COMMENTARY

Suicide Ideation and Attempts in Children and Teens

William T. Basco, Jr, MD, MS

Disclosures

November 13, 2018

Hospital Encounters and Admissions for Pediatric Suicide Ideation or Attempts

Suicide is the third leading cause of death among adolescents in the United States; sadly, these rates of completed suicide are increasing.[1] Both suicide ideation and suicide attempts are markers of increased risk for later completed suicide.

Plesson and colleagues[1] used the Pediatric Health Information System to evaluate whether rates of hospitalization for suicide ideation or attempts have increased since 2009. They also sought to evaluate the contribution of hospitalizations for suicide ideation or attempts to the overall number of pediatric hospitalizations during the same period.

The children and youth in this study were aged 5-17 years (2.8% were aged 5-11 years, but 50% were aged 15-17 years, and the median age was 15 years). The analysis cohort included 115,856 hospital encounters for suicide ideation or attempts. Over one half, 58.3%, were hospital inpatient admissions; 7.7% required intensive care. The remainder, 41.7%, were emergency department encounters only. Almost two thirds of the admissions were girls.

During the years studied, hospitalization and encounters for suicide ideation or attempts increased from 0.66% of all encounters in 2008 to 1.282% of the encounters in 2015. This correlated to an increase of 292% for these two diagnoses, with a corresponding increase of 43% in all encounters and hospitalizations.

Encounters and hospitalizations for suicide ideation or attempts increased significantly more for girls, although they were higher for both genders. Marked seasonal variations were obvious. The summer months had the lowest frequencies of suicide ideation and attempts, whereas the fall and spring months had the highest frequencies.

The conclusion of this analysis was that hospital encounters for suicide ideation and suicide attempts more than doubled during the years studied, and that hospitalizations for these conditions comprised an increased proportion of all pediatric hospitalizations.

Viewpoint

These data support what I suspect many pediatric providers who have been providing care to teens during the years of this study have anecdotally experienced. Although 2% of all pediatric hospitalizations may not seem like a very high percentage, these young people can experience long, stressful hospitalizations, which are emotionally costly to the families and fiscally costly to the healthcare system.

At the Pediatric Hospital Medicine 2018 meeting in Atlanta, I learned that several children's hospitals had developed "medical mental health" units (as opposed to psychiatric hospital units) as a way of providing inpatient space for the growing number of mental health admissions. I suspect that, just as outpatient pediatric providers have had to learn more about caring for patients with behavioral and mental health issues, even general hospitalists will need to do the same as the prevalence of pediatric behavioral and mental health conditions outstrips both the outpatient and inpatient capacity of developmental pediatricians and child psychiatrists.

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