There has been a 53-per-cent increase in the number of CHEO emergency department mental health visits in the past four years in which suicidal ideation or suicide attempt was the primary diagnosis.
The 2014-18 CHEO figures, released upon a request from this newspaper, come in the wake of an eye-opening study by Canadian researchers that found annual visits in U.S. emergency rooms for suicidal thoughts and suicide attempts among children aged five to 18 almost doubled between 2007 and 2015, from 580,000 to 1.12 million.
“We’re seeing a significant increase in suicidal behaviour since 2014. Everyone is wondering why the rates of ideation (suicidal thoughts) and behaviour are increasing,” said CHEO psychologist Dr. Allison Kennedy, clinical lead in urgent care and crisis intervention and a professor in clinical psychology at the University of Ottawa.
“A single suicide attempt is the strongest predictor of future completed suicide,” said Dr. Brett Burstein, a pediatric emergency room physician at Montreal Children’s Hospital and the co-author of the study, published last week.
Burstein and his colleagues sampled 300 U.S. emergency rooms, analyzing public health data from the Centers for Disease Control and Prevention. One of the most disturbing findings was that 43 per cent of the children taken to the emergency room were between the ages of five and 12, said Burstein. (There was no age-based data available from CHEO.)
Comparable national Canadian data isn’t available, said Burstein. However, he noted that at Montreal Children’s Hospital, there has been a 55-per-cent increase in suicidal behaviour between 2015 and 2018. That’s only three years and shows a rise that is faster than what was reported in the U.S. study, which covered eight years.
As to why it’s happening, there are number of theories, including time teens spend on social media, said Kennedy. Teens are spending more time in their rooms and less time interacting with family, even if they are at home.
“It contributes to disconnection,” she said. “They’re sleeping more poorly. Any peer issues at school are following them home. If you’re being bullied at school, you’re not getting a break.”
Teens and their parents are also more aware of mental health issues. “People want make sure that when a teen is in distress, they get the help they need,” said Kennedy.
Suicide is the second-most common cause of death among Canadian adolescents, behind accidents.
Canada was one of five countries with the highest teenage suicide rates in 2015 — more than 10 for every 1000,000 teens, according to report by the O’Brien Institute for Public Health at the University of Calgary, released last year by Children First Canada.
A 2016 survey conducted by Kids Help Phone found that 22 per cent of teens between the ages of 13 and 18 had considered suicide in the past 12 months.
Burstein doesn’t believe that increased recognition of mental health issues is the primary driver behind the numbers. Fewer than 13 per cent of the children in the U.S. study arrived in the emergency room for isolated suicidal thoughts. Most of the children — 87 per cent — were presenting in the wake of a suicidal gesture or attempt. It suggests there’s an actual increasing burden of mental health problems among children, he said.
In view of this, there’s good news from the CHEO numbers: most of the increase was attributed to increasing rates of suicidal thoughts. The number of emergency department visits in which suicide attempt was identified as the primary diagnosis has remained fairly stable, said Kennedy.
The numbers show there’s a need for more community-based mental health resources as well as emergency department preparedness — especially among non-pediatric hospitals — and risk reduction interventions after the patient leaves the emergency department, said Burstein. “Community and general emergency departments are not resourced to give these children the comprehensive assessments and followup they need for optimal care.”
Parents can help by being watchful, said Kennedy. Signs that a teen is having difficulties include problems sleeping or eating, academic difficulties and spending less time with friends. Encourage your teen to spend less time isolated in their room and more time interacting with family and friends.
“Conversations with teens involve mostly listening. Avoid giving advice,” she said.
Insist that your teen shut down their cellphone at night. “A good night’s sleep means good mental health,” said Kennedy.
If you suspect your teen is thinking about suicide, ask him or her. “Asking questions won’t prompt a suicide.”
Crisis lines are also an excellent way to get immediate help, she said. Among the options:
• The Youth Services Bureau’s 24/7 Crisis Line, 613-260-2360 or toll-free 1-877-377-7775. Online chat is at chat.ysb.ca
• Mental Health Crisis Line, 613-722-6914 or toll-free 1-866-996-0991
• Kid’s Help Phone is 1-800-668-6868 or Text CONNECT to 686868. There is also a live chat option.
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