Screenings Help Identify Kids at Risk for Suicidal Behavior

February 27, 2024

University Hospitals Rainbow Babies & Children'sExperts in Children's Health

A recent analysis found that mental health-related hospital stays among children in the U.S. increased by more than 25 percent between 2009 and 2019. Over 60 percent of those hospitalizations involved suicidal behavior – an increase from around 30 percent in 2009. Mental health hospitalizations also increased significantly in the 11 – 14 age group.

This alarming trend is being seen in hospitals across the country, including here in Ohio, says University Hospitals Chief of Pediatric Emergency Medicine, Charles Macias, MD, MPH. He says the key to helping decrease hospitalizations is identifying mental health problems in children early and getting them the help they need – before a crisis situation develops.

What’s Driving the Increase?

Emergency departments across the country are seeing a steady increase in visits for all types of behavioral health issues, including suicidal ideation and suicide attempts. Suicide has become the second leading cause of death among adolescents, after car accidents.

The root source of the problem is complex, but systemic barriers to care are a big part of what’s driving the increase in mental health hospitalizations, says Dr. Macias. Long wait times to see mental health providers, problems with insurance coverage, and other access issues mean the emergency room is often where parents go when they have nowhere else to turn.

Growing social media use among children and teens has also been cited as a contributor to mental and behavioral health issues. Although the analysis cited above didn’t include data past 2019, the COVID-19 pandemic and the isolationism it spurred may have played a role in the trend continuing, says Dr. Macias.

Who’s at Risk?

There are a number of factors that could put a child at risk for a mental health crisis or suicide attempt. These include underlying anxiety, depression or behavioral health disorders, bullying, past suicide attempts, and drug or alcohol use. Children may also be influenced by other suicide deaths or attempts, especially when it involves a peer or family member. They can be more at risk if they have experienced other trauma in their lives, such as a death in the family or violence.

Identifying At-Risk Children

Screening to identify children who are at risk for suicidal behavior is a key tool in getting them access to appropriate mental healthcare before an emergency situation occurs. Dr. Macias notes that the barriers to care that many parents encounter make early identification all the more important for the well-being of at-risk kids.

“Emergency room visits can’t be the solution,” he says. “We need to go upstream to catch depression early, before it escalates to suicidal ideation.”

The ASQ suicide risk screening tool involves a series of yes-or-no questions to help gauge a child’s immediate and long-term risk for suicidal behavior. The questionnaire can be administered by the child’s primary care provider during well child or sick visits, or by other qualified health providers. Dr. Macias says the screening tool is well tested and is proven to be effective at identifying children at risk for suicidal behavior.

If a child is determined to be at risk, their provider can refer them for a further mental health evaluation and connect families with resources to address their child’s mental health needs, such as access to a licensed therapist or pediatric psychiatrist.

How Parents Can Help a Struggling Child

Parents who are concerned about whether their child is at risk should be on the lookout for new behaviors or personality changes. These can include:

Becoming increasingly isolated or withdrawn
Not socializing well at school
New or escalating impulsivity or aggression

It’s important to keep the lines of communication open with your child and not be afraid to bring up their mental health struggles, says Dr. Macias. It’s okay to ask your child directly if they’ve ever had suicidal thoughts and let them know that it’s okay to talk to you about it.

Don’t wait until a child has severe symptoms before seeking help, advises Dr. Macias. Contact your child’s pediatrician at the first signs of at-risk behavior. They will be able to connect you with the resources your child needs to stay safe.