US youth suicide attempts double in nine years


Emergency department numbers reveal a huge jump in suicide-related visits, especially by children under the age of 11. Andrew Masterson reports. 


Numbers of children reaching emergency departments after suicide attempts are rising sharply.

FRANCOIS GUILLOT/AFP/Getty Images

The number of children visiting US hospital emergency departments as a result of suicidal thoughts or actions doubled between 2007 and 2015, figures reveal.

In a research letter published in the journal JAMA Pediatrics, Brett Burstein, Holly Agostino, and Brian Greenfield, all from the Montreal Children’s Hospital in Canada, report that youth suicide-related hospital visits over a nine-year period show a stark upward trend.

Suicide is now the second leading cause of death for American children aged between 10 and 18 years old. Suicide attempts and suicidal ideation, they report, often carry on into adulthood and are regarded as “the strongest predictor” of later death by suicide.

Burstein and colleagues looked at the US National Hospital Ambulatory Medical Care Survey (NHAMCS) emergency department database, concerning hospital visits by people aged 18 or less. The data is collected annually by the Centres for Disease Control and Prevention (CDC).

The researchers found roughly 2.8% of the visits met the inclusion criteria for suicide attempt or suicidal ideation. In raw numbers, 580,000 visits occurred in 2007, rising to 1.2 million in 2015. Across the nine year period, there were 7.3 million suicide-related visits.

The median age of the children was just 13. Just over 43% of the cases identified involved children aged between five and 11. Only 2.1% were admitted to hospital.

The increase reflected a similar finding focussed only on US tertiary children’s hospitals. It also broadly agreed with a previous study that “reported a doubling in ED visits for suicidal behaviour in all age categories between 1993 and 2008”.

Many of the hospital records used related to children in emergency departments of hospitals that were not specifically geared to paediatric medicine, or to teaching. This suggests, the researchers say, that there are more at-risk children in the general community than previously assumed.

They also note that suicide attempts and suicidal ideation, while closely related, are different behaviours with correspondingly different predictive importance for future events. However, a second analysis using only suicide attempt data produced the same rate of increase.

Burstein and colleagues make no attempt to define the cause of the surge, saying that is likely to be multifactorial. They do, however, make a strong recommendation.

“Findings suggest a critical need to augment community mental health resources, ED physician preparedness, and post–emergency department risk reduction initiatives to decrease the burden of suicide among children,” they write

  1. https://doi.org/10.1001/jamapediatrics.2019.0464
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