You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

CME / ABIM MOC / CE

Are Suicide Attempts in Early Adolescents on the Rise?

  • Authors: News Author: Marcus A. Banks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 4/15/2022
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 4/15/2023, 11:59 PM EST
Start Activity


Target Audience and Goal Statement

This activity is intended for primary care physicians, pediatricians, psychiatrists, nurses, and other members of the health care team who treat and manage children and adolescents.

The goal of this activity is for learners to be able to describe trends in suicidal ingestions among children and adolescents.

Upon completion of this activity, participants will:

  • Analyze the effect of social media and other screen time on depression symptoms among US adolescents
  • Evaluate trends in the rates of suicidal ingestion among children and adolescents in the US
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Marcus A. Banks

    Freelance writer, Medscape

    Disclosures

    Disclosure: Marcus A. Banks has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline; Johnson & Johnson

Editor/Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Yaisanet Oyola, MD, has 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.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements

Medscape

Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

IPCE

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

    For Nurses

  • Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

Are Suicide Attempts in Early Adolescents on the Rise?

Authors: News Author: Marcus A. Banks; CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 4/15/2022

Valid for credit through: 4/15/2023, 11:59 PM EST

processing....

Clinical Context

Rates of depressive symptoms among children and adolescents have increased during the COVID-19 pandemic, but the pandemic may have only accelerated a previous trend toward higher rates of depression among young people. Boers and colleagues evaluated how the use of social media and other screen time could be contributing to this problem, and their study results were published in the September 2019 issue of JAMA Pediatrics.[1]

Researchers performed a secondary analysis of a randomized clinical trial of interventions focused on the prevention of drug and alcohol use among 3826 adolescents. In both between-person and within-person analyses during the 4-year study period, each additional hour of social media use was associated with a significant increase in depression symptoms. This result was statistically significant and was mirrored in a within-person analysis of television viewing. The study analysis suggested that there was a causative effect of social media and television use and depression symptoms, as opposed to an effect of screen time eliminating time for healthy behaviors such as exercise.

Although multiple studies have tracked trends in depression symptoms among children and adolescents, there is less research on the issue of suicidality in this group. The current study addresses this question.

Study Synopsis and Perspective

Suicide attempts spurring calls to poison control centers more than quadrupled among US children aged 10 to 12 years from 2000 to 2020, according to research published online March 14 in JAMA Pediatrics.[2]

For all children older than 9 years, the proportion of suicide attempts increased as misuse or abuse of potentially poisonous substances declined. Only very young children (aged 6-9 years) saw no increase in suicide attempts, the study found.

"It's a huge problem we're seeing in emergency departments [EDs]. It's exponentially blowing up numbers across the nation," said David Sheridan, MD, an ED pediatric physician at the Oregon Health and Science University, in Portland, who led the study.

Adolescents or preteenagers who have attempted suicide can sit in EDs "for days or weeks" as they wait to be placed elsewhere in the hospital or an outpatient facility, Dr Sheridan told Medscape Medical News. The delays not only are unpleasant for the children, he said, but they also strain hospitals by leaving less space available for emergency care.

"It's really tough on the entire healthcare system, and most importantly, it's really rough on the families who are going through a crisis," Dr Sheridan said. He noted that young people often attempt suicide by taking excessive quantities of common over-the-counter products found in many medicine cabinets (acetaminophen, ibuprofen, diphenhydramine), not items marked "poison."

Twenty-Year Trend

The researchers examined calls from 2000 to 2020 recorded in the National Poison Data System, which is maintained by the American Association of Poison Control Centers. Of more than 1.2 million total calls, 854,000 involved girls. A poison control data analyst determined whether the call involved attempted suicide or deliberate misuse/abuse of a potentially poisonous substance.

The researchers identified 1005 deaths, and nearly 29% of ingestions led to health outcomes that were considered worse than minor.

During the 20-year period, more than 90% of the calls involved children aged at least 13 years, with approximately 72,000 (5.7%) pertaining to children aged 10 to 12 years. Most calls for children aged 13 years and older were for suicide attempts. Suspected suicide attempts accounted for about 50% of the total calls to poison control centers among children aged 10 to 12 years in 2000, a figure that had ballooned to 80% by 2020, according to the researchers.

