Study details ‘deeply concerning’ rise in ER visits among youth with suicidal thoughts

The number of adolescents presenting to emergency rooms with suicidal thoughts has jumped in recent years and was accelerating even before the COVID-19 pandemic.

That’s according to new research on data from 205 hospitals in Illinois. The state’s diverse population means findings are nationally representative, authors explained, writing in the journal Pediatrics.

Of the total 81,051 visits coded for suicidal ideation, just under a quarter led to hospitalizations. All youth were between the ages of 5 and 19. The study included visits where suicidal ideation was the primary diagnosis as well as those of patients who presented for different reasons but had thoughts of harming themselves. 

Researchers looked at three 22-month periods, from January 2016 to October 2017, November 2017 to September 2019, and October 2019 to June 2021. During that time, visits among those with suicidal thoughts rose by 59 percent. Visits where the ideation was the principal diagnosis rose from 34.6 percent to 44.3 percent in this time period. 

Hospitalizations also rose by nearly 60 percent. Youths with severe mental illness, substance use, anxiety or depression, or previous visits to emergency departments in children’s or behavioral health hospitals were more likely to be admitted.

Between the fall of 2019 and the fall of 2020, visits for suicidal thoughts increased by 57 percent.

All visits were consistently higher in fall and winter months and were most common among females and those aged 14 through 17.

“A lot of people have talked about mental health problems in youth during the pandemic, but it was happening before the pandemic,” said study author Audrey Brewer in a release. “This has been an issue for so long, and it’s getting worse.”

Children as young as 5 have presented to emergency rooms with suicidal thoughts. 

Suicide is the second-leading cause of death among U.S. youth. In December 2021, U.S. Surgeon General Vivek Murthy issued an advisory on the youth mental health crisis.

“Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade,” Murthy said at the time. 

Between 1999 and 2020, youth suicide rose by 45 percent.

Researchers defined suicidal ideation as having thoughts of wanting to hurt or harm oneself but not having made an attempt.

“Suicidal ideation can be thought about as two types: actively thinking about suicide or having thoughts, but not having a plan,” Brewer said. “That could be the difference in why someone might get admitted to the hospital.”

The study also assessed the number of visits made to each ER and not individual patients, meaning the same youth could have visited a hospital more than once. But because not all children who have suicidal thoughts visit emergency rooms, the total number of youths suffering is likely higher. 

The researchers did not look into the cause of the spikes, but several factors likely contributed to the increase, including school-related stress, social isolation and growing hopelessness about climate change, authors wrote. Other factors could include heavy social media exposure, political discord and gun violence, and family neglect, abuse or adversity.

Calling the study’s findings “deeply concerning,” co-author Matthew Davis noted that “our health care system needs to train more community members, primary care providers and subspecialty physicians to address mental health needs for youth. To improve this crisis is going to require a broad, intense, coordinated approach.”

Alongside worsening mental illness, the results underscore hurdles in access to low cost, high-quality outpatient mental health services, authors concluded.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org.