Two studies published today shed light on youth suicide and ingestion of illicit substances among US youth in 2021, with one finding an increase of 30% in suspected self-poisonings among children 10 to 19 years old, and one showing an immediate 26% rise in likely unintentional ingestion of cannabis, opioids, and ethyl alcohol among children younger than 6.
Girls made up 81% of suicide attempts
In the first study, researchers at the University of Virginia School of Medicine analyzed National Poison Data System data on the rate of suspected suicide attempts by poisoning among youth aged 10 to 19 years in 2021, the first full year of the COVID-19 pandemic.
The rate of suicide attempts through poisoning rose 30.0% in 2021 over prepandemic (2019) rates, with increases of 73.0% among children aged 10 to 12 years, 48.8% among those aged 13 to 15, and 36.8% among girls. Girls made up 81.2% of the suspected suicide attempts among youth aged 10 to 19 years in 2021, up from 77% in 2019. These increases came at the same time as a 3.1% decrease in overall calls to US poison centers from 2019 to 2021.
The two substances most often involved in the suicide attempts were the over-the-counter pain relievers acetaminophen and ibuprofen, followed by the antidepressants sertraline and fluoxetine and the antihistamine diphenhydramine (eg, Benadryl).
"These findings suggest that the mental health of children and adolescents might still be affected by the pandemic, raising concerns about long-term consequences, especially given that previous attempted suicide has been found to be the strongest predictor of subsequent death by suicide," the researchers wrote.
The authors noted that in 2020 suicide was the second-leading cause of death among children aged 10 to 14 years and the third-leading cause among those 15 to 24 years old. "A comprehensive public health approach to suicide prevention measures focusing on children and adolescents and involving partnerships among families, school teachers, mental health professionals, and public health leadership is needed," they wrote.
These findings suggest that the mental health of children and adolescents might still be affected by the pandemic, raising concerns about long-term consequences, especially given that previous attempted suicide has been found to be the strongest predictor of subsequent death by suicide.
Because over-the-counter medications are often used in suicide attempts, the researchers recommend safety measures such as heightened public education initiatives on their safe storage, the availability of assistance in case of overdose through poison centers by calling 800-222-1222, and more promotion of the national 988 Suicide and Crisis Lifeline for people having a mental health crisis.
In a University of Virginia news release, senior author Christopher Holstege, MD, said the research team was surprised by the results of the study. "We are alarmed at the dramatic increase in suicide attempts in such a young population, which continues to escalate, according to our data," he said. "As a society, we need to come together in a multi-disciplinary manner and strategize on how to best mitigate this rapidly escalating threat to our youth."
Opioid ingestion up 28%, ethanol 81%
In JAMA Network Open, a University of North Carolina–led study used an interrupted time series design to assess monthly rates of illicit-substance ingestion among 7,659 children 5 years old and younger at 46 US children's hospitals from January 1, 2017, to December 31, 2021. The average patient age was 2.2 years, and 76.0% were insured through Medicaid or self-pay.
The rate of illicit-substance ingestions rose 25.6% immediately at the onset of the pandemic relative to before, attributable to cannabis, opioids, and ethanol. A 1.8% monthly increase above the prepandemic era was sustained due to opioid ingestion. Medicinal or recreational cannabis legalization wasn't associated with the rate of cannabis ingestion.
Before the pandemic, rates of cannabis ingestion in this age-group were increasing 2.2% per month. After controlling for medicinal and recreational cannabis legalization, the rate of cannabis ingestion cases climbed 70.7% immediately after the pandemic began but then leveled off.
Ingestion of amphetamines, cocaine, and benzodiazepines didn't increase significantly at pandemic onset, but opioid ingestions immediately rose 27.5%, and ethanol ingestions increased 80.8%.
Monthly opioid-ingestion rates continued to rise 4.9% per month, while amphetamine ingestions declined 1.1% per month. Modeling revealed cumulative increases in ingestions from April 2020 to December 2021 of 40.9 more overall ingestions per 10,000 hospital visits, 23.9 more of cannabis, 12.4 more of opioids, and 2.3 more of ethanol.
Ingestion of amphetamines, cocaine, and benzodiazepines didn't increase significantly at pandemic onset, but opioid ingestions immediately rose 27.5%, and ethanol ingestions increased 80.8%.
The proportion of hospital visits requiring an intensive care unit stay remained consistent before and during the pandemic (18%). A total of 3,809 substance-related visits took place in the prepandemic period, compared with 3,850 amid the pandemic. In 214 cases, the patient ingested two substances and were counted twice in the model. In seven cases, the patient ingested three substances and were counted three times, and 99 patients had two separate ingestions during the study period.
The authors noted that children younger than 6 years make up most pediatric illicit-substance ingestion, and greater than 99.9% of cases are unintentional. "The presence of illicit substances in the home is particularly dangerous to young children, leading to potentially life-threatening outcomes when ingested," they wrote.
The increases in ingestions may be due to pandemic-related increases in stress, worse mental health, increased parental substance use, disrupted substance-use treatment, the loss of childcare, and insecure substance storage, the researchers said.
"Additional studies are needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education," they wrote.
