Suicide rates among children are going up again. According to research conducted at Vanderbilt University and published in Pediatrics, the number of school-aged children and adolescents hospitalized for suicidal thoughts or attempts has more than doubled since 2008.
The study, "Hospitalization for Suicide Ideation or Attempt" examined trends in emergency room and inpatient encounters for suicide ideation and attempts in children ages 5-17 years at U.S. children's hospitals from 2008 to 2015. Researchers identified 115,856 encounters for these conditions in emergency departments at 31 children's hospitals. The study showed that almost two-thirds of those encounters were girls, and while increases were seen across all age groups, they were highest among teens ages 15-17, followed by ages 12-14.
Seasonal variation was also seen consistently across the period, with October - the front end of the academic school year - accounting for nearly twice as many encounters as reported in July. This data is important because the rates for suicide among children were lowest in summer, which has historically seen the highest numbers in adults. This suggests that youth may face increased stress and mental health challenges when school is in session.
While there are many debatable causes for this alarming trend, there is no debate about the importance of pediatricians in screening for the public health problem. The shortage of mental health clinicians who treat children makes the job of pediatricians - especially their screenings for this condition - more important than it has ever been. Just as comprehensive computational advances in data-collection enabled these researchers to determine the scope of this problem, tools such as electronic health records (EHR) software can assist pediatricians in screening and treating this illness.
What is Causing This Increase in Attempted Suicide Among Children?
In media reports that followed the publishing of this research, the authors noted that they are “not certain what is driving the growth of depression and suicidal behavior but theorize that decreasing stigma might be causing more children and their parents to seek help, leading to a wider reporting of the problem.”
Researchers also opined that social media such as Facebook, Instagram and Twitter and smartphones might have an effect on this increase in youth suicide. Social media and mobile devices are virtually ubiquitous among teens and even younger children. Some experts feel this can lead to cyberbullying and feelings of inadequacy. However, more data is needed before concluding that these are contributing causes for children contemplating suicide.
How a Pediatric-Focused EHR Can Help Physicians Screen for Suicidal Tendencies
Independent pediatricians are on the front lines of fighting this war on suicide among children and a pediatric-focused EHR can be a powerful ally in this battle. Research has shown that family histories of mental illness can suggest potential for this condition in younger family members. Mental illness such as bipolar disease and depression are also found in clusters among family members. Collecting this data as a part of a regular pediatric examination is critical to screening for potential suicides.
Barb Laarman (BSN, RN) is the practice administrator for Holland Pediatric Associates in Holland, Michigan. She has successfully led the efforts to continually improve the practice’s depression screening among teens.
“Our standard screening approach is to use the PHQ 9 questionnaire for every teen well visit and the PHQ 2 for every sick visit,” she said. “This has allowed us to catch many potential depressions before they escalate. This is supported by everyone in the practice, from the partners to the clinical team and the administrative staff."
“We also use the ‘clinical alerts’ from PCC EHR if the patient has a previous diagnosis for depression. If this is in the patient’s chart, there is a ‘flag’ that prompts the intake nurse to always give the PHQ 9 (which is more extensive) survey to this patient. This allows us to track the patient’s progress.”
The Holland team also uses telephone follow-ups for any patient who might show tendencies towards depression.
As a PCC client, Laarman and her team have access to the Dashboard which compares clinical efficacy in several areas - including depression screening - with other practices around the country.
“This really helps us,” Laarman said. “This is because we are very competitive and we want to be among the best! Interestingly, since we are doing so well with this area, it allows me to look at other Dashboard measures to see where we might improve. The system’s robust reporting capabilities is one of the things I really like about the PCC EHR.”
The PCC Platform Helps Track Depression
The PCC EHR platform was designed specifically for gathering pediatric data. As has been noted in a previous post on social media and teen suicide, “many PCC clients use programs such as CHADIS to check up on their patients and see how they are doing. This is a behavioral, developmental, and health- screening program. Both parents and kids fill out surveys before the visit, so that when they arrive the pediatrician has a better idea of what to talk about and look out for.”
“Our platform allows the pediatrician to collect and organize these data before the exam, in a very efficient manner,” said Chip Hart, Director of PCC’s Pediatric Solutions consulting group and author of the popular blog Confessions of a Pediatric Practice Consultant.
“This saves the clinician valuable time which can be used to begin evaluating the reasons for the child’s emotional distress."
“Another extremely valuable tool for screening and treating mental conditions is found in the Bright Futures guidelines on the PCC platform", Hart continues. "This allows the pediatrician to ask more relevant questions of the child and his or her parent during an exam and offer advice that is based on current information from the American Association of Pediatrics.
“Finally, the “Guidelines for Adolescent Depression in Primary Care” (GLAD-PC) are included in PCC EHR and they offer comprehensive tools and analysis of mental illness among children.”
Due to a dearth of mental health providers, effective screening for depression and the potential for suicide among children has fallen into the lap of pediatricians. It is incumbent upon these practitioners to use every clinical tool available to help save the lives of these young people.