Youth Suicide Attempts by Poisoning Jumped During the Pandemic

Rates of suspected suicide attempts by poisoning increased among children and adolescents during the COVID pandemic, according to a retrospective study.

Compared with 2019, the overall rate of suspected suicide attempts by self-poisoning among those ages 10 to 19 increased by 30% in 2021 (95% CI 28.6-30.9), reported Christopher Holstege, MD, of the University of Virginia School of Medicine in Charlottesville, and colleagues.

These rates increased 73% among kids ages 10 to 12, 48.8% among adolescents ages 13 to 15, and 36.8% among females, with trends continuing into the third quarter of 2022, they reported in the Morbidity and Mortality Weekly Report.

“These findings suggest that the mental health of children and adolescents was affected by the pandemic, raising concerns about long-term consequences, especially given that previous attempted suicide has been found to be the strongest predictor of subsequent death by suicide,” Holstege and colleagues wrote.

An increase in emergency department visits for suspected suicide attempts was also noted among those ages 12 to 17, particularly among adolescent girls, beginning in mid-2020, based on data from the National Syndromic Surveillance Program, they said.

Substances most frequently involved in suspected suicide attempts included acetaminophen, ibuprofen, sertraline, fluoxetine, and diphenhydramine (Benadryl). Acetaminophen-involved overdoses increased 71% in 2021 and 58% in 2022, while diphenhydramine-involved overdoses increased 24.2% and 35.8%, respectively, compared with those in 2019.

Of note, the monthly variation in suspected suicide attempt calls among kids and teens increased during schools months, with a sharp increase in September, and a decline during summer months and winter breaks. In addition, during the period when the national lockdown was implemented (April-May 2020), rates of suspected suicide attempt calls were lower compared with rates during the same months in 2019, as well as in 2021 and 2022. The overall rate of suspected suicide attempts by self-poisoning among those ages 10 to 19 increased by 5.4% in 2020 compared with 2019.

“It is imperative to mitigate this increase with suicide prevention measures that focus on children and adolescents and involve partnerships between key partners in the communities, such as families, school teachers, mental health professionals, and public health leadership,” Holstege and team wrote.

“Suicide prevention resources and tools are available to help communities prevent suicide,” they added. “These strategies include identifying and supporting youth at risk for suicide, creating protective environments through reduction of access to lethal means, improving access to mental healthcare, and teaching coping and problem-solving skills.”

Furthermore, the 988 Suicide and Crisis Lifeline, a network of centers supported by local and state sources, as well as HHS, became available nationally in July 2022.

For this study, Holstege and colleagues used the National Poison Data System (NPDS) to examine trends in suspected suicide attempts by self-poisoning among children and teenagers before and after the pandemic. Overall, 88,535 attempts were reported in 2019 (rate of 209.2 per 100,000); 93,265 in 2020 (220.7 per 100,000); 114,664 in 2021 (272 per 100,000), and 104,888 in 2022 (248.6 per 100,000).

Though the overall number of human exposure calls to poison control centers decreased 3.1% from 2019 to 2021, suspected suicide attempt calls increased 29.5% over that same period.

Holstege and colleagues noted several limitations to their study. NPDS data are not designed to assess potential risk factors leading to increases in suspected suicide attempts. Furthermore, NPDS data are susceptible to reporting bias because they are affected by completeness of reporting from healthcare providers and the general public, as well as the accuracy of data entry and coding by poison control center staff.

In addition, multiple substances can be reported for each call to these centers, and it was not possible to determine which substance was most related to the clinical effects and medical outcome. Because reporting to poison control centers is voluntary, NPDS data do not represent all cases of suspected suicide attempts.

If you or someone you know is considering suicide, call the 988 Suicide and Crisis Lifeline.