WASHINGTON (Sinclair Broadcast Group) — The Centers for Disease Control and Prevention reported an alarming increase in the number of suicide attempts by adolescent girls during the pandemic.
Between February and March 2021, the number of emergency department visits for presumed suicide attempts was 50.6% higher among girls aged 12-17 compared to the same period in 2019.
Suicide attempts for boys rose 3.6% during the early months of 2021, remaining relatively unchanged from pre-pandemic rates, according to the CDC study, published Friday. Suspected suicide attempts for young adults aged 18–25 years also remained relatively stable.
Emergency department mental health visits were up 31% among adolescents during the same period, driven by higher incidents of crises among young girls.
The data is another piece of the picture showing how much youth have been affected by the pandemic, mentally and emotionally. It also likely underrepresented the true prevalence of suicide attempts among young people, according to researchers. That's because many people avoided medical settings during the pandemic and children with less severe injuries may have been less likely to seek emergency care.
While troubling, the increase in attempted suicides follows a pattern of adolescent girls attempting suicide almost twice as often as males. At the worst point in the winter of 2021, females were attempting suicide at over four times the rate of young males.
The authors of the study did not explain why girls were disproportionately impacted. "However, the findings from this study suggest 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 wrote.
Even before COVID-19 hit, suicide attempts and self-harm behavior among middle and high school-aged girls had been rising. "It's not something that began with the pandemic but it may be something that's been exacerbated by the pandemic," said Dr. Richard McKeon, the branch chief for suicide prevention at the Substance Abuse and Mental Health Services Administration (SAMHSA).
Overall suicide rates for young people between 10 to 24 years old increased 57% over the last decade, according to the latest CDC data. Suicide remains the second leading cause of death for 10 to 18-year-olds and the single leading cause of death for youth between 13 and 15.
Youth reported high rates of depression and anxiety in 2019, noted Richard Lieberman, head of the suicide prevention unit for the Los Angeles Unified School District and former chair of a National Association of School Psychologists crisis response team. "Their mental health was fragile going into this period," he said.
The CDC acknowledged that young people were likely at higher risk of suicidal behavior because of the effects of pandemic mitigation measures, though researchers did not draw a causal connection between the pandemic and increased suicidality. Physical distancing and school closures limited connections to teachers and peers. Barriers to accessing mental health treatment, increased substance use, potential rise in child abuse and anxiety about family health and economic problems also increased vulnerabilities.
It's also possible that parents were more responsive to changes in their children after spending more time at home together, making them more likely to bring them to the emergency department.
"There's no one cause of suicide," Lieberman emphasized. It usually takes a combination of at least eight different risk factors coming together in a "perfect storm," he continued. That can include chronic factors, like depression, mental illness, substance abuse or a previous suicide attempt. There are also acute factors, like a sudden loss or other life stressors.
"As COVID descended upon the nation and we moved to remote learning, I could just see the components of the storm brewing," Lieberman said.
Studies throughout the pandemic showed higher rates of adverse mental health outcomes among young people, including depression, anxiety and suicidal thoughts. There have also been anecdotal reports of self-harm behavior, eating disorders, technology addictions and obsessive-compulsive behaviors increasing among children during the pandemic.
Suicide attempts initially fell during the early months of the pandemic and first lockdown, supporting research that populations experiencing mass trauma are typically resilient. As the pandemic dragged on, more people reported mental health problems, particularly young adults. Parents shared the tragic stories of losing children as young as 9 to suicide.
That may be a testament to suicide prevention efforts by federal, state and local organizations. The 2020 CARES Act allocated $50 million for suicide prevention out of a $450 million relief package for mental health and substance abuse treatment. The 2021 American Rescue Plan added another $2.5 billion to deal with the nation's addiction and mental health crises.
Part of the funding went toward expanding chat and text options for the National Suicide Prevention Lifeline, which are used disproportionately by youth and young adults. "To prevent youth suicide, to prevent youth suicide attempts, we have to focus on providing help to kids in the way that they want to be helped or in the way they are willing to ask for help," McKeon said.
Mental health experts are looking ahead to the start of the fall school year with cautious optimism. On the one hand, most students will be returning to in-person learning with peers five days a week. Many afterschool activities will resume and most older students will have access to the vaccine. However, that doesn't mean things will snap back to pre-pandemic norms.
Despite the increase in attempts, the CDC has not seen an increase in adolescent suicide deaths. According to preliminary data, adolescent suicides appeared to be mostly unchanged from 2019. The number of Americans who took their lives reportedly fell by 6% in 202, defying expectations. If the preliminary figures hold, the U.S. could be on track for the largest annual decline in suicide deaths in at least four decades.
"We're going into another transition," explained Ben Fernandez, the lead school psychologist for Loudoun County Public Schools in Northern Virginia. After the adjustment to remote learning and the readjustment to hybrid classes, getting back to fully in-person classes will be another shift. Parents and educators should watch for traumas that may have gone unnoticed over the last year suddenly emerging.
"It's easy when a kid has a broken arm because you can see it. With trauma, with grief, with some of the other mental health concerns, you don't always see it until it reveals itself," Fernandez noted. "I think there are going to be a lot of issues that come to the surface that we didn't know about prior."
It's likely that the mental health effects will outlast the pandemic. The improved conditions and lifting of COVID-19 restrictions have not led to any immediate reduction in the prevalence of depression and other measures of mental health. A study by the COVID States Project, a consortium of university researchers, found that reported rates of depression, generalized anxiety and suicidal thoughts remained roughly the same in May as they were in December 2020. The rates of depression were roughly three times as high as pre-pandemic.
The spike in youth suicide attempts was rising before the pandemic and is not likely to go away on its own. The pandemic may have even exacerbated the existing trend.
There is good news, though. "One, suicide is preventable. And everybody plays a role in suicide prevention," Lieberman noted. There is also evidence-based treatment for every risk factor that leads a young person to consider suicide and there are school and community resources to help reach young people.
"I am the eternal optimist. I'm hopeful that kids are resilient and they can get better," said Lieberman.
To get help for yourself or someone you care about, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Or chat with someone at suicidepreventionlifeline.org.