Study finds ‘huge’ increase in children going to emergency room with suicidal thoughts

Editor’s note: If you or someone you know is struggling with suicidal thoughts or mental health issues, please call the 988 Suicide and Crisis Lifeline or visit the helpline’s website.


There has been a steady rise in the number of children being seen in emergency departments for suicidal thoughts, according to a new study – and the increase began even before the Covid-19 pandemic, which has led to record demand for children’s psychological services.

The effects of the pandemic have drawn renewed attention to suicide among teenagers and young children. In June, the Biden administration called the recent rise in rates of depression, anxiety and suicidal thoughts among children an “unprecedented mental health crisis.”

The study, published Monday in the journal Pediatrics, used data from hospitals in Illinois. Researchers looked at the number of children ages 5 to 19 who sought help for suicide in emergency departments between January 2016 and June 2021.

During this period, there were 81,051 visits by young people to emergency departments who were coded for suicidal ideation. About a quarter of those visits turned into hospital stays.

The study found that emergency department visits with suicidal thoughts increased by 59% from 2016-17 to 2019-21. There was a corresponding increase in cases where suicidal ideation was the primary diagnosis, rising from 34.6% to 44.3%.

Hospitalizations due to suicidal ideation increased by 57% between fall 2019 and fall 2020.

“It really highlights how mental health issues were really a problem before the pandemic. I mean, we’ve seen this huge increase [emergency department] visits for children of all ages, frankly, in 2019, and that’s very troubling,” said study co-author Dr. Audrey Brewer, an attending physician in advanced general pediatrics and primary care at Ann & Robert H. Lurie Children’s Hospital in Chicago. “We saw more kids than usual who … we wouldn’t necessarily think would have problems with suicidal ideation.” We saw 5 year olds.

“Seeing them present in mental health emergency rooms or for suicidal visits is very concerning.”

Brewer thinks the true numbers are likely much higher than what the study found because not all children struggling with suicidal thoughts go to the emergency room.

Experts say this is not a problem unique to any one country.

Dr. Nicholas Holmes, senior vice president and chief operating officer at Rady Children’s Hospital in San Diego, said the increase in the number of children seeking help in his health system is “profound.”

“In the last nine years, where we used to see about one to two patients a day who had a behavioral health crisis, now we’re seeing more than 20 a day,” said Holmes, who was not involved in the new research.

He said Radi, the West Bank’s largest pediatric hospital, is fortunate to have an inpatient child and adolescent psychiatric unit.

To help more of these children, Holmes Hospital System is working with county Health and Human Services to help create a pediatric-focused mental and behavioral health campus. It will double the size of Rady’s inpatient behavioral health unit, in addition to boosting services for children who need therapy but don’t need to be hospitalized.

Other places in the US are not so lucky. There is a nationwide shortage of beds for children who need mental health help, research shows. A 2020 federal study found that the number of children’s treatment centers was down 30 percent from 2012.

The lack of care comes alongside a significant increase in the prevalence of mental health challenges that can lead to suicide. In 2019, 1 in 3 high school boys and half of all high school girls reported persistent feelings of hopelessness and sadness, up from 40% in 2009. And there was a 36% increase in students reporting suicidal thoughts, according to the U.S. Centers for Disease Control and Prevention disease prevention.

The new study can’t pinpoint exactly why so many more young people are going to hospital with suicidal thoughts, but Brewer thinks it may be a combination of factors.

Many of the children who were hospitalized with suicidal thoughts had other mental health problems such as anxiety, depression and substance use, she said.

Children also respond to trauma in their lives and social influences on their health such as poverty, historical trauma and marginalization, problems at school, online bullying and social media pressures, in addition to lack of access to counseling and therapy.

Brewer said adults can step in when a child is having suicidal thoughts. She advises caregivers to watch for problems at school or with friends, and to watch for a child who is isolating or showing signs of more anxiety or aggression than usual.

“They may act out or have trouble sleeping. Irritability and being more withdrawn and isolated are a lot of things that we’re going to think about a lot,” Brewer said.

It never hurts to seek help from a pediatrician on how to help a struggling child.

“It’s important for parents to feel empowered to really relax and listen to their children and talk to them.” Really try to reach out and understand what’s going on with them and help foster positive relationships,” Brewer said.

She said she hopes mental health care will become less stigmatized and more accessible to children.

“We really need to develop more of a strategy to help all species in different ways and really focus on some of these trauma and social influences on health,” Brewer said. “We need to make sure more children have safe places to grow and thrive.”

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