Illinois has seen a recent surge in the number of kids arriving in the emergency room for suicidal thoughts -- both during and shortly before the pandemic, according to a new study.
Among kids ages 5 to 19, ER visits for suicidal thoughts rose by 59% across the state between 2016 and 2021, researchers found. That included a sharp spike in the fall of 2019, followed by another in the fall of 2020.
Experts said that while the findings come from one state, they reflect what's been going on nationally. They also highlight a sobering fact: U.S. children and teenagers have been showing a deterioration in their mental health for years.
"It's absolutely not the case that this started with the pandemic," said senior researcher Joseph Feinglass, of Northwestern University Feinberg School of Medicine in Chicago.
Over the past two decades, suicide deaths have risen by more than 50% among U.S. teens and adults younger than 25. And a 2019 government study found that about one-third of high school students said they felt persistently sad or hopeless -- a 40% increase from a decade before.
The new study, published Nov. 14 in the journal Pediatrics, focused on emergency room visits for suicidal thoughts -- which are indicative of kids in real crisis, Feinglass said.
Researchers found that from 2016 to June 2021, Illinois hospitals recorded 81,051 ER visits for suicidal ideation in the 5 to 19 age group. The numbers increased moderately between 2016 and 2018, and then soared in the fall of 2019. That was followed by a similar jump a year later, during the first pandemic autumn.
"There were two equally striking spikes," Feinglass said.
The reasons for the surge in 2019 are not clear. But the fact that ER visits rose in the fall is not surprising: School is a prime source of stress for kids, Feinglass said.
That can come in the form of bullying or problems with peers, but there's also the pressure to perform. These days, Feinglass said, kids hear the message that they need to go to college to have a good life -- to a degree that past generations did not.
He speculated that school-related stress could be one reason behind the national trends in suicide deaths of the past couple decades.
But there could be many other things going on, too, Feinglass said. He pointed to the economic downturn and housing crisis that began in 2008, because when families suffer those strains, kids are affected, too.
Social media is another potential culprit, Feinglass said. One way it could affect kids' mental well-being is through the constant comparisons they make between themselves and others -- not only with the peers they know, Feinglass noted, but with countless strangers online.
Social media can also expose kids to unhealthy ways of coping with feelings, according to Dr. Christine Crawford, associate medical director of the nonprofit National Alliance on Mental Illness.
"We do know that kids learn from each other," said Crawford, who was not part of the study. "Social media can be a quick way to learn maladaptive ways to cope."
But, she added, "I don't want to blame everything on social media."
Many factors could be driving the worsening mental health among U.S. kids, Crawford said, and no one is sure exactly what is going on.
When children are seen in the ER for suicidal thoughts, they may be admitted to the hospital. In this study, there was a sharp increase in hospitalizations between the fall seasons of 2019 and 2020, at 57%.
That may, Feinglass said, be a sign that kids were in more serious condition in 2020 -- perhaps because people were avoiding ERs in the early months of the pandemic and delaying care.
Exactly what happens post-ER varies depending on where kids live, Crawford said. Some communities have "bridge clinics," staffed by nurse practitioners, where kids can get mental health help; others have "mobile clinics," which provide follow-up visits at home. Often, though, families are told to follow up with their pediatrician.
Feinglass said there is a dearth of mental health providers for young people, and that needs to be addressed.
"But that won't get at the causes of the problem," he added.
Kids are not alone in their worsening mental health. Feinglass noted that so-called "deaths of despair" -- from suicide, drugs and alcohol -- have been rising for years among U.S. adults, particularly those who are working class and lack a college degree.
That also means more kids living with parents or other family members with substance abuse problems and other mental health conditions, Feinglass said.
"I do think there's something about the broader American culture contributing to this," he said. "There's a social disintegration factor."
Both experts said it's critical for kids to have caring adults in their lives. And that's something many may lack, Feinglass said.
"We need to surround kids with a community of adults who support them," he said.
The American Academy of Pediatrics has advice on teenagers' mental health.
SOURCES: Joseph Feinglass, PhD, research professor, medicine, Northwestern University Feinberg School of Medicine, Chicago; Christine Crawford, MD, MPH, associate medical director, National Alliance on Mental Illness, Arlington, Va., and assistant professor, psychiatry, Boston University School of Medicine; Pediatrics, Nov. 14, 2022, online