Children’s suicide-related emergency visits spiked by 74% in the US between 2016-2022

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Children's suicide-related emergency visits spiked by 74% in the US between 2016-2022

Half occurred in hospitals that often lack specialized resources to care for kids in mental health crises

• Study represented more than 5 million emergency visits for mental health concerns
• Authors stress all EDs need additional training, access to pediatric mental health professionals, and should universally screen all children for risk of suicide
• EDs can access free toolkits to help care for children with mental health needs

CHICAGO --- Emergency visits by children with suicide-related crises increased by 74% between 2016 and 2022, according to a new study from scientists at Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago.

The study represented more than 5 million emergency department (ED) visits for mental health concerns by U.S. children in the six-year period. About half of suicide-related ED visits - and half of all children's mental health ED visits - occurred in hospitals with lower pediatric volume (under 10,000 annually). A child experiencing a mental health crisis may arrive at any emergency department, and many are not prepared to care for children with acute mental health needs, the study authors said.

"Our findings underscore the need to equip every ED - not only large pediatric centers - with tools and resources to provide evidence-based mental health care," said corresponding author Dr. Audrey Brewer, assistant professor of advanced pediatrics and primary care at Northwestern University Feinberg School of Medicine. "Strengthening mental and behavioral health capacity across all emergency care settings is essential to ensuring children receive timely, effective and equitable care."

The study was published Sept. 3 in Annals of Emergency Medicine.

Brewer, who also is a pediatrician and researcher at Lurie Children's, stressed that all EDs need additional training and access to pediatric mental health professionals, either onsite or via telehealth, as well as linkage to follow-up care. Additionally, she said every ED also needs to offer universal suicide screening for children, regardless of if they come in for a mental health concern. And if there are concerns, EDs should provide families with a clear plan to help keep their child safe at home.

The study analyzed ED visits among children ages 5-17 with a primary mental health diagnosis, using the Nationwide Emergency Department Sample database.

Additional findings:

• All pediatric mental health-related ED visits increased by 24% during the study period
• Suicide-related ED visits increased 74% during the study period
• The most frequent mental health diagnosis groups were suicide or self-injury (24%) and depressive disorders (23%)
• Indigenous children were more likely to come to EDs with lower pediatric volume
• Youth with substance use concerns were seen more often at lower pediatric volume EDs
• At EDs with the lowest pediatric volume, close to 30% of children seen for mental health conditions were transferred to other hospitals to receive definitive care

"Transfer to another hospital for pediatric mental health care often means a prolonged wait in the ED, sometimes lasting days, increasing the burden on children and their families," said senior author Dr. Jennifer Hoffmann, assistant professor of pediatric emergency medicine and medical social sciences at Feinberg and a pediatric emergency medicine physician and researcher at Lurie Children's. "Toolkits are readily available to help EDs care for children with mental health needs, especially while kids wait for a transfer to another facility."

Hoffmann said EDs across the country can access the New England Regional Behavioral Health Toolkit, as well as the National Pediatric Readiness Project, to improve the care provided to children, including youth with mental and behavioral health conditions.

"To improve care, ED-based mental health interventions need to be developed and tested for children of color, since many have not been studied in diverse populations," Brewer said. "Delivering culturally responsive, evidence-based interventions for children in the community and outpatient primary care settings can help to potentially lessen ED reliance for mental health care and may help reduce disparities in youth mental health outcomes."

Funding for the study was provided by the National Institute of Mental Health of the National Institutes of Health (grant number K23MH135206).