|
Abstract
|
This is a commentary to: Brewer AG, Doss WD, Sheehan KM, Davis MM, Feinglass J. Trends in suicidal ideation-related emergency department visits for youth in Illinois: 2016–2021. Pediatrics. 2022;150(6):e2022056793
In 2020, 23% of all youth deaths aged 5 to 19 in the United States were by suicide, a preventable cause of death.1 Youth emergency department (ED) visits for suicidal ideation (SI) represent a critical benchmark for youth mental health. In this issue of Pediatrics, Brewer et al present new findings on increasing trends in SI-related ED visits for youth in Illinois, 2016 to 2021.2 The design allowed for pinpointing changes over time, including the first 14 months of the COVID-19 pandemic. Visit rates were divided into 22-month periods. Rates during fall months were analyzed to control for temporal variations before and during the pandemic. The sharpest increase was seen in fall 2019, before the start of the pandemic, followed by an even larger spike during fall 2020. Was it the pandemic that exacerbated the increase or is this a growing trend? These rising rates underscore the worsening mental health crisis for youth, as noted by the 2022 Surgeon General report and several youth mental health organizations.
Brewer et al examined over 80 000 ED visits coded for SI, of which 24.6% resulted in hospitalization. Youth aged 14 to 17 years had the highest increase in SI-related ED visits of any age group. Notably, 5- to 13-year-old youths had SI-related ED visit rates comparable to 18- to 19-year-old youths, who typically have higher rates. Overall, increases were higher for females. Over one-half of youth with SI-related visits were uninsured or on Medicaid and had significantly lower likelihood of hospitalization than privately-insured youth, suggesting that insurance status influences mental health care of patients at risk for suicide. The largest difference in hospitalization was for youth with a primary diagnosis of SI who were 84% less likely to be hospitalized than those presenting with serious mental illness, depression, anxiety, or substance use.
What are public health prevention measures that can make a difference in lowering ED visits for SI in youth? An influx of acute mental-health–related visits can impose burdens on patients and their families and disrupt efficient ED flow. If one-quarter of patients who visit the ED for mental health reasons are being hospitalized, interventions are needed that focus on safe transitions from inpatient hospitalization back to the community, to prevent return visits to the ED.5 Furthermore, ED interventions like safety planning,6 lethal means counseling,7 and family-centered interventions8,9 might even reduce the likelihood of hospitalization. Research is needed to better understand the underlying reasons for higher hospitalizations rates on weekends. Previous studies have suggested lack of coverage and lower quality of care for higher acuity patients with weekend ED visits …
Language: en |