Pediatric Suicide Research Articles

Pediatric Suicide: Supporting Nurses on the Front Lines.

Pediatric Suicide: Supporting Nurses on the Front Lines.

Pediatric suicide attempts lagged during the COVID-19 pandemic: a European multicenter study

BackgroundElevated rates of suicidal behavior were reported during the COVID-19 pandemic. However, information is scarce on patients’ profiles during this period. Studies evoke the potential adverse effects of the mandatory lockdown, but they remain relatively speculative.MethodsWe monitored fluctuations in suicide attempts (SA) in six European countries. We gathered data, retrospectively for under 18-year-old SA episodes (1 January 2018 to 31 December 2021), through records of psychiatric emergency services. We collected clinical profiles individually. We extracted environmental indicators by month, as provided by Oxford COVID-19 Government Response Tracker (OxCGRT). We used the Pruned Exact Linear Time (PELT) method to identify breakpoints in SA episodes reported for each country, and logistic regressions to estimate changes in patients’ characteristics after the breakpoints. Finally, we used a univariate and multivariate negative binomial model to assess the link between SA and OxCGRT indicators, accounting for the delay (lag) between the interventions and their impact on SA.ResultsThe study comprised 2,833 children and adolescents (mean age = 15.1 years (SD 1.6); M: F sex-ratio = 1:5.4). A significant increase in SA was found either 6 or 10 months after the beginning of the pandemic, varying by country. Patients were more likely to be girls (aOR = 1.77 [1.34; 2.34]) and used SA methods “other than self-poisoning” (aOR = 1.34 [1.05; 1.7]). In the multivariate model, an association was found between SA and the contact tracing indicator with an 11 months delay, and the number of COVID-19 deaths with a 3-months delay.ConclusionsFindings confirmed a delayed increase in SA during the COVID-19 pandemic in children and adolescents as well as changes in patients’ profiles. The duration and severity of the pandemic emerged as the strongest predictor in the rise of SA. If faced with a similar pandemic in the future, the gap between the onset of pandemic and the increase in suicide attempts presents an opportunity for prevention.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

Changes in severity of pediatric suicide attempts before and after coronavirus disease 2019.

The recent coronavirus disease 2019 (COVID-19) pandemic and school closures were reported to have negatively impacted the mental health of children and adolescents. This study aimed to examine the change in the number and severity of pediatric suicide attempts before and after the COVID-19 pandemic. This study enrolled 54 patients (26 vs. 28 patients before and after the COVID-19 pandemic, respectively) under 19 years of age who were transported to the emergency department as a result of suicide attempts between April 2017 and December 2021. The primary outcome includes the rate of serious suicide attempts (SSAs). The SSA rates were 19% (5/26) and 43% (12/28) before and after the COVID-19 pandemic, respectively (p = 0.62). The average number of transported suicide attempts per month almost doubled (0.72 vs. 1.33, respectively) and suicide attempts as a percentage of all ambulance transportations of individuals under 19 years old increased significantly from 0.95% (26/2729)to 1.98% (28/1414) (p = 0.006). The COVID-19 pandemic increased the severity of pediatric suicide attempts but not to a statistically significant degree. Social preventive support and early psychological intervention are therefore needed currently and in the future.

6.94 Familiar Methods in Novel Settings: Implementing Pediatric Suicide Risk Screening in a Podiatric Practice

6.94 Familiar Methods in Novel Settings: Implementing Pediatric Suicide Risk Screening in a Podiatric Practice

Routine Pediatric Suicide Screening: Updated Recommendations

Suicide is the 2nd leading cause of death among children aged 10 to 14 and the 3rd leading cause of death among adolescents and young adults in the United States. Research demonstrates that the current depression screenings are missing patients with thoughts of suicide. Given this information, the American Academy of Pediatrics, the American Foundation for Suicide Prevention, and the National Institute of Mental Health released an updated recommendation for suicide risk screening in 2022. The updated recommendations for suicide risk screening are reviewed, and screening tools are provided along with a suicide screening pathway/algorithm and patient and provider resources.

