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CME / ABIM MOC / CE

Did COVID-19 Cause Spike in Attempted Suicide in Teen Girls?

  • Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 7/23/2021
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 7/23/2022, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for psychiatrists, infectious disease clinicians, emergency medicine clinicians, adolescent medicine clinicians, internists, nurses, pharmacists and other members of the healthcare team who care for teen girls who may be at increased risk for suicide attempts (SAs) related to the COVID-19 pandemic.

The goal of this activity is to describe trends in emergency department (ED) visits for suspected SAs during January 1, 2019 to May 15, 2021, among persons aged 12 to 25 years, by sex, and at 3 distinct phases of the COVID-19 pandemic, according to an analysis of data from the National Syndromic Surveillance Program (NSSP) by the Centers for Disease Control and Prevention (CDC).

Upon completion of this activity, participants will:

  • Describe trends in ED visits for suspected SAs during January 1, 2019 to May 15, 2021, among persons aged 12 to 25 years, by sex, and at 3 distinct phases of the COVID-19 pandemic, according to an analysis of NSSP data by the CDC
  • Determine clinical and public health implications of trends in ED visits for suspected SAs during January 1, 2019 to May 15, 2021, among persons aged 12 to 25 years, by sex, and at 3 distinct phases of the COVID-19 pandemic, according to an analysis of NSSP data by the CDC
  • Outline implications for the healthcare team


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


News Author

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Disclosure: Megan Brooks has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor/CME Reviewer

  • Esther Nyarko, PharmD

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.


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CME / ABIM MOC / CE

Did COVID-19 Cause Spike in Attempted Suicide in Teen Girls?

Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 7/23/2021

Valid for credit through: 7/23/2022, 11:59 PM EST

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The proportion of mental health-related emergency department (ED) visits among adolescents aged 12 to 17 years increased 31% from 2019 to 2020. In June 2020, 25% of surveyed adults aged 18 to 24 years reported pandemic-related suicidal ideation in the past 30 days.

Study Synopsis and Perspective

Suspected suicide attempts (SAs) by teenaged girls have increased significantly during the COVID-19 pandemic, according to data released today by the Centers for Disease Control and Prevention (CDC).

Among children and adolescents aged 12 to 17 years, the average weekly number of ED visits for suspected SAs was 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding periods in 2019.

The increase was most evident among young girls.

Between February 21 and March 20, 2021, the number of ED visits for suspected SAs was about 51% higher among girls aged 12 to 17 years than during the same period in 2019. Among boys aged 12 to 17 years, ED visits for suspected SAs increased 4%, the CDC reported.

"Young persons might represent a group at high risk because they might have been particularly affected by mitigation measures, such as physical distancing (including a lack of connectedness to schools, teachers, and peers); barriers to mental health treatment; increases in substance use; and anxiety about family health and economic problems, which are all risk factors for suicide," wrote the authors, led by Ellen Yard, PhD, with the CDC's National Center for Injury Prevention and Control.

In addition, the findings from this study suggest there has been "more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to, and prevention for, this population," they pointed out.

The results were published June 11 in Morbidity and Mortality Weekly Report.[1]

The findings are based on data for ED visits for suspected suicide from the National Syndromic Surveillance Program (NSSP), which includes about 71% of the nation's EDs in 49 states (all except Hawaii) and the District of Columbia.

Earlier data reported by the CDC showed that the proportion of mental health-related ED visits among children and adolescents aged 12 to 17 years increased by 31% during 2020 compared with 2019.

"Time for Action Is Now"

These new findings underscore the "enormous impact the COVID-19 pandemic is having on our country's overall emotional well-being, especially among young people," the National Action Alliance for Suicide Prevention (Action Alliance) Media Messaging Work Group said in a statement responding to the newly released data.

"Just as we have taken steps to protect our physical health throughout the pandemic, we must also take steps to protect our mental and emotional health," the group said.

The data, the group said, specifically speak to the importance of improving suicide care both during and after ED visits by scaling up the adoption of best practices, such as the "Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe"[2] and "Best Practices in Care Transitions for Individuals with Suicide Risk: Inpatient Care to Outpatient Care."[3]

"These and other evidence-based best practices must be adopted by health care systems nationwide to ensure safe, effective suicide care for all," the group said.

"However, health care systems cannot address this issue alone. Suicide is a complex public health issue that also requires a comprehensive, community-based approach to addressing it. We must ensure suicide prevention is infused into a variety of community-based settings -- such as schools, workplaces, and places of worship -- to ensure people are connected with prevention activities and resources before a crisis occurs," the group said.

