Letters to the Editor • Opinion
We already know how to prevent pandemics

In the early months of 2021, visits to emergency departments for suspected suicide attempts increased roughly 50 percent for adolescent girls compared with the same period in 2019, according to a report released Friday by the Centers for Disease Control and Prevention.

The report, which analyzed emergency department data from certain weeks in 2020 and 2021, found that trips for suspected suicide attempts among adolescents, especially girls, ages 12 to 17, began to increase in May 2020. From February to March 2021, the visits among girls rose 50.6 percent compared with 2019. For boys, the increase was 3.7 percent.

Though the report’s authors emphasized that their findings do not mean suicide deaths among adolescents have increased, mental health experts say the data is concerning. The pandemic’s effect on mental health is well-documented and it’s long been known that females are more likely than males to attempt suicide, but the CDC researchers noted that their study appears to provide new insights into the psychological toll younger Americans are experiencing.

“The findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to, and prevention for, this population,” the authors wrote.

Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, called the report “a very significant signal to pay attention to young people and especially adolescent girls.”

“This is really, in a way, a ring-the-alarm moment that distress is mounting so much that it’s overwhelming coping strategies and young people are either attempting more or at least being brought to the emergency department more related to that,” she said.

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The study examined data from the National Syndromic Surveillance Program, which includes approximately 71 percent of the nation’s emergency departments across 49 states. But analyses were restricted to emergency departments that reported data consistently and had at least one visit for suspected suicide attempts — or about 41 percent of the overall sample.

Researchers noted that the rate of visits by adolescents to emergency departments for suspected suicide attempts increased as the pandemic progressed, and they largely attributed the rise to visits by girls aged 12 to 17. Similar dramatic spikes were not observed in adolescent boys in the same age demographic or men and women ages 18 to 25.

“While provisional data shows that suicide deaths in 2020 decreased, we know that factors brought on by the pandemic, such as loneliness and isolation, are negatively impacting Americans across the country,” Colleen Carr, director of the National Action Alliance for Suicide Prevention, said in a statement. “It’s time we make suicide prevention a national priority and take the necessary actions needed to address this leading public health issue.”

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Some mental health experts had anticipated an eventual rise in suicide attempts during the pandemic, as a result of the rebound effect.

“Historically, we see a decrease in suicide deaths in the early part of a disaster or a catastrophe and then an increase,” said Jonathan Singer, president of the American Association of Suicidology. Though suicide deaths and attempts are very different, Singer noted that it’s possible the CDC’s recent findings are “following that trend of lower percentages early on and then increasing percentages as it goes on.”

But while the data is alarming, experts highlighted that the study’s various limitations make it difficult to draw firm conclusions about the findings. The researchers wrote in the report that their findings were subject to at least nine limitations, including that the “analysis was not designed to determine whether a causal link existed between these trends and the COVID-19 pandemic.”

One main drawback is that the report does not break down the numbers by race and ethnicity, geography, or whether the young people identify as LGBTQ+, said Singer, an associate professor of social work at Loyola University Chicago.

For months, he helped his son keep suicidal thoughts at bay. Then came the pandemic.

Past research on youth mental health has found significant differences among various demographics of young people who attempt suicide. The CDC’s 2019 Youth Risk Behavior Survey, which focused on high school students age 14 to 18, found that about 12 percent of Black students reported attempting suicide compared with 8 percent of White students. Students who identified as lesbian, gay or bisexual were also more likely to report a suicide attempt, according to the CDC.

“It’s really important to be able to disaggregate these data by some of these demographic categories, because the story is vastly different when you look at that,” and because the coronavirus has disproportionately affected communities of color, Singer said.

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Singer also noted two pandemic-related factors that could partly explain the rise in emergency room visits: limited access to traditional mental health care and an increase in the time parents were spending with their children.

Unlike school counselors and trained mental health professionals who are experienced in dealing with adolescent “ups and downs,” many parents “have a much lower threshold for what constitutes a crisis,” he said. But for suicide prevention, that may be a benefit.

“It could be that parents were identifying their own kids” who were struggling with suicidal ideation and took them to the emergency room, Singer said. “This could actually be an indicator that parents staved off a bunch of suicide deaths by responding to these suspected attempts.”

Such parental influence may reflect a “skewing of the data in the most positive sense,” Moutier said. Rather than a reflection of distress related to the pandemic, the increase in emergency room visits could be the result of “families spending time together, adults paying more attention and stigma going down,” she said.

However, Moutier said, research has shown that adults, many of whom are parents, have been struggling psychologically because of the pandemic, which can create a “ripple effect in the family environment that is detrimental to kids.”

How parents can protect kids’ mental health during the pandemic

Moving forward, experts urged adults — including parents, health-care providers, teachers, and community and faith leaders — to educate themselves about suicide prevention approaches and to be prepared to have open conversations with young people about mental health and suicide risk. Organizations such as the American Foundation for Suicide Prevention have resources for discussing mental health and guides for parents.

“Clinical interventions are incredibly pivotal, and that’s where most of the evidence is for driving down suicide rates,” Moutier said. “However, it has to start in the home, in the community, in the school.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.

William Wan contributed to this report.