111: EFFECT OF COVID-19 LOCKDOWN ON LENGTH OF HOSPITALIZATION FOLLOWING SUICIDE ATTEMPTS IN ADOLESCENTS

Introduction: Mental health related concerns have increased as a consequence of the Covid-19 pandemic. Emerging evidence has suggested that adolescents are at a greater risk compared to other age groups. Frequently, it is hypothesized that suicide attempts have increased following the global pandemic; however, inconsistent data currently exists illustrating the pattern of suicide attempts surrounding the pandemic. Therefore, our purpose was to examine the length of stay (LOS) following pediatric suicide attempts across three phases of the pandemic and the potential associated financial burden. Methods: 1,467 patient encounters from the pediatric ED and PICU with a diagnosis of suicide were retrospectively reviewed. A total of 262 patient records (age: 15±2 yo, 82% female) were included and grouped based on Covid-19 lockdown (defined as March 2020). Three time periods were demarcated: 1-yr pre-lockdown, 1-yr immediately following lockdown, and 2nd-yr following lockdown. A Pearson correlation was conducted between LOS and total cost of care. A 1-way between group ANOVA was used to examine mean differences in LOS. A p-value < 0.05 was defined as significant. Results: A positive relationship was found between LOS and total cost of care (n=142; r=.743; CI95%=.658-.808). The number of attempts per time period was 80, 93, and 89, respectively. The between group ANOVA indicated there was a significant (F=3.77, p=0.024) increase in LOS following the lockdown. Specifically, pairwise comparisons showed that LOS was greater during the 2nd-yr of lockdown compared to pre-lockdown (mean±SEM: 1.11 ± .14 vs. 1.63 ± .13 days; mean difference =.52, CI95% = .15 - .89). Conclusions: There was a relationship between LOS and total cost of care such that the more time spent hospitalized resulted in higher cost. While it still remains to be determined to what degree the incidence rate of attempt was affected by Covid-19 lockdown, here we suggest that LOS (and perhaps cost) increased following the lockdown date. Interestingly, there was only a difference between pre-lockdown and the 2nd-yr of lockdown. Therefore, future studies should examine factors contributing to greater LOS, such as access to mental health professionals and bed availabilities at inpatient psychiatric facilities.

“13 Reasons Why”: An Analysis of Pediatric Psychiatric Visits Pre and Post Release of A Popular Netflix Show Detailing Pediatric Suicide

Background: Among Americans, child suicide is the second leading cause of death between the ages of 10-24 years. The release of “13 Reasons Why” (www.netflix.com/title/80117470), one of the most popular Netflix series, has caused controversy as proponents feel it serves as a catalyst for conversation for issues people with mental illness face. On the other hand, opponents state it may sensationalize or glamorize suicide. We hypothesized that after the release of “13 Reasons Why” on March 31, 2017, there may be an increase in the numbers of patients between 10 and 20 years of age presenting to Emergency Departments (EDs) with the chief complaint of suicide attempt (SA), suicide ideation (SI), self-harming (SH) and other psychiatric complaints. We hypothesize that admission rates for psychiatric illness during this time would simultaneously be higher. Methods: Retrospective cohort protocol comparing the number of presentations to 26 emergency departments in the Northeast and Southeast USA for a 60-day period before and after release of “13 Reasons Why”. Data was collected from a proprietary electronic charting system and examined for the numbers of patients seen for SI/SA/SH and for all psychiatric evaluations, with a separate comparison for admission rates and age differences. We examined data from the matching time periods in 2016 to determine if there was a difference in 2017. Results: 3362 patients met criteria for the 120-day period in 2017. 1880 (56%) were female, mean age was 15.9 (95% CI 15.7-16.2), IRQ of 14-17. The number of patients seen in the 60-day post release period was 1799 vs 1563 prerelease (proportion of 0.54 (95%CI 0.52 to 0.56); p value &lt;0.0001) representing a 15% increase post release. There was no significant change in presentations for chief complaints with regards to the combination of SI/SA/SH before (n 218) and after release (n 257) (p &lt;0.08). There was no difference in overall admission rates before and after release (p &lt;0.08) or in admission rates for those who had SI/SA/SH. There was no change in age before or after release: 16.5 years vs 16 years respectively, mean difference 0 (95% CI -0.4 to 0.7, p 0.65). There was a significant difference in total presentation for the 60-day pre vs the post March 31, 2017 time frame, however more patients presented in the pre March 31 period for 2016. While no change in admission rates or SI/SA/SH occurred, there was a 15% increase in overall psychiatric presentations to EDs after release of “13 Reasons Why”. Discussion and Conclusion: Although there was no increase in pediatric psychiatric visits specifically for SI/SA/SH after the release of “13 Reasons Why”, there was a significant increase in overall psychiatric visits in the pediatric ED after the release of this series. This is in line with our theory that media, and in particular this television show, may have a profound influence on young patients with regards to serious mental health issues. Whether these numbers represent a positive vs negative effect on the psychiatric health of children is unknown.

