Rates of attempted suicide by self-poisoning among U.S. adolescents and young adults have more than doubled in the past decade. Among girls and young women, rates nearly tripled during that period.
That's according to a retrospective study(www.jpeds.com) from Nationwide Children's Hospital in Columbus, Ohio, and the Central Ohio Poison Center that was published online May 1 in The Journal of Pediatrics.
Study Methodology and Results
Researchers reviewed intentional suspected-suicide self-poisoning cases reported to the National Poison Data System by U.S. poison centers from 2000 to 2018 for patients ages 10-24. To compare annual rates, population data by year of age were obtained from the U.S. Census Bureau.
The study evaluated changes in annual incidence, annual rate per 100,000 population, and medical outcome by patient age and sex.
- Rates of attempted suicide by self-poisoning among U.S. adolescents and young adults have more than doubled in the past decade.
- Researchers reviewed intentional suspected-suicide self-poisoning cases reported to the National Poison Data System by U.S. poison centers from 2000 through 2018 for patients ages 10-24.
- During the 19-year study period, more than 1.6 million intentional suspected-suicide self-poisoning cases in youth and young adults were reported to U.S. poison centers; strikingly, more than 71% of those cases were among females.
During the 19-year study period, more than 1.6 million intentional suspected-suicide self-poisoning cases in youth and young adults were reported to U.S. poison centers. Strikingly, more than 71% of those cases were among females.
Among all age groups during the entire study period, a significant increase of 3.4% per year in the number of intentional suicide patients was seen.
Further breaking down those figures by temporal, age and sex trends, from 2000 to 2010, a 1.9% annual increase in the number of intentional suspected-suicide patients was seen, followed by a 3.9% annual increase from 2011 to 2018. This increase occurred disproportionately in children and teens ages 10-18 years and among females.
"The severity of outcomes in adolescents has also increased, especially in 10- to 15-year-olds," said study co-author Henry Spiller, M.S., director of the Central Ohio Poison Center at Nationwide Children's Hospital, in a news release.(www.nationwidechildrens.org) "In youth overall, from 2010 to 2018, there was a 141% increase in attempts by self-poisoning reported to U.S. poison centers, which is concerning."
According to the study, previous research has shown that suicide is the second leading cause of death among young people ages 10-24. And although males die by suicide more frequently than females, females attempt suicide more than males.
Self-poisoning is the leading cause of suicide attempts in general and the third leading cause of suicide in adolescents, with higher rates for both variables among females, the study said.
"Suicide in children under 12 years of age is still rare, but suicidal thoughts and attempts in this younger age group do occur, as these data show," said co-author John Ackerman, Ph.D., clinical psychologist and suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children's Hospital, in the release.
"While certainly unsettling, it's important that parents and individuals who care for youth don't panic at these findings, but rather equip themselves with the tools to start important conversations and engage in prevention strategies, such as safe storage of medications and reducing access to lethal means," he added. "There are many resources and crisis supports available around the clock to aid in the prevention of suicide, and suicide prevention needs to start early."
Experts with the hospital's Big Lots Behavioral Health Services unit recommend parents check in regularly with their children, ask them directly how they are doing and whether they have ever had thoughts about ending their life, the release noted. Asking these direct questions is even more critical if parents see warning signs of suicide in their children.
"There is no need to wait until there is a major crisis to talk about a plan to manage emotional distress," said Ackerman. "Actually, a good time to talk directly about suicide or mental health is when things are going well."
A good starting point for parents to open and maintain this dialogue is OnOurSleeves.org,(www.nationwidechildrens.org) a resource Nationwide Children's Hospital launched last year to help families begin this important conversation, he added.
Family Physician's Perspective
Family physician Kathleen Eubanks-Meng, D.O., of Lee's Summit, Mo., told AAFP News that as social media, video and cellphone cameras have become more accessible to adolescents, suicide attempts in this population have spiked.
"Unfortunately, for adolescents today, something they said without thinking or a bad outfit choice, haircut or just figuring out how to live in their own skin is then displayed on the internet," she said. "It's not simply forgotten the next day at school, and they are no longer safe at home from their mistake or misgiving of the day. It's on the internet forever to be seen over and over by not only their close friend group, but also a significantly larger population that is worldwide."
Help for Patients
It's important for family physicians to remind parents and adolescents that in the event immediate help is needed to quell suicidal thoughts, they should go to the ER and contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Crisis Text Line by texting "START" to 741-741.
If it's suspected that an overdose has already occurred, call the Poison Help hotline at 1-800-222-1222 to connect to a local poison center.
As to why adolescents are more susceptible to depression and the risk of suicide, Eubanks-Meng said their brains are still developing and impulse control is limited, with the frontal lobe not fully mature until about age 25.
"Their ability to process and consider actions and reactions to what they are seeing and feeling is unable to 'keep up' at the rate it is being delivered to their brain," she explained. "Adolescents also lack the ability to see beyond the immediacy of their current situation and place in time. The future is the 'here and now.'"
Additionally, Eubanks-Meng said today's society can be isolating, and interactions with others often happen through a screen, adding to adolescents' susceptibility to and risk for suicide.
Tips for Physicians and Patients
Eubanks-Meng said family physicians need to drive home the importance of parents talking with their kids.
"Parents need to keep open lines of communication at all times," she said. "Be sure they have adults in their life that also mentor them, such as a pastor at church, school counselor, teacher, coach, or an aunt or uncle. Sometimes our teens don't want to talk to their parent, but they will talk to a trusted adult."
Parents also need to be reminded to fully educate themselves on the signs of depression, anxiety and suicide, she added.
"Often, teens will display these signs differently than adults," Eubanks-Meng said. "Parents need to know what social media and apps are on their teen's cell phone, know how to use them and have access to them."
As a reminder, the U.S. Preventive Services Task Force's current recommendation on screening for suicide,(www.uspreventiveservicestaskforce.org) including in adolescents, says that current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in primary care settings. However, the USPSTF does recommend screening for major depressive disorder in adolescents ages 12-18.(www.uspreventiveservicestaskforce.org)
If patients exhibit signs of depression, anxiety and suicide, Eubanks-Meng recommends using screening tools such as Patient Health Questionnaire-2 and Patient Health Questionnaire-9, which can serve as conversation starters with teens.
"Family physicians should ask questions regarding their hobbies or what they enjoy doing most," she said. "Also asking their feelings about school and their activities can be insightful."
Finally, Eubanks-Meng said family physicians cannot be afraid to ask tough questions or to broach the topics of depression, anxiety and suicide with these young patients.
"Our well-child visits are perfect opportunities to open up conversations with our patients and their parents," she said. "Staff training on how to recognize the signs of depression, anxiety and suicide are also helpful and may save a life."
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