidal Ideation in Youth: Not Just the COVID-19 Pandemic

November 14, 2022

Suicide is the second leading cause of death in children and adolescents. This statistic should not surprise us given our ongoing mental health crisis, exacerbated by the isolation so many of our patients have experienced during the COVID-19 pandemic. How much of the increase in emergency department (ED) visits due to the pandemic? Were there increases even before the pandemic? 

To answer these questions, Brewer et al (10.1542/peds.2022-056793) from Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine, share with us their analysis of ED visits and hospitalizations for suicidal ideation in youth ages 5-19 years throughout Illinois from January 2016 to June 2021. The authors looked at trends in suicidal ideation over 3 equal 22-month periods and patient and health system characteristics associated with ED and hospitalization for suicide risk.   

Interestingly, of the >80,000 ED visits for suicidal ideation, the biggest increase was in fall 2019, before the start of the pandemic. Since then, there was increasing rates of hospitalization for suicide risk, but no significant increase in ED visits. Youth with underlying mental health issues in addition to suicidal ideation, especially anxiety, substance use, or severe mental illness, were more likely to be hospitalized following an ED visit after the pandemic. 

What explains these trends and what can we do about it? While the authors provide a good discussion of possible reasons for the rise in suicidal ideation visits pre-pandemic and hospitalizations after the onset of the pandemic, we also invited Dr. Lisa Horowitz from the National Institute of Mental Health and Dr. Jeffrey Bridge (rom Nationwide Children’s Hospital to share their thoughts in an accompanying commentary (10.1542/peds.2022-058151). Drs. Horowitz and Bridge provide a call to action with preventive upstream strategies in the outpatient setting to identify youth at risk for suicide. They also suggest strategies to deploy in the ED to reduce the need for future ED visits or hospitalizations. This study and commentary provide an important call to action we should all read about and act on. Link to this study and commentary and learn more.

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