Suicidal behavior among children and teens was reported to have increased in the decade before the COVID-19 pandemic, but a study focused on New Jersey data suggests that part of the increase may be due to changes in the way health care providers screen for and report suicidal ideation.
The study highlights that while there has been an overall increase in suicide-related hospital visits, there has been little change in actual self-harm or suicide attempts. Instead, there was a large increase in suicidal ideation diagnoses, consistent with updated screening recommendations in 2011 and new coding regulations in 2016.
Reports from the decade before the COVID-19 pandemic show an increase in suicidal behavior among children, pointing to an underlying mental health crisis among this group. However, a new analysis of New Jersey data suggests that part of the surge may be due to changes in the way health professionals screen and report suicidal ideation in teens.
"One of our goals in conducting this study is to better understand the reasons for the increase in suicidal behavior among young people," said Adriana Corredor-Waldron, assistant professor of economics at NC State's Poole School of Management and co-author of the new study.
"We believe there is a mental health crisis among children, with high rates of suicide-related behaviors," Corredor-Waldron said. "However, in New Jersey, the state where we focused our study, rates of hospital visits for self-harm and suicide attempts changed very little over the 12 years we studied. In contrast, there was a large increase in children and adolescents diagnosed with suicidality (having suicidal thoughts). The increase in suicidal ideation diagnoses is associated with changes in the way health care providers screen for and report these behaviors."
"So this study really highlights how important it is to delve deeper into the drivers of reported health trends," Corredor-Waldron said. "This sharp trend in increased suicidal behavior may actually reflect that we are getting better at identifying young people who need treatment. That would be good news.""
For the study, researchers examined data on all hospital visits for children ages 10-18 in New Jersey from 2008 to 2019.
When all suicide-related visits were studied, it was found that suicide rates overall increased over the 12-year period. However, researchers found that this trend was driven almost entirely by an increase in diagnoses of suicidal ideation. The timing of these increases in diagnoses is related to two factors: revisions in screening recommendations and changes in the "coding" of suicidal ideation.
The screening recommendations refer to guidance issued by the U.S. Department of Health and Human Services in 2011 that encourages health care providers to annually screen girls and women ages 12 and older for depression.
Coding refers to the standardized system used by healthcare providers to record patient diagnoses. This coded data can be used to identify health trends. In late 2016, new coding rules went into effect requiring health care providers to enter a suicidal ideation code when a patient presents with symptoms of suicidal ideation, even if the patient's primary diagnosis is a mood disorder.
"For example, before 2016, if a patient was suicidal and diagnosed with depression, a health care provider might enter a medical code for depression only. After 2016, a health care provider would enter a code for both depression and suicidal ideation," Corredor-Waldron said.
Researchers found that reports of suicidal ideation increased significantly after new screening recommendations went into effect in 2011. But after new coding rules were implemented in 2016, there was an even greater increase in reports of suicidal ideation.
"It's important to note that these data are from one state, and the situation is different in each state," Corredor-Waldron said. "Also, we don't have this level of data from the time of the COVID-19 pandemic, and it would be nice to see how things may have changed over the past few years."