Pediatric suicide by violent means: a cry for help and a call for action

BackgroundSuicide is the second most common cause of death among adolescents and young adults. In the pediatric population, gunshot wounds (GSWs) and hangings are common mechanisms of pediatric suicide. Comorbid psychiatric illness is prevalent in this population, but psychiatric resource utilization after self-inflicted traumatic injury is not well characterized.MethodsWe analyzed patients < 18 years old presenting to a level 1 pediatric trauma center after suicide attempt by GSW, hanging, or jumping from a height from 2009 to 2019. The primary outcome was psychiatric resource utilization. Secondary outcomes included prior emergency department (ED) visits to identify prior opportunities for intervention.ResultsOf 6538 pediatric trauma patients, there were 219 GSWs, 7 hangings, and 7 jumps from height, for a total of 233 patients. Of these, 14 presented following a suicide attempt (four GSWs, six hangings, and four jumps, total 6.0%). Half of these patients died due to their injuries. Self-inflicted GSWs had the highest mortality (75%). Most surviving patients were placed on involuntary psychiatric holds (n = 5/7, 71.4%), and three patients were discharged to an inpatient psychiatric hospital (n = 3/7, 42.9%). Five of the 14 patients had prior ED visits (35.7%), and of these, 60% were for suicidal ideation or suicide attempts.ConclusionsAmong pediatric trauma patients, suicide attempts are rare, but are highly lethal, with the highest mortality rate seen in self-inflicted GSWs. Psychiatric resource utilization is high both during and after the hospitalization. Prior ED visits may represent opportunities for depression and suicidality screening in this at-risk population.

Pediatric Suicide Screening: A Review of the Evidence

BackgroundSuicide rates are increasing for youths and suicide is the second leading cause of death for 10–24 year olds. This evidence-based practice project critically reviews literature regarding the effectiveness of pediatric suicide screening. MethodsA literature search was guided by the following question: In pediatric patients, does suicide screening at every health encounter compared to an annual screen increase clinician identification of patients at-risk. Ten articles met inclusion criteria and were critically appraised and synthesized. FindingsYouths had high rates of suicidal ideation (SI), anxiety, and depression. Pediatric universal suicide screening identified SI in youths with both psychiatric and non-psychiatric medical complaints. Patients with chronic health conditions reported higher rates of mental health symptoms and SI. A specific suicide screening instrument should be used as general mental health screens likely miss youths at-risk for SI. The Ask Suicide-Screening Questions tool is an easy to use and highly sensitive instrument for detecting suicide risk in youths. DiscussionMany youths that screen positive for SI do not have known mental health concerns and would have been missed if not asked directly. Universal screening for SI identifies at-risk youth and allows nurses and other providers to intervene. The need for universal screening across pediatric health care settings using brief, validated screening tools is paramount. Application to practiceNurses working in pediatric settings should champion universal screening for SI. Unit-based quality improvement projects using the Plan-Do-Study-Act change cycle provides a model for instituting universal screening for SI.

Suicide Ideation and Neurocognition Among 9- and 10-Year Old Children in the Adolescent Brain Cognitive Development (ABCD) Study

