ER visits among youth with suicidal thoughts had already spiked in fall 2019

In the fall of 2019 — before the onset of COVID-19 — emergency departments in Illinois experienced a spike in visits from youth ages 5 to 19 with suicidal thoughts or ideas, according to a new study from Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children’s Hospital of Chicago. There was an additional surge in these types of visits during the pandemic, the study found.

“A lot of people have talked about mental health problems in youth during the pandemic, but it was happening before the pandemic,” said corresponding author Dr. Audrey Brewer, instructor of pediatrics at Feinberg and a pediatrician at Lurie Children’s. “This has been an issue for so long, and it’s getting worse.”

Although the study focused on Illinois data, the study authors said the diverse demographics of Illinois’ population are representative of the general population of the U.S.

Defining ‘suicidal ideation’

Suicide is the second-leading cause of death among children and adolescents in the U.S. and has increased over 45% between 1999 and 2020, when more than 47,000 adolescents ages 10 to 19 died. There is a growing incidence of youths seeking emergency care with suicidal thoughts, which relate to the growing prevalence of depression, anxiety and severe mental illness in recent decades. Individuals who experience suicidal thoughts are more than three times more likely to die by suicide in the future than individuals who don’t have suicidal thoughts.

A lot of people have talked about mental health problems in youth during the pandemic, but it was happening before the pandemic.”

Using data from 205 Illinois hospitals, the research team examined ER visits involving suicidal ideation — having thoughts of wanting to hurt or harm oneself but not necessarily having made an attempt — and hospital stays resulting from those ER visits.

It is also important to note the study examined the number of visits related to suicide ideation — not the number of individuals — meaning multiple visits could have been made by the same person.

“Suicidal ideation can be thought about as two types: actively thinking about suicide or having thoughts, but not having a plan,” Brewer said. “That could be the difference in why someone might get admitted to the hospital.” 

Why is this happening? 

Although the data used in this study do not shed light on the reasons that suicidal ideation has spiked in recent years, it could be a combination of school-related stress, social isolation, including heavy social media exposure, growing hopelessness about climate change, political discord and gun violence, and family adversity, neglect or abuse, said senior author Joe Feinglass, research professor of medicine at Feinberg.

“This is like smoke,” Feinglass said of the study findings. “And there’s definitely a fire, but we don’t yet know and are not yet addressing what is causing the fire.”

The findings highlight the need for caring, supportive interactions to improve adolescents’ mental wellness, Brewer said. 

“The much higher levels of suicidal ideation among youth in Illinois that we are seeing now are deeply concerning,” said Dr. Matthew Davis, chair of the department of pediatrics at Feinberg and Lurie Children’s. “And our health care system needs to train more community members, primary care providers and subspecialty physicians to address mental health needs for youth. To improve this crisis is going to require a broad, intense, coordinated approach.”

The study breaks down whether suicidal ideation was the patients’ principal diagnosis (the reason they came to the emergency department) or if it was coded as the secondary diagnosis (for instance if they came in for their anxiety or substance use but also had thoughts of harming themself). 

Emergency department visits for suicidal ideation increased 59% from 2016-2017 to 2019-2021 overall, with a corresponding increase from 35% to 44% of visits coded as the principal diagnosis. Hospitalizations during that same period increased 57%. Youth were more likely hospitalized if their visit included severe mental illness, substance use, anxiety or depression, or had emergency department visits to children’s or behavioral health hospitals.

The study was published Nov. 14 in the journal Pediatrics. Other Northwestern co-authors include Dr. Karen Sheehan. Co-author William Doss is a former Feinberg staff member.  

If you or someone you know is having thoughts of self-harm, seek help. The 988 Suicide and Crisis Lifeline provides 24/7, free and confidential support for people in distress.