Visits to the emergency department related to suicide among children and adults aged 6 to 24 in the U.S. increased fivefold from 2011 to 2020, according to a new study published Tuesday. The increase was significant in all age groups across sex, race and ethnicity, insurance type, and geography.
“It is somewhat expected, given increasing rates of suicide deaths, but … it is just sad news … and fivefold is a huger increase than we expected,” said Greg Rhee, one of the study authors and an assistant professor of medicine and public health at Yale University.
The study, published in the Journal of the American Medical Association, looked at mental health-related ED visit data from the National Hospital Ambulatory Medical Care Survey, the gold-standard tracking system for the use of medical services in the U.S. Researchers estimated the annual percent change increase over time. Among youth and young adults, they broke down cases by age and compared rates among those smaller categories.
From 2011 to 2022, the proportion of ED visits for mental health reasons nearly doubled among children, adolescents, and young adults, from 7.7% to 13.1% of all ED visits for this age group. The proportion of all types of mental health-related ED visits, including those related to mood, non-suicidal behavior, substance use, and psychosis, increased significantly.
These findings coincide with the known rise in both suicides and the proportion of people experiencing severe distress over time, particularly among youth. The heightened effects of peer pressure, bullying, social media, and other pressures and stressors on adolescent brains have all been seen as compounding factors for greater mental distress among youth and young adults.
That said, the new data could be interpreted in more hopeful ways, according to experts STAT spoke with.
“To the extent that it reflects people being more likely to seek care when they do experience severe distress, that’s not bad,” said Greg Simon, a psychiatrist and researcher with Kaiser Permanente who was not involved in the study.
The rise in mental health-related ED visits might also reflect some positive developments over the past decade, he said. For one, the data capture a period when more and more people were getting health insurance. If that contributed to more people being able to seek and get care, “that would be a good thing,” Simon said. It’s not a far-fetched assumption: Medicaid expansion, for instance, is disproportionately helpful to young adults.
Additionally, some of the increase in ED visits could be tied to major national initiatives over the past five years on screening for mental health problems and on addressing suicidal ideation among young people.
The increase might signal a greater awareness of mental health-related signs and screening needs among ED staff in recent years than, say, in 2010. It might also point to reduced stigma in and out of the ED. In turn, a decline in stigma overall in the U.S. could translate to youth and people in their lives talking more about mental health and potentially better knowing how to access help — even if that help is through the ED instead of outpatient services dedicated to mental health care.
The ED is not the optimal place for people to get mental health care, experts say. While EDs vary in their degree of readiness to treat mental health issues, a visit to the ED is, by definition, an emergency, when people don’t see or have access to other treatment options. Many EDs are especially understaffed and have a paucity of psychiatric specialists on staff or on call during any given visit, Rhee said.
Simon said future research could build on this study’s snapshot of mental health-related ED visits to investigate the quality of non-emergency mental health care.
“The question we need to be asking is, how often could emergency department visits have been avoided?” he said. “And after an emergency department visit, how often do people get connected with the care they need?”
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
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