It also highlights the crucial role of social connectedness as a protective factor against suicide.

"Research indicates that a sense of belonging and social connectedness improves physical, mental, and emotional well-being. Everyone can play a role in being there for each other and helping to build resiliency. Having real, honest conversations about our own mental health opens the door for connection and social support," the group said.

It calls on leaders from all sectors and industries to make suicide prevention "a national priority by becoming engaged in the issue and bringing resources to bear. The time for action is now."

Study Highlights

  • Using NSSP data, the CDC examined trends during January 1, 2019 to May 15, 2021 in ED visits for suspected SAs among persons aged 12 to 25 years.
  • These were identified using a combination of chief complaint terms and administrative discharge diagnosis codes and therefore included some nonsuicidal self-harm visits.
  • Persons aged 12 to 25 years had fewer ED visits during March 29 to April 25 for suspected SAs in 2020 than in 2019.
  • By early May 2020, ED visits for suspected SAs began increasing among adolescents aged 12 to 17 years, especially girls.
  • Among adolescents aged 12 to 17 years, mean weekly ED visits for suspected SAs were 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding 2019 periods, particularly among girls.
  • Mean weekly number of ED visits during July 26 to August 22 for suspected SAs among girls aged 12 to 17 years was 26.2% higher in 2020 than in 2019.
  • Mean weekly ED visits during February 21 to March 20 for suspected SAs among girls aged 12 to 17 years were 50.6% higher in 2021 than in 2019; among boys, these increased 3.7%.
  • Rate of ED visits for suspected SAs among adolescents aged 12 to 17 years increased as the pandemic progressed; 2.4-fold higher during spring 2020; 1.7-fold higher during summer 2020; and 2.1-fold higher during winter 2021 than in 2019 seasons, driven largely by female persons.
  • Among adults aged 18 to 25 years, the ED visit rate for suspected SAs was higher throughout the pandemic than during 2019 (1.6-fold higher during spring 2020, 1.1-fold higher during summer 2020, and 1.3-fold higher during winter 2021).
  • The investigators concluded that suicide prevention measures targeting young persons call for a comprehensive approach, supporting persons from becoming suicidal as well as persons who are at increased risk for suicide, which should be adapted during times of infrastructure disruption.
  • This involves multisectoral partnerships (eg, public health, mental health, schools, and families) and implementing evidence-based strategies addressing the range of factors affecting suicide risk.
  • Strategies specific to young persons include preventing and mitigating adverse childhood experiences, strengthening family economic supports, safe medication and firearm storage, training community and school staff members and others to learn the signs of suicide risk and appropriate response, improving access and delivery of evidence-based care, increasing young persons’ social connectedness and coping skills, and providing safe messaging by media and in schools after a suicide.
  • The difference in suspected SAs by sex and the increase in suspected SAs among young persons, especially adolescent female persons, is consistent with previous research.
  • The current findings suggest more severe distress among young female persons during the pandemic than identified previously, reinforcing the need for increased attention to, and prevention for, this population.
  • Despite increases in ED visits for suspected SAs among adolescent female persons during 2020 and early 2021, suicide deaths have not increased.
  • Provisional mortality data showed an overall decrease in age-adjusted suicide rate from July to September 2019 to July to September 2020, and no significant change in suicide rate among persons aged 15 to 24 years during this same period.
  • Future analyses should clarify these provisional rates by age, sex, race, ethnicity, and geographic setting.
  • Young persons may be at high risk because of being particularly affected by mitigation measures, including physical distancing with less connectedness to schools, teachers, and peers; barriers to mental health treatment; increased substance use; and anxiety about family health and economic problems.
  • Average ED visit rates for mental health concerns and suspected child abuse and neglect, also risk factors for SAs, also increased from 2019 to 2020.
  • Conversely, adults spending more time at home together with young persons may have become more aware of suicidal thoughts and behaviors and therefore more likely to take their children to the ED.
  • Study limitations include unavailability of national level NSSP race and ethnicity data; data not nationally representative; and likely underestimation of the true prevalence of suspected SAs.

Clinical Implications

  • Suicide attempts by teen girls increased during the COVID-19 pandemic.
  • These findings mandate increased attention and prevention in this population, using a comprehensive approach involving multisectoral partnerships.
  • Implications for the Healthcare Team: Young persons may potentially be at higher risk for suicide attempts due to the affect COVID-19 mitigation measures had on social interactions. Healthcare professionals should utilize multisectoral partnerships (eg, public health, mental health, schools, and families) and implement evidence-based strategies to address the range of factors affecting suicide risk in teens.

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