Children’s hospital visits for suicide ideation and attempts are increasing

1. The percentage of patients seen at children’s hospital for suicidal ideation (SI) and suicide attempts (SA) more than doubled between 2008 and 2015.

2. Fall and spring months accounted for a higher percentage of encounters for SI and SA than summer and winter months, suggesting that the academic school year may play a role.

Evidence Rating Level: 2 (Good)

Study Rundown: Suicide is a leading cause of death among children and adolescents, and previous studies have noted recent increases in suicide, depression, and other mental health diagnoses. In this retrospective study, researchers used clinical and billing data from 31 children’s hospitals across the United States to further characterize the number of hospital encounters for SI and SA. Results indicated that encounters for SI and SA more than doubled between 2008 and 2015. Increases were most prominent among girls and adolescents aged 12-17 years. A higher percentage of total annual SI and SA encounters took place during fall and spring months when compared to summer months, which authors noted correlates with the traditional academic year. While the study is limited by a lack of differentiation between encounters for SI and SA and lack of generalizability given completion at only free-standing children’s hospitals, the study is notable for its large sample size and does contribute to the pediatric community’s understanding of recent longitudinal, demographic, and seasonal trends in SI and SA encounters at children’s hospitals. These work emphasize the growing need for mental health services and training for clinicians at children’s hospitals, and suggests that further study of the contribution of school to SI and SA is needed.

Click to read the study, published today in Pediatrics

Relevant reading: Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance?

Study author, Gregory Plemmons, MD, speaks to 2 Minute Medicine: Associate professor in clinical pediatrics at Vanderbilt University School of Medicine.

“We began to notice in our own children’s hospital about ten years ago we were beginning to see an increase in the number of children admitted for suicide ideation or attempt and were surprised to find the increase is nationwide. We were also surprised to see the strong temporal association with the academic calendar (hospitalization rates were twice as high in October than July, for instance).”

In-Depth [cross-sectional study]: Researchers used clinical and billing data from 31 children’s hospitals in the United States within the Pediatric Health Information System database to identify 115 856 encounters (emergency department, inpatient, and intensive care unit) for SI and SA between 2008 and 2015 based on International Classification of Diseases, Ninth Edition (ICD-9) codes. The primary outcome measured was the percentage of SI and SA encounters out of total encounters within a month, with further subgroups defined by age, sex, race and/or ethnicity, and household income quartile.

A total of 0.66% of all encounters at the studied children’s hospitals in 2008 were for SI and SA, a rate that more than doubled to 1.82% in 2015 with an average annual increase of 0.16 percentage points (95%CI: 0.15-0.17). There were significant increases in percentage of SI and SA encounters across all age groups, sexes, races and ethnicities, and household income quartiles except for the lowest quartile income subgroup. Seasonal variation was noted. Summer months only accounted for 18.5% (95%CI: 5.6-6.1) of total annual SI and SA encounters, whereas spring and fall months accounted for 28.3% and 28.1% of encounters, respectively.

Image: CC/Wiki/Sander van der Wel

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