Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young Adults from 2000 to 2018

doi:10.1016/j.jpeds.2019.02.045

The Journal of Pediatrics

Volume 210, July 2019, Pages 201-208

https://doi.org/10.1016/j.jpeds.2019.02.045 Get rights and content

Objective

To evaluate the incidence and outcomes from intentional suspected-suicide self-poisoning in children and young adults ages 10-24 years old from 2000 to 2018.

Study design

Retrospective review of intentional suspected-suicide self-poisoning cases reported to the National Poison Data System from US poison centers from 2000 to 2018 for patients 10-24 years old. For comparison of annual rates, population data by year of age were obtained from the US Census Bureau. We evaluated changes in the annual incidence, the annual rate per 100 000 population, and the medical outcome by patient age and sex.

Results

There were 1 627 825 intentional suspected-suicide self-poisoning cases, of which 1 162 147 (71%) were female. In children 10-15 years old from 2000 to 2010, there was a decrease in number and rate per 100 000 population followed by a significant increase (from 125% to 299%) from 2011 to 2018. In children 10-18 years old, the increase from 2011 to 2018 was driven predominantly by females. In 19-24 years old age groups, there was a temporal delay and reduced increase in slope compared with the younger groups. There were 340 563 moderate outcomes, 45 857 major outcomes, and 1404 deaths. The percentage of cases with a serious outcome, major effect, or death increased over time and with age.

Conclusions

The incidence and rate of suicide attempts using self-poisoning in children less than 19 years old increased significantly after 2011, occurring predominantly in young girls. There has been an increase in the severity of outcomes independent of age or sex.

Section snippets

Methods

A network of regional Poison Control Centers (PCC) in the US, covering the full population of all 50 states and the District of Columbia, offer free, confidential medical advice 24 hours per day by telephone through the Poison Help Line. During the case management by PCCs, multiple measures are recorded by the healthcare professionals (nurses, pharmacists, and physicians) managing the poisoned patients including: reason for poisoning, age, substance, clinical effects, therapies, and medical

Results

There were 1 647 681 cases reported to US poison centers with the reason of intentional suspected suicide and with an age of 10-24 years from January 2000 to November 30, 2018. There were 19 856 cases (1%) with an estimated age (45 patients in 6-12 group, 5038 in the 13-19 group, and 19 856 in the 20-29 group) leaving 1 627 825 cases for analysis. The majority (n = 1 162 147 [71%]) were female (Table I). For the total group (ages 10-24) from 2000 to 2018 there was a significant increase of

Discussion

Our findings converge with the growing evidence of worsening outcomes related to suicidal behavior among children and adolescents.10, 11, 21 A number of findings in the present study add additional evidence of changes in temporal trends, age and sex differences, and changes in outcome that are occurring. We found that, although overall suicide attempt rates are increasing, an inflexion point occurred in 2011 with a significant increase in rates in children less than 18 years of age, that this

