Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children’s hospitals from 2008 to 2015.
We used retrospective analysis of administrative billing data from the Pediatric Health Information System database.
There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall.
Encounters for SI and SA at US children’s hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children’s hospitals and health care delivery systems.
Comments
RE: Seasonal variation of suicide ideation and attempts noted
We read with interest “Hospitalization for Suicide Ideation or Attempt: 2008-2015” by Plemmons et al. in the June issue of Pediatrics. Their observation that SI and SA was noted most frequently in the fall and spring, particularly October and March, opened the question of whether this increase was a true increase in suicidal intent or indicative of enhanced screening and referral. Our group had previously queried the CDC Wonder database (1) for U.S. suicide deaths in youth aged 10-19 years from 2009 through 2012, identifying 8026 child and adolescent suicides over four years. We found a similar peak to that identified by Plemmons et al. in October and April. Deaths due to suicide totaled 2158 in spring (March, April, May) and 2128 in fall (September, October, November), as compared with 1801 during the summer (June, July, August). This difference was most pronounced in younger children- aged 10 to 14 years- as compared with children aged 15 to 19 years. When a 10-year adult age span was queried (age 45 to 54 years), the pattern reversed with 9218 suicide deaths occurring in the summer versus 9155 in the spring and 8604 in the fall. In their paper, they postulated that the increase in SA and SI during spring and fall, as compared with summer, represented a true difference in suicidality. We believe that our experience wholeheartedly confirms their assertion that this is an increase in suicidality and not merely an effect of improved recognition.
References
1. Centers for Disease Control and Prevention: CDC Wonder. https://wonder.cdc.gov/, Accessed 10/01/2017