Dr Sheridan said that because both the frequency and the proportion of calls related to suicide attempts rose among children aged 10 to 12 years, by 2020, poison control centers were fielding 4.5 times as many suicide-related calls among persons of this age group as they had in 2000. This jump was the largest such increase for any age group in the study, he noted.

The reasons for such a large rise among preadolescents are unclear, the researchers note. The increase became apparent around 2013, at the time many popular social networks launched. Dr Sheridan's group cited studies showing an association between increased time on social networks or watching television and depression in adolescence, but said that further research is needed to understand the root causes of this increase.

The latest study did not specifically look at the effect of the COVID-19 pandemic on suicide among young people. The Centers for Disease Control and Prevention reported a sharp rise in suicide attempts among youth during the early months of the pandemic, especially among girls aged 12 to 17 years.[3] By February 2021 suicide attempts within this group had climbed by 50.6% compared with 2 years earlier.

Although suicide attempts are concerning enough, successful attempts are even more worrisome, experts said. "The increase in the rate of suicidal ingestion among 10- to 12-year-olds vs 13- to 18-year-olds is consistent with youth suicide mortality trends between 2010 and 2020," Jeff Bridge, PhD, an epidemiologist at Nationwide Children's Hospital, Columbus, Ohio, told Medscape Medical News. From 2010 to 2020, suicide rates increased by 50% among 13- to 18-year-olds, Dr Bridge said, and more than doubled in children aged 10 to 12 years.

The latest study captured only calls to poison control centers and so did not count suicide attempts that did not result in a call for help. Another limitation is that poison control data are not stratified by race or ethnicity, prompting Bridge to urge researchers to look specifically at the effect of race and ethnicity on these trends.

"This study supports screening for suicide risk as young as 10 years old," Dr Bridge, who recently coauthored an article about improving suicide screening among pediatric primary care physicians, told Medscape Medical News.[4]

Dr Sheridan said he agreed that prevention is essential: "The ER is where kids come when they're in crisis. Trying to be more preventative by diagnosing or picking up on this earlier, I think, is really important."

Sheridan and Bridges have disclosed no relevant financial relationships.

JAMA Pediatrics. Published online March 14, 2022.

Study Highlights

  • Study data were drawn from the US National Poison Data System between 2000 and 2020. Researchers evaluated all cases of ingestion among patients between the ages of 6 and 18 years.
  • Researchers focused on cases with the following labels: intentional, suspected suicide; intentional misuse; and intentional abuse.
  • There were 1,256,963 cases of ingestions recorded: 68% of cases were female and the mean age of subjects was 15.3 years.
  • 73.8% of ingestions were considered to be suspicious for suicide attempt. Health outcomes for ingestions included in the study were as follows:
    • No effect: 31.4%
    • Minor effect: 39.9%
    • Moderate effect: 25.7%
    • Major effect: 2.9%
    • Death: 0.1% (1005 subjects overall)
  • Misuse and abuse ingestions remained stable during the 20-year study period. In contrast, there was a dramatic overall increase in suicidal ingestions.
  • The increase in suicidal ingestions was fairly stable over time among children between 6 and 9 years of age, but it increased most dramatically among children between the ages of 10 and 12 years (4.5 times increase during the study period). The increase in suicidal ingestions among adolescents over time was smaller (2.4 times increase during the study period).
  • The authors of the current study note that their data underestimate the number of suicidal ingestions among children and adolescents, as many cases are not reported to the National Poison Data System.

Clinical Implications

  • In a previous study, the use of social media and watching television were both associated with higher rates of depression symptoms among adolescents. The study analysis suggested that there was a causative effect of social media and television use and depression symptoms, as opposed to an effect of screen time eliminating time for healthy behaviors such as exercise.
  • In the current study, the rate of suicidal ingestions increased among children and adolescents between 2000 and 2020, led by a strong increase among children between 10 and 12 years of age.
  • Implications for the healthcare team: The healthcare team should monitor for symptoms of depression and suicidality among preadolescents since the number of suicidal ingestions among children and adolescents is underestimated, study data between 2000 and 2020 found that many cases are not reported to the National Poison Data System.

 

Earn Credit

  • Print