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The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic.
A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models.
Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021.
The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13–15 years of age), with a preference for paracetamol as DSP substance.
Social media and adolescent mental health
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With the proliferation of social technologies in today's digital world, adolescents need to adapt to ever-shifting social, cultural, and technological environments. We describe the impact of these technologies on the development of adolescents and the mental health processes relevant to these technologies. We not only explore mental disorders and risky behaviors (e.g., depression, anxiety, fear of missing out, self-harm, etc.) but also the positive dimensions of social media on mental health, including social connectedness, resilience, and access to supportive online relationships. We connect these psychological processes to core elements and affordances of social media, to describe patterns of usage across different platforms. We conclude with future research challenges and recommendations for interventions utilizing these findings such as advice for pediatricians guiding their patient families to collaborations with user-centered computing industry experts which can further co-create technological solutions centering on the needs of adolescent wellbeing.
Association of Paraphenylenediamine (PPD), with suicidal attempts in Pakistan- A cross-sectional study
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This study will provide us the details about the vulnerable population in relation to suicidal attempts by ingesting paraphenylenediamine and will help in designing focused preventive measures to address this serious health issue while reducing the burden on healthcare resources.
This descriptive cross-sectional study was carried out from January 1, 2017 to December 31, 2021 at the National Poison Control Centre, Karachi, using a consecutive sampling technique. The sample size was n = 321 reported cases of Paraphenylenediamine poisoning, data was collected from the hospital record. Incomplete records were excluded.
The analysis was done using SPSS Statistics (version 22), a statistical software suite developed by IBM. Numerical data was expressed as mean and standard deviation. Categorical data associations were recorded using chi-square. A p-value less than 0.05 was taken as significant.
There were n = 321 patients who reported with paraphenylenediamine poisoning to National Poison Control Centre, of which 53.8% (n = 173) were females. While 55.4%(n = 178) of patients were young post-adolescent adults (aged 20–40 years). Analysis according to months revealed that a maximum number of cases 15.26% (n = 49) were reported in April. The mortality rate was 12.1% (n = 39).
Paraphenylenediamine ingestion has a strong association with suicidal attempts, post-adolescent females are most vulnerable. The cases of paraphenylenediamine ingestion were highest in Spring and summer seasons in Karachi. A nationwide ban on the trade of paraphenylenediamine will obviously reduce accessibility and the number of suicides.
Associations between screen time and internalizing disorder diagnoses among 9- to 10-year-olds
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Children and adolescents spend an increasing amount of time with screen media. Identifying correlates of youth mental disorders has become more urgent with rates of depression, self-harm, suicide attempts, and suicide deaths rising sharply among U.S. children and adolescents after 2012. This study examined the relationship between screen time and internalizing disorders in preadolescent children between the ages of 9 and 10.
Participants were 9- and 10-year-old youth (n = 11,780) in the baseline of the multi-site Adolescent Brain and Cognitive Development Study (ABCD). Youth reported the number of hours a day they spent watching TV shows or movies, watching videos online, playing video games, texting, using social media, and video chatting. Youth responded to an abbreviated version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-5), a semi-structured clinical interview measuring current and past symptoms of internalizing disorders using DSM-5 criteria.
Youth spending 2 or more hours (vs. less than 2) a day with screen media were more likely to fit criteria for depressive disorders, self-harm, and suicidal ideation or attempts, even after adjustment for demographic covariates. For anxiety disorders, associations with digital media use (social media, texting, gaming, and online videos) were stronger than with screen time generally.
This is a cross-sectional study utilizing retrospective screen time reports, which limits our ability to determine causality and the accuracy of the reports.
Preadolescents who spend more time using screens, especially digital media, are more likely to fit DSM-5 criteria for internalizing disorders.
Suicidal behavior in juvenile bipolar disorder and major depressive disorder patients: Systematic review and meta-analysis
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Citation Excerpt :
Of note, the ratio of attempts/suicides (A/S) among adolescents appears to be much higher (lower lethality) than in adults in the general population. Among adolescents in the general population, the A/S ratio was recently estimated at 135 in the US (Spiller et al., 2019) and 389 in the UK (average = 262), and to be 8.5-times lower (greater lethality) among males than females (Geulayov et al., 2018). In adults in the general population, the estimated A/S ratio is 30–40 (Jacobs and Klein-Benheim, 2021), and is as low as 5–10 among adults with major mood disorders (Tondo et al., 2007; Baldessarini et al., 2019).
