Suicide Risks in Children and Adolescent Youth

Suicide Risks in Children and Adolescent Youth

Each year the Centers for Disease Control and Prevention (CDC), report that the rate of suicide attempts and related deaths have alarmingly increased. This has become a large social issue throughout the nation and continues to be a central focus on preventative care within the realm of mental health. The mental health crisis is growing and so has the need for increased community awareness and intervention respectively. Suicide for all population age groups continues to be a part of the leading mental health indicators under the Healthy People 2020 initiative. This paper will discuss the topic of suicide risks specifically in children and adolescent youth, the proposed solution of early treatment and intervention, and determine the challenges of implementation. This paper will also discuss the proposed research topic through a scientific and analytical perspective of inquiry to expand current knowledge of suicide and relevant risk factors present in younger psychiatric patients.

Background

The mental health community has experienced an upward trend of increased suicides and suicide attempts within the past decade (Curtin, Heron, Miniño, & Warner, 2018) The World Health organization (WHO) reports that near 800,000 individuals commit suicide annually and for each completed suicide there were approximately 20 prior attempts (2019). The result of the increase in suicide and related incidents has transformed the field of mental health and consequentially called for increased patient advocacy and awareness. Unfortunately, the issue of the mental health crises affects many of the young children and adolescents in the school and social community settings. However, early identification of significant risk factors results in earlier treatment and intervention and the appropriate response can potentially decrease the number of intentional or unintentional suicides nationwide. There is an immediate need to address the mental health crisis and it is critical to utilize the position of influence in nursing to raise awareness, educate the community, and continue to eliminate stigmatization.

Scientific Perspective of Inquiry

There are many investigative studies on the biological or epidemiological causes for suicide. A great wealth of information is available on the associations between psychosocial stressors and psychiatric disorders. A familial history of suicide in a high-risk youth is also a known risk factor. Unfortunately, there is little known about the biological influences that result in suicide or high-risk suicidal behaviors. The neurobiology of suicide is a new field of study, however, the recent research available is nothing short of intriguing. Pandey (2013) investigates the neurobiology of suicide through the analysis of peripheral tissues such as platelets, lymphocytes, and cerebral spinal fluid (CSF) of not only suicidal patients but also the postmortem tissues of suicide victims.

Pandey’s (2013) study revealed an abnormality of serotonergic mechanisms such as increased serotonin receptor subtypes. Serotonin is the neurotransmitter that is closely related to clinical depression. The serotonin hypothesis suggests that “diminished activity of the serotonin pathways play a causal role in the pathophysiology of depression” (Cowen & Browning, 2015).  In addition to the serotonergic mechanism abnormalities, other biological systems become dysregulated in suicide victims including the hypothalamic-pituitary-adrenal (HPA) axis and neurotrophins and its receptors (Pandey, 2013). More recent studies have also linked suicide to abnormalities of neuroimmune function.

Epidemiology of Suicide

Suicide and suicide attempts are closely related to psychiatric and mental disorders characterized by thought or mood dysregulation. Such disorders include major depressive disorder, substance abuse or dependency, psychosis/thought dysregulation, anxiety disorders, personal trauma, as well as personality or eating disorders. There are also many risk factors that are critical to note including prior attempts, existing psychiatric disorders, family history, and social/personal stressors. The most common methods utilized for self-harm or suicide are hanging, self-poisoning with medications/substances, and use of firearms (Bachmann, 2018). The method of suicide is not predictable in children or adolescents, but the combination of risk factors present can indicate a high-risk for suicide and suicidal behaviors.

Suicide is defined as the intentional and self-inflicted death of oneself. In addition, suicide attempts are considered self-harm or self-injurious behaviors that did not intentionally or unintentionally result in suicide or death (self-inflicted). Although there is limited research data on attempts, the number of attempts, with or without an intention to die, is on the rise. The exact cause of suicide would vary in the manifestation of depressive or acute symptoms displayed by the child or adolescent and is largely dependent on the risk factors or combination of that exist on presentation. However, it is a significant consideration to account the majority of suicides to psychiatric diseases.

There are several chemical or biological issues that are important to note when discussing suicides. It is imperative to consider the genetic disposition of an individual of developing certain psychiatric disorders as well as a family history of suicide or relevant mental illness. Additionally, it is important to note an individual’s social or familial stressors for any present risk factors such as socioeconomic status or substance abuse or dependency which places the youth at risk. A combination of psychosocial stressors and the neurobiological causal factors, together, increase an individual’s tendency to suicide in addition to the presence of maladaptive coping strategies.

