By Lisa Rapaport
The number of kids and teens visiting U.S. emergency departments after considering or attempting suicide has almost doubled in recent years, according to a new study, suggesting these young patients may not be getting the mental health care they need.
From 2007 to 2015, annual ED visits for suicidal thoughts and suicide attempts by kids 5 to 18 years old surged from 580,000 to 1.12 million, researchers report in JAMA Pediatrics, April 8. There was no meaningful change in the total number of annual ED visits during the study period.
But the proportion of children's ED visits related to suicide climbed from about 2.2 percent to 3.5 percent.
"A single suicide attempt is the strongest predictor of future completed suicide, and most children with suicidal behavior first present in the ER setting," said lead study author Dr. Brett Burstein of Montreal Children's Hospital and McGill University Health Center in Montreal.
"ERs are not resourced to give these children the comprehensive assessments and follow-up necessary for optimal care," Burstein said by email. "The growing number of these presentations means that we critically need to augment resources for community-based mental health services, ER preparedness particularly among non-pediatric centers, and post-ER risk reduction interventions."
Researchers examined data on 59,921 ED visits for children younger than 18, including 1,613 visits for suicidal thoughts or attempted suicide.
Only about 2 percent of the children and teens were admitted to the hospital after suicide-related ED visits.
The majority of suicide-related visits, about 87 percent, were for suicidal thoughts.
About 43 percent of the visits for suicidal thoughts or suicide attempts involved kids 5 to 10 years old, the study found.
More than four of every five kids with suicide-related ED visits had either private insurance or coverage through Medicare or Medicaid; slightly less than 8 percent of these cases were "self-pay," which typically means without insurance.
Most of the cases - about 72 percent - involved white children and teens. Another 24 percent involved black kids.
Just 13 percent of these suicide visits were at children's hospitals where patients might be more likely to receive care from specialists in pediatric or adolescent psychiatry or mental health.
The study wasn't designed to prove whether specific factors might be causing an uptick in suicide-related ED visits by children and teens.
It's also possible that doctors may have misdiagnosed some cases of non-suicidal self-harm like cutting or other injuries as a suicide attempt, even when kids didn't plan to kill themselves, the study authors note.
More children and teens may be showing up in the ED for reasons related to suicide because doctors in the community are doing a better job of screening for depression and suicidal thoughts, said Nicholas Westers, a psychologist at Children's Health in Dallas and a professor at the University of Texas Southwestern Medical Center.
"As a result, they may be referring more children and adolescents to the ER to assess the need for a higher level of care, especially if they do not feel comfortable treating the depression/suicidality," Westers, who wasn't involved in the study, said by email.
Parents may also be on the lookout for mental health problems, Westers said. They should seek treatment when they see abrupt changes in mood, behavior, sleep, socializing or academics or hear kids talking about being a burden or feeling like they don't want to live, he advised.
"It is okay to ask your child if he or she has ever thought of suicide," Westers said. "If your child discloses current thoughts of suicide and you are worried they may act on them, it is best that they be evaluated in the ER immediately."
JAMA Pediatrics 2019.
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