Abstract
Emergency department (ED) visits for suspected suicide attempts among females ages 12–17 increased 51% during February–March 2021 compared with 2019. Visits among males during that time increased 4%, according to new data released by the Centers for Disease Control and Prevention (CDC) June 11.
Bottom Line…
The finding that young females are experiencing more severe distress underscores the need for increased attention to this population, the study authors stated.
Emergency department (ED) visits for suspected suicide attempts among females ages 12–17 increased 51% during February–March 2021 compared with 2019. Visits among males during that time increased 4%, according to new data released by the Centers for Disease Control and Prevention (CDC) June 11.
The report, Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID‐19 Pandemic — United States, January 2019–May 2021, expands upon previous work highlighting increases in ED visits for suspected suicide attempts earlier in the pandemic among all persons and suggests that these trends persisted among young persons as the pandemic progressed.
Compared with the corresponding period in 2019, persons ages 12–25 made fewer ED visits for suspected suicide attempts during March 29–April 25, 2020, the period that followed the declaration of the COVID‐19 pandemic as a national emergency and a concurrent 42% decrease in the total number of U.S. ED visits.
However, ED visits for suspected suicide attempts increased among adolescent girls ages 12–17 during summer 2020 and remained elevated throughout the remaining study period; the mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019.
COVID‐19 has undoubtedly had a significant impact on adolescent mental health, especially girls. Recent findings from a study of over 59,000 Icelandic adolescents published in The Lancet Psychiatry found that negative mental health outcomes were disproportionately reported by girls and older adolescents (13–18) compared to same‐age peers prior to the pandemic (see MHW, June 14).
Method
The CDC used data from the National Syndromic Surveillance Program (NSSP) to examine trends in ED visits for suspected suicide attempts during Jan. 1, 2019, to May 15, 2021, among individuals ages 12 to 25.
The CDC examined NSSP ED visit data, which includes approximately 71% of the nation's EDs in 49 states (all except Hawaii) and the District of Columbia. ED visits for suspected suicide attempts include visits for suicide attempts, as well as some nonsuicidal self‐harm visits.
Results
In May 2020, during the COVID pandemic, ED visits for suspected suicide attempts began to increase among adolescents ages 12–17, especially girls. During Feb. 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls ages 12–17 than during the same period in 2019; among boys ages 12–17, suspected suicide attempt ED visits increased 3.7%.
‘The finding that young females are experiencing more severe distress underscores the need for increased attention to, and prevention for, this population.’
Ellen Yard, Ph.D.
Why are young girls presenting with suicide attempts? “The analysis in this report is reflecting overall trends and does not tell us the reasons behind the suspected suicide attempts,” Ellen Yard, Ph.D., an epidemiologist and the study's lead author, told MHW in an email. “We do know that the trends we see among young females are consistent with other reports showing greater risk for nonfatal suicide attempts among females than males.”
Yard added, “In addition, previous research found that young females had higher rates of ED visits for suspected suicide attempts compared with young males, and the rate among females was increasing faster compared with the rate among males. The finding that young females are experiencing more severe distress underscores the need for increased attention to, and prevention for, this population.”
The difference in suspected suicide attempts by sex and the increase in suspected suicide attempts among young persons, especially adolescent females, is consistent with past research: self‐reported suicide attempts are consistently higher among adolescent females than among males, and research before the COVID‐19 pandemic indicated that young females had both higher and increasing rates of ED visits for suicide attempts compared with males.
Although this report found increases in ED visits for suspected suicide attempts among adolescent females during 2020 and early 2021, researchers say this does not mean that suicide deaths have increased. Provisional mortality data found an overall decrease in the age‐adjusted suicide rate from quarter three (July–September) of 2019 to quarter three of 2020. The suicide rate among young persons ages 15–24 during this same period saw no significant change. Future analyses should further examine these provisional rates by age, sex, race, ethnicity and geographic setting.
According to the CDC, suicide prevention requires a comprehensive approach that is adapted during times of infrastructure disruption, involves multisectoral partnerships and implements evidence‐based strategies to address the range of factors influencing suicide risk.
Implications
This data speaks to the importance of improving suicide care both during and after ED visits, including scaling up adoption of evidence‐based best practices such as the Recommended Standard Care and Best Practices in Care Transitions, Yard said, pointing to resources from the National Action Alliance for Suicide Prevention (Action Alliance).
“Additionally, together we can address these concerns and promote well‐being, using a comprehensive approach to prevention,” said Yard. Such an approach addresses the many factors associated with suicide. For example, strategies include increasing youth connectedness, teaching coping and problem‐solving skills, identifying and supporting youth at increased risk and limiting access to lethal means (e.g., medication and firearms), Yard noted. Adapting these strategies during times of uncertainty — such as the COVID‐19 pandemic — can help prevent suicide, she added.
Active Minds
While the latest CDC data is interesting and compelling, more data is needed to examine trends, especially among certain populations, such as LGBTQ+; Blacks, Indigenous and people of color; and Native Americans, said Amy Gatto, senior campus program manager at Active Minds, a nonprofit organization dedicated to raising mental health awareness among college students via peer‐to‐peer dialogue and interaction. “We need to do a little more digging and examining trends for marginalized groups,” Gatto told MHW.
A lot more can be done to stress a community‐based approach for suicide prevention, she said. “We know that suicide is a complex public health problem,” said Gatto. Suicide prevention–related activities can be conducted in schools, in after‐school programs and through religious organizations, for example, with prevention activities that are reflective of the populations those groups serve, she said.
“We advocate for a community approach to suicide prevention working together in the community with strategies involving youth connectedness, teaching youth and young adults problem‐solving skills and strategies,” Gatto said.
The Validate, Appreciate, Refer (VAR) approach can help people have those difficult conversations, said Gatto. VAR works with youth and young adults, she noted, and it's an approach people working with young people can use. “We know that connectedness is a key protective factor against suicide,” Gatto said. Social isolation is a risk factor, she noted, adding that creating a sense of belonging and connectedness is important to emotional well‐being.
“Another piece in strengthening communities is that we all play a role in this, being there for people in our lives, building resiliency to go back to VAR, make phone calls, text people and let them know you care,” she said. Having a safe place can open up their emotional health, she added.
The Action Alliance emphasized the importance of evidence‐based practices that must be adopted by health care systems nationwide to ensure safe, effective suicide care for all. “The time for action is now,” officials stated.