To assess rates and lethality of suicidal behavior in studies of children and adolescents diagnosed with major depressive disorder (MDD) or bipolar disorder (BD).
This PROSPERO-registered protocol (CRD-42019159676) systematically reviewed reports on suicidal behavior among juveniles (age ≤ 18 years), and pooled data on risk (% of subjects) and rates (%/year), followed by random-effects meta-analysis and multivariable linear regression modeling.
Included were 41 reports (1995–2020) from 15 countries involving 104,801 juveniles (102,519 diagnosed with MDD, 2282 with BD), at risk for 0.80–12.5 years. Meta-analytically pooled suicide attempter-rates averaged 7.44%/year [95%CI: 5.63–9.25] with BD and 6.27%/year [5.13–7.41] with MDD. Meta-analysis of 5 studies with both diagnostic groups found significantly greater attempt risk with BD vs. MDD (OR = 1.59 [1.24–2.05], p < 0.0001). In 6 studies, suicide rate with juvenile mood disorders averaged 125 [56.9–236]/100,000/year, similar to adult rates, >30-times greater than in the general juvenile population, and higher among older adolescents. The ratio of attempts/suicides (A/S) was 52.6 among mood-disordered juveniles, indicating greater lethality than among juveniles in the general population (A/S ≥ 250), but somewhat less than in the estimated adult general population (A/S ca. 30).
Rates of suicide attempts in juveniles with a major mood disorder averaged 6580/100,000/year, were greater in BD versus MDD observed under the same conditions, and greater with shorter periods of observation. Lethality (fatalities per suicide attempt) was greater in juveniles diagnosed with major affective disorders than in the juvenile general population, but less than in adults.
Machine learning algorithms to classify self-harm behaviours in New South Wales Ambulance electronic medical records: A retrospective study
2022, International Journal of Medical Informatics
Citation Excerpt :
Importantly, females aged 15–19 years accounted for a large proportion of cases. These findings support findings from other studies that also provide evidence of increasing incidence of self-harm in adolescents and young adults [33,34], and findings from previous Australian [35] and international [36,37] studies showing this trend for young females in particular. These findings also support previous research showing that adolescent females specifically seem to be at an increasing risk for thoughts of suicide, suicide attempts, and being diagnosed with a mood disorder [38].
There is increasing interest in suicide surveillance solutions to identify non-fatal suicidal and self-harming behaviours in the Australian community not currently captured through national administrative datasets.
The aim of the present study was to develop machine learning models to classify self-harm related behaviours using unstructured clinical note text from New South Wales (NSW) Ambulance data and compare their performance via traditional methods.
Primary data were derived from NSW Ambulance electronic medical records (eMRs) for potential self-harm related NSW Ambulance attendances for the period 2013–2019. Data included paramedic clinical notes detailing the nature of the attendance, clinical outcome, and narrative information. We assessed sensitivity, specificity, positive predictive value, negative predictive value, F-score, and the Matthews correlation coefficient (MCC) for four algorithms (Support Vector Machine, random forest, decision tree, and logistic regression).
The performance of these algorithms was compared using the MCC measure. In a test sample of 3157 ambulance attendances (1349 self-harm related behaviours and 1808 unrelated), the MCC for classification of self-harm related behaviour ranged from +0.681 to +0.730. The Support Vector Machine (sensitivity = 82.7%, specificity = 89.6%, MCC = 0.730) and the logistic regression (sensitivity = 83.1%, specificity = 89.3%, MCC = 0.727) models performed best.
This study demonstrates that machine learning models can be applied to paramedic notes within unstructured medical records to classify self-harm related behaviours. The resulting model could be used to compliment current manual abstraction of self-harm behaviours and provide more timely approximations to be used for self-harm surveillance.

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: The authors declare no conflicts of interest.

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Original ArticleSex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young Adults from 2000 to 2018

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Am Acad Child Adolesc Psychiatry

Lancet Psychiatr

J Adolesc

Psych Clin North Am

Youth Risk Behavior Survey Data

Recent increases in injury mortality among Children and adolescents aged 10-19 years in the united States:1999-2016

Natl Vital Stat Rep

Psychiatric diagnosis in child and adolescent suicide

Arch Gen Psychiatry

Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement

JAMA Psychiatry

A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

Psychol Med

Current perspective on the role of psychological factors in adolescent suicide

Psychiatr Ann

Hospitalization for suicide ideation or attempt: 2008-2015

Pediatr

Youth Risk Behavior Surveillance – United States 2017

MMWR Surveil Summ

National trends in the prevalence and treatment of depression in adolescents and young adults

Pediatrics

What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries

PLoS One

Suicide acts in 8 states: incidence and case fatality rates by demographics and method

Am J Public Health

Suicide attempt as a risk factor for completed suicide: Even more lethal than we thought

Amer J Psychiatr

Completed suicide after a suicide attempt: a 37-year follow-up study

Am J Psychiatry

Original Article
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young Adults from 2000 to 2018