12/24/20 – WCHD Health Advisory: Be aware of the increased suicide risk in youth during COVID-19

| December 25, 2020
Female doctor with white coat and stethoscope

WCHD Health Advisory

Requested Actions

  • Screen patients for suicide risk, particularly children, teens, and young adults.
  • Share information and resources with patients and their families on crisis support and suicide risk factors and warning signs

Background

Increased concern of suicide risk in youth

A convergence of factors may be the cause of an increased risk of suicide attempts, suicidal ideation and psychological distress among Washington youth, including:

  • Extended disillusionment phase of disaster for the COVID-19 pandemic—the phase with the greatest potential behavioral health impacts. (For a description of each phase in the disaster timeline, see page 5 of COVID-19 Behavioral Health Group Impact Reference Guide.)
  • Other effects related to the pandemic, like disruption of two school years, economic effects and social isolation.
  • Seasonal changes, like reduced daylight hours and winter weather conditions.

CDC estimates, 1 in 4 people under age 18 have struggled with suicidal thoughts since the beginning of the pandemic nationwide. Moreover, more than twice as many adults reported having serious thoughts of suicide in the previous 30 days in June 2020 (10.7%) compared to the previous 12 months in 2018 (4.3%). Rates were particularly high among certain populations, including respondents who are age 18-24 years (25.5%), Latinx (18.6%), Black (15.1%) and essential workers (21.7%). As a result, CDC recommends community-level intervention and prevention to address this concern.

Screening

We recommend using the National Institute of Mental Health’s Ask Suicide-Screening Questions (ASQ) tool for patients age 10-24 years. For example, ask patients if they have:

  1. Current or recent suicidal ideation.
  2. Past suicidal ideation or attempts.
  3. A plan.
  4. The means or access to carry out the plan.
  5. The intention to carry out the plan.
  6. Protective factors.

Prepare for screening and supporting patients and families

Have information ready to advise young people struggling with suicidal thoughts or actions and their families. Parents may need counseling on safety planning and contact numbers for crisis outreach. See the Resources section below for information for providers, patients and families.

The COVID-19 pandemic has created difficulty in accessing behavioral healthcare, as behavioral health providers are seeing a surge in new patients. Counsel parents that it may take some time before their child can get into treatment. It may be helpful to discuss interim planning. For example, you can offer follow-up appointments to monitor and support until the patient can begin behavioral health treatment.

Sometimes young people in crisis may not agree to treatment. Provide parents information on involuntary treatment in Washington, including the need for a designated crisis outreach provider to assess and make the determination. Learn about these processes and gather contact information for designated crisis responders. Additionally, provide counseling and information for parents on safety planning and actions for reducing access to methods of self-harm.

To help increase emotional health, we encourage everyone to work on building resilience. Whenever possible, encourage patients to access their support network for assistance, and consider facilitating that connection with the patient’s permission.

Suicide warning signs: Everyone can play a role in suicide prevention. Know the suicide warning signs:

  • History of suicide attempt(s).
  • Current talk of suicide or making a plan.
  • Strong wish to die or a preoccupation with death.
  • Giving away prized possessions.
  • Signs of depression, like moodiness, hopelessness or withdrawal.
  • Increased alcohol and/or other substance use.
  • Hinting at not being around in the future or saying goodbye.

Suicide risk factors: Ask patients about the following risk factors for suicide:

  • Unsecured firearms.
  • Recent loss or trauma.
  • Accessible medications or substances in the home.
  • Social isolation.
  • Hopelessness for the future.

Although there is stigma around discussing suicide, research shows it is best to ask about suicide directly. Ask patients candidly if they have had thoughts or feelings about suicide and if they are a danger to themselves. Asking about suicide does not increase risk—it increases safety.

Resources

For providers:

For patients and families:

For more information, contact:

Whatcom County Health Department

1500 N State Street, Bellingham WA 98225

360-778-6100 Main | 360-778-6150 24-hour Communicable Disease Program Report Line

360-778-6101 Fax