Self-harm, Suicide on the Rise in US Youths

NOVEMBER 28, 2017
Kevin Kunzmann
Melissa C. Mercado, PhD, MSc, MAMelissa C. Mercado, PhD, MSc, MA
Emergency department visits for nonfatal self-inflicted injuries in young patients has been on a significant rise for the past decade.

According to a new study from the Center for Disease Control & Prevention (CDC), the rate of US emergency department (ED) visits due to nonfatal self-inflicted injuries has been increasing annually by 5.7% (95% CI, 3.0%-8.4%) since 2008 in patients aged 10 to 24 years old.

The data, collected from 66 US hospital EDs via the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), found that 303.7 young people per 100,000 population were treated for nonfatal self-inflicted injury in 2015.

Researchers — led by Melissa C. Mercado, PhD, MSc, MA, of the Division of Violence Prevention at CDC’s National Center for Injury Prevention and Control — analyzed the weighted age group’s annual ED visits for self-infliction for the years from 2001 to 2015. What they found was a steady rate of incidences, before a boom occurring about midway through in 2008.

The increase was most notably found in females, whose annual ED visit rates for nonfatal self-inflicted injuries increased an average of 8.4% (95% CI, 5.6%-11.2%) annually from 2009 to 2015. More particularly, females aged 10 to 14 years reported the greatest annual increase from this span — at an average of 18.8%.

Females aged 15 to 19 years old reported a 7.2% (95% CI, 3.8%-10.8%) annual increase from 2008 to 2015, and females 20 to 24 years old reported a 2% (95% CI, 0.8%-3.1%) increase in the same span.

The rising female ED visit rate is significantly contrasted by the steady rate of males visits in the same span. From 2001 to 2015, the annual weighted rate of ED visits for nonfatal self-inflicted injuries in all males aged 10 to 24 years old increased just 11.8% — from 160.2 (95% CI, 127.9-192.5) per 100,000, to 179.2 (95% CI, 144.9-213.5) per 100,000.

The overall increase in ED visits for nonfatal self-inflicted injuries parallels previous trends which show an increased youth suicide rate from 2006 to 2014, Mercado told MD Magazine. The particular increase in young females’ ED visits also coincides with increased reports of depression among that demographic.

Suicide was the second leading cause of death among people aged 10 to 24 years old in 2015, Mercado said.

“Youth suicide rates in the US increased after 2006, with females ages 10 to 14 years experiencing the greatest increase,” Mercado said. “This is consistent with our study, which found that females ages 10 to 14 years experienced the most pronounced increases in nonfatal self-inflicted injury ED visit rates from 2009 to 2015.”

The study also tracked the common methods by which young patients caused nonfatal self-harm. Among poisoning, sharp objects, and blunt objects, females most prominently used poisoning during the span of annual ED visit increases. From 2007 to 2015, the rate of young female nonfatal poisonings increased 5.3% (95% CI, 0.5%-10.4%) annually.

When asked if the growing presence of social media and online harassment could have played a role in the increasing rate of youth self-inflicted injuries, Mercado said the research could not allow an understanding as to why the increases have occurred. However, she said most previous CDC studies show youths involved in bullying do not engage in suicide-related behavior.

“Strategies relevant to youth suicide prevention include strengthening access to and delivery of suicide care, creating protective environments, promoting youth connectedness, teaching coping and problem-solving skills, and identifying and supporting at-risk youth through evidence-based treatment strategies,” Mercado said.

The results show a need to implement “evidence-based, comprehensive suicide and self harm prevention strategies within health systems and communities,” Mercado said. She called on health care providers everywhere to consider their role in patient interaction and case note documentation.

“This is essential for public health surveillance,” Mercado said. “Most importantly, that patient-provider interaction could mean a world of a difference in a person’s life.”

The study, "Trends in Emergency Department Visits for Nonfatal Self-inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015," was published online in JAMA last week.

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