Objective During the past decade, the pediatric suicide rate has nearly tripled. Yet, little is known about suicide behavior (SB) in children. Identification of risk factors associated with SB during childhood may be critical to preventing future attempts. The purpose of this study was to examine the relationship between neurocognitive performance and suicide ideation (SI) in children. Method The present study utilized baseline data from 11,875 participants in the Adolescent Brain Cognitive Development (ABCD) study, a longitudinal study that follows 9- and 10-year-old children through late adolescence to examine factors that influence developmental trajectories. Suicidality was assessed by the Kiddie Schedule for Affective Disorder and Schizophrenia (KSADS) suicide module completed by the parent. Neurocognitive ability was assessed using the NIH Toolbox Cognition measures administered to the youth. Results Children with a history of SI reported by their parent or concordant parent and youth report of SI demonstrated lower performance on the NIH Toolbox Picture Sequence Memory Test compared to children without SI. The difference in performance on the memory task remained significant when including demographic characteristics, family history of suicide, and internalizing symptoms in the model as covariates. Conclusions To our knowledge, this is the first study to identify decreased episodic memory in children with SI. These findings are similar to results from adult and adolescent studies which have reported decreased memory performance among suicide attempters. Deficits in episodic memory may impact a child’s ability to problem-solve and generate potential future outcomes, which may increase the risk for SB. Early identification of memory deficits in children may inform suicide prevention and intervention efforts. Highlights 6% of parents and children reported a history of active suicide ideation in children. Children with a history of suicide ideation had lower episodic memory performance. Early identification of memory deficits may inform suicide intervention efforts.

Harnessing the Power of Community to Prevent Pediatric Suicide

Harnessing the Power of Community to Prevent Pediatric Suicide

Contemporary Characteristics and Lethality Correlates of Serious Suicide Attempts in Children and Adolescents.

Adolescent suicide rates have increased in the past decade. Few studies have examined contemporary pediatric suicide attempters with medically serious suicide attempts, particularly among younger pediatric suicide attempters. This preliminary chart review study examined 200 adolescents with medically serious suicide attempts and sought to identify general cohort characteristics, differences in cohort characteristics based on age, correlates of lethality, and correlates of rescue (likelihood of prompt medical attention). Our study found that younger adolescents specifically endorsed increased cyberbullying (β=1.1, p=.046) and less hopelessness (β=-0.83, p=.02) compared to older adolescents. Suicide attempt lethality was negatively associated with female gender (β=-0.59, p=.041), rescue (β=-0.19, p=.005), an anxiety diagnosis (β=-0.81, p=.0003), and history of consensual sexual activity (β=-0.79, p=.002). Rescue was positively associated with an ADHD diagnosis (β=0.73, p=.018) and less attempt planning (β=0.96, p=.01), while a history of previous suicide attempt (β=-0.54, p=.04) and more proximal suicide attempt (β=-0.045, p=.008) were associated with a lower rescue score. Our preliminary findings suggest clinicians and future researchers may need to assess certain social and diagnostic factors in children and adolescents at particularly high risk for death by suicide.

Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016

Suicide is the second leading cause of death among youths aged 10 to 19 years in the United States, with rates nearly doubling during the past decade. Youths in impoverished communities are at increased risk for negative health outcomes; however, the association between pediatric suicide and poverty is not well understood. To assess the association between pediatric suicide rates and county-level poverty concentration. This retrospective, cross-sectional study examined suicides among US youths aged 5 to 19 years from January 1, 2007, to December 31, 2016. Suicides were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes from the Centers for Disease Control and Prevention's Compressed Mortality File. Data analysis was performed from February 1, 2019, to September 10, 2019. County poverty concentration and the percentage of the population living below the federal poverty level. Counties were divided into 5 poverty concentration categories: 0% to 4.9%, 5.0% to 9.9%, 10.0% to 14.9%, 15.0% to 19.9%, and 20.0% or more of the population living below the federal poverty level. The study used a multivariable negative binomial regression model to analyze the association between pediatric suicide rates and county poverty concentration, reporting adjusted incidence rate ratios (aIRRs) with 95% CIs. The study controlled for year, demographic characteristics of the children who died (age, sex, and race/ethnicity), county urbanicity, and county demographic features (age, sex, and racial composition). Subgroup analyses were stratified by method. From 2007 to 2016, a total of 20 982 youths aged 5 to 19 years died by suicide (17 760 [84.6%] were aged 15-19 years, 15 982 [76.2%] male, and 14 387 [68.6%] white non-Hispanic). The annual suicide rate was 3.35 per 100 000 youths aged 5 to 19 years. In the multivariable model, compared with counties with the lowest poverty concentration (0%-4.9%), counties with poverty concentrations of 10% or greater had higher suicide rates in a stepwise manner (10.0%-14.9%: aIRR, 1.25 [95% CI, 1.06-1.47]; 15.0%-19.9%: aIRR, 1.30 [95% CI, 1.10-1.54]; and 20.0% or more: aIRR, 1.37 [95% CI, 1.15-1.64]). When stratified by method, firearm suicides had the strongest association with county poverty concentration (aIRR, 1.87; 95% CI, 1.41-2.49) in counties with 20% or higher poverty concentration compared with counties with 0% to 4.9% poverty concentration. The findings suggest that higher county-level poverty concentration is associated with increased suicide rates among youths aged 5 to 19 years. These findings may guide research into upstream risk factors associated with pediatric suicide to inform suicide prevention efforts.

