Mass. Psychiatrists Concerned About Increase In Suicidal Thoughts, Attempts Among Adolescents

The effects of the pandemic on mental health in the U.S. are profound.

But clinicians who work with children say they're particularly concerned about one trend over the last several months: a spike in adolescents who have suicidal thoughts or have tried to take their lives.

Boston Children's Hospital reports that between July and October of last year it saw a 47% increase, over the same period the year before, in kids needing to be hospitalized for suicidal ideation or attempts.

The uptick from last year has continued. For example, Children's Hospital said on the day this story was published, March 25, it had more than 50 children through age 17 either admitted or waiting for an inpatient bed for reasons related to suicide.

WBUR's All Things Considered host, Lisa Mullins, spoke with three doctors who are seeing this up close: Dr. Patricia Ibeziako, associate chief for clinical services in the psychiatry department at Boston Children's Hospital; Dr. Elizabeth Pinsky, pediatric psychiatrist at Massachusetts General Hospital; and Dr. Michelle Durham, child, adolescent and adult psychiatrist at Boston Medical Center.

According to the psychiatrists, there needs to be greater attention and resources put toward community-level care and access to therapies for kids from all communities, income levels and insurance plans in order to keep kids from getting to the point that they need to go to the hospital because they're suicidal. But, the clinicians said, several stressors related to the pandemic are contributing to the despair that's bringing kids to emergency rooms and leading them to get admitted.

Dr. Patricia Ibeziako: "Over the past six to eight months, the stresses that we've heard about from patients who are presenting with suicidality are academic struggles like declining grades, having difficulty focusing, family stresses and conflicts, and also social isolation and decreased social interactions. I must say, though, that school and academic stress have always been frequently reported — the most frequently reported stress in youth presenting to the hospital with mental health struggles. [Now] it's just much higher volumes of patients and pandemic-related impact."

Dr. Elizabeth Pinsky: "You think about the young people you know — the adolescents you know — who are going through the process that is completely normal and very important, of separating from their families and developing an identity outside of that ... Those identities are an athlete, an actress, a friend, a person out in the community. And we have taken those things away from these kids in a way that really attacks the things that make kids really healthy. We know that kids who are committed to sports, who have activities, who sort of have good peer groups, do better. The losses that adolescents, in particular, are experiencing around identity and around who they are in the world, I think is one of the reasons that we're seeing such an uptick in self-harm."

On how the pandemic has exacerbated situations in Black and brown communities that can contribute to despair and suicidal ideation:

Dr. Michelle Durham: "Food insecurity, housing insecurity, working multiple jobs, multigenerational families — that's always been at play for our families. For these families in particular, financial struggles and whether or not you're going to be evicted or be able to have a roof over your head is obviously quite challenging. And then on top of that, we know that there's also a lot of loss, a lot of death that unfortunately impacted the same families that are some of our essential workers and have multiple jobs. For the kids we see here [at BMC], discrimination, racism, systemic issues were always a struggle. And so, not everyone was paying close attention to those kids that were struggling. And now people are just talking about it more."

On whether the racial justice movement of the last year has changed how clinicians talk with — or approach treatment for — pediatric patients who come in because of suicidal thoughts or suicide attempts: 

Pinsky: "I guess what I would say is that we are all in evolution as we try to think about that, learn more about it and think about all of the ways that it infiltrates our systems, the way we interact with patients, the histories that families bring into our rooms with us. I mean, that is a very, very, very big question and one that I think medicine in general and psychiatry, specifically, has a great deal of work to do."

Ibeziako: "I have been saying that we're dealing with three pandemics: a COVID-19 pandemic, there's the mental health pandemic, and then there's the issue around race and systemic racism, and the health care disparities that come with that ... We are seeing teenage females presenting with suicidality in the majority, which has always been the case. The shift here hasn't been so much how we talk with patients. I'm a Black provider. I've always been aware of systemic and structural racism. However, it's opened the door for us to have conversations with other providers about how we provide culturally sensitive and safe care to the patients and families who are presenting to us. One of the things I worry about is that there are probably communities of color and patients of color who are not necessarily accessing care and coming to the hospital and are quietly suffering at home. And that keeps me up at night sometimes."

On what clinicians can say to kids that is hopeful:

Durham: "We're all sort of going through this together, right? And there is something to be said for that — that we can commiserate at some level on [the fact that] we've all lost something in this pandemic. We try a lot in the work we do to also use a strength-based approach — trying to figure out some of the positive things, and what can we grow and learn from, but also acknowledging and validating that it's been very stressful and that we hear and we understand that."

Pinsky: "It does feel that we are perhaps shifting to a new phase in the pandemic now, and that we may be moving on from sort of the darkest days in terms of isolation for children and some of the things that were hitting kids the hardest. And so I hope that some of that hope can roll down from grown-ups onto children over the coming months."

Ibeziako: "I think that it feels like the deepest, darkest period of your life when you're struggling with depression and suicidal thoughts. But we do know that things can get better and do get better, especially with the right treatment. And one of the things that gives me hope is that as a result of this pandemic, a lot more light is being shed on this problem and mental health issues. And even at the federal level, the American Rescue Plan that was just approved includes about $80 million of funding for child mental health across the country. And so for families who are struggling with this, for parents who have kids struggling with depression and suicidal thoughts, one good outcome from this pandemic is that a lot more people are paying attention to this problem."

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline (call or text) at 1-877-870-HOPE (4673). Call2Talk can be accessed by calling Massachusetts 211 or 508-532-2255 (or text c2t to 741741).