Young people drove ER utilization for suicide attempts during the COVID-19 pandemic

Photo: Elva Etienne/Getty Images

Emergency department utilization has spiked this year due in large part to suspected suicide attempts by people ages 12-17, many of them girls, according to the Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

During 2020, the proportion of mental health-related ED visits among adolescents in that age group increased 31% compared with 2019. 

In May 2020, during height of the COVID-19 pandemic, ED visits for suspected suicide attempts began to increase. Between February 21 and March 20, 2021, these ED visits were 50.6% higher among girls 12-17 than during the same period in 2019. Among boys in that age group, suspected suicide attempt ED visits increased 3.7%.

The data was gleaned from the National Syndromic Surveillance Program, which incorporates information from most of the nation's emergency departments.

WHAT'S THE IMPACT?

For providers, this means that adolescent suicide attempts may account for a statistically significant spike in ED utilization. What's more, these trends persisted among young people as the pandemic progressed.

ED visits for suspected suicide attempts increased among adolescent girls during summer 2020 and remained elevated throughout the rest of the year. The mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019.

The number of ED visits for suspected suicide attempts remained stable among adolescent boys ages 12-17 and among all adults ages 18-25 compared with the corresponding periods in 2019, although rates of ED visits for suspected suicide attempts increased.

The gender differences are consistent with past trends showing that self-reported suicide attempts among young girls are both higher, and rising faster, than for boys. But the new findings suggest more severe distress among adolescent girls than had previously been reported, and reinforce the need for increased attention on this demographic. 

One silver lining: While attempts have increased, successful suicide attempts, meaning deaths, showed no statistically significant change.

CDC researchers speculated on the possible reasons for these spikes. One possibility is that young people may have been particularly affected by pandemic mitigation measures such as social distancing, which translated into a lack of connectedness to schools, teachers and peers. Other factors may include barriers to mental health treatment, increases in substance use and anxiety about family health.

Average ED visit rates for mental health concerns and suspected child abuse and neglect also increased in 2020 compared with 2019, potentially contributing to increases in suspected suicide attempts. Conversely, by spending more time at home together with young people, adults may have become more aware of suicidal thoughts and behaviors, and thus been more likely to take their children to the ED.

THE LARGER TREND

Emergency department visits have been in the spotlight lately, particularly in the wake of major insurer UnitedHealthcare's decision to enact a policy by which it could retroactively deny ED claims – a policy it later rescinded temporarily, after backlash from provider groups, which said the move could harm patients.

On Twitter, many said this could inspire hesitancy in patients, even for events that are true emergencies, such as heart attacks. That would, in effect, lead to lower reimbursement for some providers, who are still struggling to regain financial health after delayed and deferred care during the COVID-19 pandemic caused revenues to sink.

Internal data from UnitedHealth Group, UnitedHealthcare's parent company, points to the very real problem of ED misuse, which costs the U.S. healthcare system roughly $32 billion annually. Misuse typically manifests as patients seeking out costly ED care for minor ailments that could have been addressed through other avenues.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com