SCREENING TOOLS IN THE EMERGENCY DEPARTMENT

The number of patients presenting to the emergency department (ED) with behavioral health complaints have been increasing, as have pediatric suicide rates and substance use issues. The ED is a crucial site for identifying these issues and helping patients connect with the level of care they need. Use of standardized instruments can help identify those at risk and link them to ongoing care.

Pediatric suicide is a preventable phenomenon: a single center experience

Pediatric suicide is a preventable phenomenon: a single center experience

Young lives cut short: The relationship between firearms and pediatric suicide.

To describe the demographic characteristics and burden of pediatric suicides by firearm in the United States using a large all-payer pediatric inpatient care database. Children and young adults (<21 years old) were identified with an International Classification of Diseases, Ninth Revision diagnosis of suicide and self-inflicted injury with a firearm (SIF) in the Kids' Inpatient Database for the study years of 2006, 2009, and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed to examine the association between SIF and risk factors while adjusting for various sociodemographic characteristics using separate models incorporating mental health diagnoses. There were a total of 613 hospitalizations for SIF during the years under study. Almost four hospitalizations per week occurred, and in-hospital mortality was 39.1%. The mean age of the study population was 17.3 years, and this population was predominantly male (87.5%), white (62.4%), resided in an urban area (43.8%), lived in the south (51.3%), and within the lowest income quartile (33.8%). Mental health (38.3%) and mood disorders (28.3%) were common. Males had a markedly increased likelihood of hospitalization for SIF (adjusted odds ratio [aOR], 7.56; 95% confidence interval [CI], 5.54-10.30). Children and adolescents from rural environments and those in the south were more likely to have a hospitalization for SIF than respective comparison groups. Using separate regression models, a diagnosis of any mental health disorder increased the likelihood of hospitalization for a SIF (aOR, 11.9: 95% CI, 9.51-14.9), mood disorders (aOR, 17.2; 95% CI, 13.3-22.3), and depression (aOR, 21.3; 95% CI, 16.1-28.3). Pediatric hospitalizations for SIF are a common occurrence with high associated mortality. The prevalence of mental health disorders and their impact on this population highlight the need for early identification and intervention for individuals at risk. Epidemiological, level III.

Understanding Suicide Across the Lifespan: A United States Perspective of Suicide Risk Factors, Assessment & Management.

Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence-based risk management strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were "Forensic Science," "Suicide Risk Management," "Pediatric Suicide Risk Factors," "Adult Suicide Risk Factors," "Geriatric Suicide Risk Factors," "Suicide Risk Assessment." Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.

A 27-Year Retrospective Study of Pediatric Suicide Cases Referred to the Medical University of South Carolina (1988-2014).

Suicide by individuals under 18 years of age is a tragic reality of society. To assess local trends and demographics, we retrospectively reviewed all pediatric cases referred to our institution from 1988-2014 (27 years). Pediatric cases were defined as individuals younger than 18 years of age. The incidence of reported suicides declined from 3.8 cases per year to 2.4 cases per year as compared to observations at our institution over a previous ten-year period (1988-1998). In concert with the overall decrease in cases were increases in the proportion of adolescents younger than 15 and the female demographic. Furthermore, a shift in suicidal methodology was noted, with an increase in suicide by hanging. Indeed, for females, hanging became the most common suicide modality, replacing firearms. Our findings are congruent with national trends and underline the need for global suicide preventive interventions targeted toward increasingly younger adolescents and females.

Mental Health and Psychosocial Issues in Pediatric Suicide – Review of the National Child Death Case Reporting System

Mental Health and Psychosocial Issues in Pediatric Suicide – Review of the National Child Death Case Reporting System