The Alarming Rise in Pediatric Suicide

I’ve always known my job is hard. Child and adolescent inpatient psychiatric care brings patients who are exposed to unfathomable traumatic experiences, misunderstood by their closest loved ones, and wishing for magic wands to make life feel different. One of the biggest challenges has been observing the rise in suicidality among children. According to the CDC, suicide is currently the second leading cause of death in children age 10-14 (second only to death by firearms.) The rate of suicide in this age group has nearly tripled in the last decade. Nonfatal suicide attempts also represent a significant and growing threat to public health among young people with national samples showing dramatic increases in inpatient visits for suicidal ideation and self-injury for children and adolescents age 10-14. 

A recent declaration of national emergency for youth mental health by the American Academy of Pediatrics, Children’s Hospital Alliance, and American Academy of Child and Adolescent Psychiatrists (AAP, AACAP, CHA declare national emergency in children’s mental health | AAP News | American Academy of Pediatrics) and the U.S. Surgeon General’s advisory on mental health among youths (“urgent public health crisis” U.S. Surgeon General Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-19 Pandemic | HHS.gov) has highlighted the further impact of the pandemic on this crisis. 

There’s still much to be done to understand this rise in suicidality. Albeit limited, studies have identified risk factors that include both externalizing problems (for example, impulsivity, hyperactivity, aggression, and other disruptive behaviors) and internalizing distress (most notably in the form of depressive symptoms including self-perceived worthlessness). What limited research we have on unique risk for younger children, shows that five to 11-year-olds who died by suicide were more commonly boys, Black, had conflicts with family members and friends, and were more likely to have attention-deficit/hyperactivity disorder (ADHD).  To extrapolate, impulsivity and aggression place young children at risk for failing to adapt or find a “place” in school and within a prosocial peer network which can lead to depression, withdrawal, and anger. The accumulated losses resulting from these negative relationships and further disengagement from the socializing agents of parents, school, and prosocial peers can lead to increased risk for impulsive actions in the form of suicide. 

What can we do?  

1. Ask!

It’s critical to screen children for suicidal thoughts and behaviors. Talking about suicide not only reduces the stigma, but also can be a relief for someone who is experiencing suicidal thoughts. We also want to assess and understand the presence of risk factors including impulsivity, sadness, irritability, worthlessness, aggression, and conflict in relationships. Ask how children are doing coping with social and academic stresses. 

2. Provide resources.

Many excellent websites provide education and support, including: 

Effective Child Therapy – The Society of Clinical Child & Adolescent Psychology 

Children’s Mental Health – Association for Behavioral and Cognitive Therapies 

Home | AFSP 

Suicide Resource Center (aacap.org) 

3. Encourage safe homes.

Childproofing must not end after toddlerhood, as limiting access to lethal means is an important risk mitigation strategy. Families should be encouraged to keep medication, including over the counter medicine, locked away. Firearms are best stored out of the home. Children are at an increased risk for suicide when there is a gun in the home. 

4. Support the expansion of high-quality mental health care.

Mental health is an essential part of overall health. When the opportunity presents, advocate for the inclusion of mental health services within your care model. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.