Research In Action

The COVID-19 pandemic is having a wide range of effects on our children and teens. Restrictions on in-person school attendance reduces the amount of time youth spend with their peers and the ability of school personnel to support students’ educational, health, and mental health needs. Additionally, many families have been negatively impacted by the pandemic in various ways, such as:

• loss of employment and associated financial strain
• parents/caregivers who are essential workers and therefore at increased risk for COVID-19 exposure
• increased stress
• loss of routine socialization due to stay-at-home orders

Children and adolescents may also experience restricted access to routine and specialized medical and behavioral health care due to the health care system’s focus on infection prevention strategies and treating patients sick from COVID.

A Challenging Combination

An article by Golberstein and colleagues highlights the potential negative impact on child mental health by the challenging combination of a public health crisis, restricted access to typical social interactions, and economic downturn. This is occurring in the context of many barriers to accessing high-quality behavioral health care for children that existed prior to the pandemic.

Given the social isolation, reduced access to behavioral health care, increased familial stress, and educational disruption that are resulting from the ongoing COVID-19 pandemic, there is speculation about increasing rates of suicidal ideation and behavior among children and adolescents. This is a distressing potential development, as prior to COVID-19, suicide was identified as the second leading cause of death among individuals ages 10-24.

Suicide Risk During the Pandemic

A recent study by Hill and colleagues examined rates of endorsement of suicidal ideation and suicide attempts among patients age 11-21 presenting to pediatric emergency rooms and completing routine screening of suicide risk. The investigators compared rates in 2019 with the same months in 2020 and found increased risk of endorsement of both suicidal ideation and attempts among this patient population. Although the study examines a sample that may not be reflective of the overall child and adolescent population, the results suggest that there may be increased suicide risk among youth in the context of the COVID-19 pandemic.

What Clinicians Can Do

Although suicide is the result of actions that typically occur outside of a healthcare setting, there are steps that healthcare systems can implement to reduce the risk of suicide among the patients they serve:

• The Zero Suicide framework, a quality improvement approach to addressing suicide risk adopted by multiple health care systems, is organized into seven elements that support healthcare  institutions in developing initiatives focused on identifying and engaging patients at risk, providing timely intervention, supporting transitions across levels of care, and sustaining progress via continuous quality improvement.
• All healthcare professionals are in a position to use evidence-based approaches to identify  suicide risk in their patients, including screening and assessment instruments, such as the Columbia Suicide Severity Rating Scale, whether providing care in-person or via telehealth.
• Clinicians should recognize that pre-existing behavioral health conditions, as well as psychosocial stressors, may be exacerbated due to the effects of the pandemic. This may require more active monitoring of patients and ensuring patients are connected with appropriate behavioral health services.

Clinicians working with youth should be aware of the need to recognize signs of increased stress among children and families as they continue to cope with the effects of the pandemic.

For more information:

• If you, or someone you know, are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
• If you, or someone you know, are in crisis, access Crisis Text Line: Text "Home" to 741741 for free, 24-hour support.
• Learn more about the Center for Violence Prevention's suicide prevention programs.