Many healthcare professionals fear the social isolation, anxiety, threat of contagion, and uncertainty caused by the COVID-19 pandemic may lead to an increase in suicide rates.

The Spanish Flu epidemic—the last crisis comparable to COVID-19—was associated with an increase in death by suicide due to the decrease in social integration and interaction during the event.

Multiple cases of COVID-19-related suicides in the hardest-hit countries have already been reported. As disturbing as this is, the fear that suicide rates will increase among adolescents is even more so.

With this month’s emphasis on suicide prevention—September is National Suicide Prevention Month and September 10 is World Suicide Prevention Day—we want to turn our attention to children and adolescents, explore the difficulties kids face this year because of COVID-19, and discuss how to be conscious of youth behavioral health.

Youth Behavioral Health & Suicide Prevention During COVID-19

Suicide is already the second leading cause of death for people age 10-24, and suicide rates among teens are on the rise, according to a 2019 study published by the Journal of Abnormal Psychology, as reported by Time.

The concern is that COVID-19’s impact on youth behavioral health could be detrimental due to the financial, emotional, and health-related stressors impacting a family. As one mental health professional put it, “If there were problems at home to begin with, they are definitely going to be heightened during this time.”

A 2019 study in the journal European Child & Adolescent Psychiatry found that three main contributors increase the risk of suicide among young people:

  • Psychological factors - depression, anxiety, and drug abuse;
  • Stressful life events - family problems and peer conflicts;
  • Personality traits - neuroticism and impulse problems.

“In children and adolescents, life events preceding suicidal behavior are usually family conflicts, academic stressors (including bullying or exam stress), trauma, and other stressful life events,” the study's authors wrote.

The danger is that all of these are at play during the pandemic. 

While it’s too soon to say empirically what effect the pandemic will have on youth suicide rates, a recently-published study out of China found that children confined at home by the coronavirus lockdown had “elevated rates of depression and anxiety, raising concerns about the risk for American kids as the pandemic sweeps the nation.” 

“Nearly 23% of the 1,784 children who responded to a survey reported feeling depression, likely due to ‘the reduction of outdoor activities and social interactions,’ according to JAMA Pediatrics, citing the study. “Almost 19% said they had anxiety symptoms.” Both figures were higher than the baseline rates of 17.2% for depression and 9.3% for anxiety.

Suicide Signs & Symptoms

Despite the lack of evidence, it’s in the child’s best interest for parents and caretakers to be aware of suicidal signs and symptoms and take proper precautions. 

The Mental Health America website lists these and other warning signs:

  • Threats of suicide—either direct or indirect;
  • Verbal hints such as “I won’t be around much longer” or “It’s hopeless”;
  • Obsession with death;
  • Depression;
  • Sudden cheerfulness after a period of depression;
  • A dramatic change in personality or appearance;
  • Becoming angered easily;
  • Changes in eating or sleeping patterns.

If a child displays any of these symptoms, call the National Suicide Prevention Lifeline at 800-273-8255. If you are concerned that a child is in immediate danger of taking suicidal action, call 911 or take them to the closest emergency room.

Warning sign awareness is one way to prevent the possibility of completed suicide, but parents and caretakers can take other steps to support children and teens.

Keep communication lines open. One way to support at-risk children and adolescents during and after the pandemic is to practice open and honest communication. Make space for dialog even if your child doesn’t want to talk and validate their feelings when they do.

Practice physical distancing, not social. Social distancing, despite the nomenclature, really means physical distancing. Even if your children are unable to attend school in-person, that doesn’t mean they can’t stay in touch with their friends via phone, chat, or video.

Keep calm and carry on. Parents and caretakers can help kids enhance their sense of control by regulating their own anxieties. Put on your oxygen mask before helping others, the saying goes. Keeping calm will ensure you and your children can carry on.

Stay positive. Parents and caretakers set the tone in the household. Expressing doom and gloom can affect teens. Try to stay positive and relay consistent messages that assure them “this, too, shall pass.”

Limit access to news coverage. Someone said, “all news is bad news,” and that’s mostly true with COVID-19. If your children spend extended time at home, limit exposure to news coverage, including social media.

Provide a structured environment. If schools are closed, do your best to keep regular routines for learning and fun activities. Also, maintain normal schedules for daytime and bedtime.

Hospital & Health System Youth Suicide Prevention Support

How can hospitals and health systems improve their support for youth mental health in the community and inside their walls?

Use Telehealth for Mental Health

There is national momentum to increase the use of telehealth in response to COVID-19. Unfortunately, “tele–mental health” treatments for individuals with suicidal ideation have lagged far behind, the AMA says. Despite possible concerns over adverse events or lawsuits, the current circumstances mandate telehealth and telemedicine use for mental health.

Prepare ED Providers to Treat Suicidal Patients

The emergency department is the hospital’s first line of defense against death by suicide, so providers must be prepared to treat suicidal patients. That includes having intimate knowledge of the risk factors, a psychiatric and risk assessment plan at the ready, and knowing how to manage suicidal patients.

Conduct a Community Health Needs Assessment

The Patient Protection and Affordable Care Act requires non-profit hospitals to conduct community health needs assessments to guide community-based health education programs. While this strategy is more long-term than immediate, it helps hospitals understand the community’s health needs, including mental health among at-risk youth.

Collaborate with Community-based Organizations

Another way hospitals can positively impact a community’s behavioral health is through collaboration with community-based organizations. The American Hospital Association has compiled an extensive list of behavioral health community collaboration resources to provide direction. 

Youth Suicide Prevention Resources

To round out this post, we have assembled a comprehensive list of youth suicide prevention resources to help parents, caretakers, schools, hospitals, and healthcare professionals. 

National Suicide Prevention Lifeline

The lifeline provides 24/7, free, and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. It also contains a section on youth suicide.

Promote National Suicide Prevention Month
This resource from the National Suicide Prevention Lifeline offers ways to raise awareness of suicide prevention during September. 

Support for Teens and Young Adults
A resource from the CDC for young people on how to manage stress related to COVID-19. 

The Jason Foundation
The Jason Foundation is a non-profit organization committed to suicide prevention. The website has an entire section devoted to youth suicide.

COVID with Kids
A toolkit for coping with kids at home during the pandemic.

Preventing Youth Suicide: Tips for Parents & Educators
A resource from the National Association of School Psychologists covers risk factors, warning signs, steps to take, and the role of schools and parents.