Suicidal Tendencies in Children and Adolescents in the US

Suicidal ideation refers to thoughts or worries about committing suicide, while suicide attempts involve actual acts of self-harm with the intent to die. Suicidality encompasses both suicidal ideation and suicide attempts and is a strong predictor of youth suicide deaths and deserves attention . It is more common among adolescents than adults, and several studies have revealed increasing trends in adolescent suicidality in recent decades.

In the US National Comorbidity Survey, 12.1% of adolescents reported serious thoughts of suicide, and approximately one-third of those with suicidal ideation attempted suicide before reaching adulthood. Rates of emergency department (ED) visits for intentional self-harm in 2020 were higher among adolescents ages 15 to 19 compared to older age groups (472 vs. 133 per 100,000), and rates of ideation Suicide or suicide attempts in the US nearly doubled between 2008 and 2015.

Seasonal patterns of suicidality should be of interest to clinicians and public health officials in the US, as intervention efforts may benefit from focusing on periods of highest risk. There are several hypotheses focusing on exogenous variables associated with seasonal patterns of suicide, including temperature changes, circadian rhythms, sunlight exposure, geographic latitude, and interactions with gender, substance use, and mental health status. However, these hypotheses have not focused on unique differences between age groups despite evidence that adolescence represents a developmental period of increased suicide risk.

Some literature suggests that peaks and nadirs in adolescent suicidality may be associated with the school calendar near the beginning and end of the school year, with corresponding declines during the summer months when school is out of session. These studies suggest that children and teens may face greater stress and poorer mental health when school is in session . Some known risk factors, such as bullying and peer pressure over alcohol and drug abuse, may be associated with the seasonal patterns observed in suicidality during the school year. The school experience creates social, academic, and extracurricular stressors, as well as poorer sleep habits, each of which can have detrimental outcomes for the mental health and well-being of children and adolescents.

Importance  

Detecting seasonal patterns in suicidality should be of interest to US clinicians and public health officials, as intervention efforts may benefit from focusing on periods of highest risk.

Goals  

To examine recent trends in suicide rates, quantify seasonality in suicide, and demonstrate patterns of seasonality disrupted during COVID-19-related school closures in spring 2020 among US children and adolescents.

Design, environment and participants  

This population-based descriptive cross-sectional study used administrative claims data from Optum’s de-identified Clinformatics Data Mart database . Commercially insured children ages 10 to 12 and adolescents ages 13 to 18 participated from January 1, 2016 to December 31, 2021. Statistical analysis was performed between April and November 2022.

Exhibitions  

Month of the year and COVID-19 pandemic.

Main results and measures  

Rates and seasonal patterns of emergency department (ED) visits and hospitalizations for suicidality.

Results 

The analysis included 73,123 ED visits and hospitalizations for suicidality reported between 2016 and 2021. Among these events, 66.1% were women, and the mean (SD) age at the time of the event was 15.4 ( 2.0) years.

The mean annual incidence of emergency department visits and hospitalizations for suicidality was 964 per 100,000 children and adolescents (95% CI, 956-972 per 100,000), increasing from 760 per 100,000 (95% CI, 745-775 per 100,000). ) in 2016 to 1006 per 100,000 (95% CI, 988-10,024 per 100,000) in 2019, with a temporary decline to 942 per 100,000 (95% CI, 924-960 per 100,000) in 2020 and a subsequent increase to 1160 per 100,000 (95% CI, 1140-1181 per 100,000) in 2021.

Compared with January, seasonal patterns showed peaks in April (incidence rate ratio [IRR], 1.15 [95% CI, 1.11-1.19]) and October (IRR, 1.24 [ 95% CI, 1.19-1.

Temporal trends in emergency department visits and hospitalizations for suicidal ideation and suicide attempts among children and adolescents, 2016-2021

The shaded background indicates the COVID-19 period from March 2020 onwards. Connected dots indicate observed monthly incidence per 100,000 members, solid orange lines indicate seasonally adjusted trends, and dashed orange lines represent projected trends based on the pre-pandemic trend if the pandemic had not occurred.

Conclusions and relevance  

The findings of this study indicated the presence of seasonal patterns and an unexpected decrease observed in suicidality among children and adolescents following COVID-19-related school closures in March 2020, suggesting a possible association between suicidality and the school calendar.

Discussion

The present study confirms a continued upward trend in suicidality among American adolescents and provides a population-level assessment using the most recent data. From 2016 to 2021, the mean annual incidence of emergency department visits and hospitalizations for suicidality was 964 per 100,000 children and adolescents (95% CI, 956-972 per 100,000), and annual incidence rates increased between 2016 and 2019, with a temporary decline in 2020 and a return to increasing trends in 2021.

The results demonstrated clear seasonal peaks in adolescent suicidality during the academic calendar. These seasonal spikes were not observed in spring 2020 during COVID-19-related school closures, when event rates decreased.