Mathematical/Analytical Perspective of Inquiry

A proposed solution to reducing the number of young suicides in the community is to emphasize crisis intervention and strategically implement early identification and intervention structures. These can include emergency screening units and crisis stabilization units that are separate entities from local emergency departments. The proposed implementation would likely reduce the number of readmissions related to psychiatric decompensation, inappropriate psychiatric admissions to emergency rooms beds, and psychiatric-related recidivism. The issue with the current mental health crisis can be compared to the analogy of “catch and release”. Meaning the current mental health system is rather reactive than proactive regarding interventions at later stages of decompensation. The goal of the proposed implementation is to not only assess patients but to stabilize and treat patients before reintegration into the community. The goal is also to prevent adverse events and consequences that may be attributed to psychiatric decompensation. Early identification and intervention programs would screen patients of immediate risk of suicide and triage them to the appropriate level of care most likely inpatient hospitalization. If there is no immediate risk, the patient could be contracted to less restrictive treatment including partial hospitalization or intensive outpatient programs.

Crisis stabilization units or psychiatric emergency screening units proves to provide many benefits to the psychiatric community including many economical advantages. According to the San Diego Center for Children (2019), for every dollar spent on children’s behavioral and mental health treatment, the community saves seven dollars in future expenses preventing incarceration, homelessness, job loss, and other relevant social services. Furthermore, the annual economic cost of children and adolescent mental health treatment is approximately 247 billion dollars (“San Diego Center for Children”, 2019). These services include inpatient/outpatient programs, primary care, education, child welfare services, foster care, and juvenile justice systems.

The goal of crisis services is to be available to the community and expand access to mental health emergency services or screening. National statistics have highlighted the need for these implementations. In 2010, 2.2 million hospitalizations and 5.3 million emergency department visits involved a psychiatric diagnosis (Agency for Healthcare Research and Quality). The healthcare industry continues to grow in order to meet the population demands as with the mental health community. The issue at hand is the need to control costs associated with mental health services while maintaining quality patient care. The economic impact of implementing crisis services and psychiatric screening reveal profound cost saving measures as a result. This is due to reduced inpatient hospitalization and diversion of emergency department beds. A study by Wilder Research (2013), claims data to calculate a return on investment of crisis stabilization programs. The economic impact of the implemented programs is compared to the resources that were invested into the programs and the benefits associated with the interventions. In their study, the programs served 315 psychiatric patients at an average cost of $1,085. The study found that the net benefit for mental health crisis stabilization services was approximately $0.3 million, with a return of $2.16 dollars for every dollar that was invested. While there is public funding available for mental health services, there is no proportion of spending on crisis services specifically. Crisis services offer significant cost effectiveness as a result of reduced inpatient hospitalizations and other avenues of inappropriate healthcare utilization.

Conclusion

Suicide rates remains a prominent issue in today’s healthcare environment. Current screening for potential suicidal candidates has largely been ineffective and investigation into biological factors/identifiers for suicide is only starting to emerge in the literature. An analytical approach to suicide that poses cost benefit analysis between current practices and the economics of crisis interventional services shows some promise as to the simultaneous reduction in intentional loss of life and healthcare cost. Such realization of crisis centers may be necessary until full understanding of the biological risk factors for suicide are established.

References

• Agency for Healthcare Research and Quality. (2010). Healthcare Cost and Utilization Project (HCUP). Custom data query. Retrieved from http://www.hcup-us.ahrq.gov/
• Bachmann S. (2018). Epidemiology of Suicide and the Psychiatric Perspective. International journal of environmental research and public health, 15(7), 1425. doi:10.3390/ijerph15071425
• Cowen, P. J., & Browning, M. (2015). What has serotonin to do with depression?. World psychiatry: official journal of the World Psychiatric Association (WPA), 14(2), 158–160. doi:10.1002/wps.20229
• Curtin, S., Heron, M., Miniño, A., and Warner, M. (2018). Recent increases in injury mortality among children and adolescents aged 10–19 years in the United States: 1999–2016. National Vital Statistics Reports. 67(4).1-15.
• Pandey G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar disorders, 15(5), 524–541. doi:10.1111/bdi.12089
• Shain, B. and AAP Committee on Adolescence. (2016). Suicide and suicide attempts in adolescents. Pediatrics. 138(1). E1-E11. Doi: 10.1542/peds.2016-1420.
• THE PROBLEM. (2019). Retrieved from https://www.centerforchildren.org/the-problem/
• Quality of suicide mortality data. (2019, July 4). Retrieved from https://www.who.int/mental_health/suicide-prevention/mortality_data_quality/en/
• Wilder Research. (2013). Crisis stabilization claims analysis: Technical report, assessing the impact of crisis stabilization on utilization of healthcare services, April 2013. Retrieved from http://www.wilder.org/WilderResearch/Publications/Studies/Mental%20Health%20Crisis%20Alliance/Crisis%20Stabilization%20Claims %20Analysis%20-%20Technical%20Report.pdf