Researchers from the Instituto de Investigación Biomédica de Salamanca, the USAL and the Complejo Asistencial Universitario de Salamanca (CAUSA) have collected data related to suicidal ideation and self-injury in all patients under 18 years of age who required psychiatric services in the ER during the years 2019 -prepandemic-, 2021 and 2022 to establish the comparative.
The results, published in the high-impact journal ‘Healthcare’, reveal that the number of children treated for suicidal thoughts has increased fourfold in this period, and the authors recommend further studies to analyze this growing trend and call for adjustments in health care systems to prevent further deterioration of child and adolescent mental health.
Researchers from the Institute of Biomedical Research of Salamanca (IBSAL), the University of Salamanca (USAL) and the Complejo Asistencial Universitario de Salamanca (CAUSA, Sacyl – Junta de Castilla y León) have evaluated the evolution of the risk of suicide in children and adolescents in the Emergency Department after the pandemic and the results show a worrying increase in 2022 compared to 2019.
The study, led by Dr. Jesús Pérez Sánchez-Toledo from the PRevención e INtervención Temprana en Salud Mental (PRINT) group at IBSAL, and published in the high-impact journal Healthcare, reveals, among other data, that suicidal behaviors in this population increased fourfold in December 2022 compared to pre-covid-19 times, and may continue to increase.
Specifically, of the 316 under-18s seen by on-call psychiatry services at the Salamanca hospital during the three time periods, 78 were seen in 2019, 98 in 2021 and 140 in 2022, showing this growing demand for urgent care in child and adolescent mental health.
Of all the patients seen, with an average age of 15 years and with a percentage of women twice that of men, the proportion of those who showed suicidal ideation increased significantly each year: more than half expressed these thoughts in 2022 when in 2019 this percentage was 25%. And if we talk about total figures, 79 patients presented suicide risk in the last year analyzed compared to 19 who did so in the pre-pandemic, i.e. four times more. And although this increase was not as large in self-injurious behaviors, almost 48% of patients seen in the ED in 2022 had self-injured compared to 33% three years earlier.
Graph: Number of patients under 18 years of age seen in the ED due to mental health problems in 2019, 2021 and 2022, and number of patients who presented with suicidal ideation or self-injurious behavior.
New habits of youth: social networks
As Dr. Jesús Pérez points out, this study, which has not included data relating to the year 2020 given the difficulties in tracking them during an unprecedented public health crisis, shows “an exponential increase” in the care of minors with suicidal ideas, and “although we have used the pandemic as a reference, we do not know whether this trend was already present or has accelerated, and whether it responds to the new habits of young people related, among other factors, to the misleading use of social networks and easy access to undesirable information”.
This would also explain increasingly prevalent phenomena in our country such as self-harm, which, as the principal investigator of the study explains, “were more widespread in the United Kingdom years ago when in Spain they were a one-off occurrence, but now we are at the same level after a process of cultural contagion may have occurred due to the immediate access to information or fashions from any country in the world”.
Along the same lines, Ana Maciá-Casasas, psychiatrist of the Child and Adolescent Mental Health Team of Salamanca and first author of this study, assures that, although this growing trend in suicidal ideation has already been seen in other studies, also in adults, “after the pandemic it has skyrocketed”. This could be due to “multiple associated socioeconomic factors that have psychological repercussions, not only in children and adolescents, but also in their families”.
According to his clinical experience, and in the absence of analyzing the 2023 data on minors seen in the emergency department for mental health problems, the situation has not improved, and “this is just the tip of the iceberg”.
Nevertheless, the published article concludes that more research is needed to understand the possible factors involved in this sustained upward trend, which may be related to or exacerbated by the long-term impact of the pandemic on our younger populations. “This understanding should help us develop initiatives and adjustments in health care systems to prevent further deterioration in the mental health of more children and youth,” the study adds.
Two new studies: psychotropic drugs and adaptation of healthcare systems
To contribute to this, the PRINT group of IBSAL already has two other national and international research projects underway, which, together with the previous study, are part of the doctoral thesis of Ana Maciá-Casas. The first of them will address whether there is also an increase in the use of psychotropic drugs in the child and adolescent population during the last five years. To address this, they will propose a study using data from BIFAP (Database for Pharmacoepidemiological Research in the Public Sphere) of the AEMPS (Spanish Agency of Medicines and Health Products); the aim is also to elucidate whether these drugs are correctly indicated for this group or whether they are prescribed because there are no other non-pharmacological treatment options available for this population.
The second work, closely related to the necessary and pending global approach to this manifest deterioration of mental health among young people, will review how health systems around the world are adapting to this new scenario and how this knowledge can be applied in Salamanca or in the rest of the national territory.
“In Spain there is still no national strategy against suicide, and it is already the leading cause of death among young people,” say the researchers, who point to prevention and early treatment as fundamental keys to tackling this problem, especially considering that serious mental disorders may underlie it.
“Most of these illnesses begin at an early age and the idea of self-injury is not usually something isolated, but there is probably already an underlying pathology. When we diagnose schizophrenia, bipolar disorder or severe depression and analyze retrospectively, we can already see how this disorder was being forged from an early age and perhaps there was a visit to a care facility for possible emerging mental health problems that was not given sufficient importance,” they conclude.
Photo: Researchers Ana Maciá-Casas and Jesús Pérez Sánchez-Toledo, at the Faculty of Medicine of the University of Salamanca.
Reference article:
Maciá-Casas, A.; de la Iglesia-Larrad, J.; García-Ullán, L.; Refoyo-Matellán, B.; Munaiz-Cossío, C.; Díaz-Trejo, S.; Berdión-Marcos, V.; Calama-Martín, J.; Roncero, C.; Pérez, J. Post-Pandemic Evolution of Suicide Risk in Children and Adolescents Attending a General Hospital Accident and Emergency Department. Healthcare 2024, 12, 977. https://doi.org/10.3390/healthcare12100977. https://doi.org/10.3390/healthcare12100977
The IBSAL
The Institute of Biomedical Research of Salamanca (IBSAL) was established on March 21, 2011 through an agreement signed by the Ministry of Health of the Regional Government of Castilla y León and the University of Salamanca, which was joined in February 2012 by the Spanish National Research Council (CSIC). It integrates and coordinates the biosanitary research carried out at the University Hospital of Salamanca, the Primary Care Management of Salamanca and the biosanitary area of the University of Salamanca, including the Institute of Neurosciences of Castilla y León and the Institute of Molecular and Cellular Biology of Cancer.
Its scientific activity is structured in six areas, with a total of 84 research groups: Cancer (23 groups); Cardiovascular, Renal and Respiratory (11); Neurosciences (12); Infectious, Inflammatory and Metabolic Diseases (17); Gene and Cell Therapy and Transplants (6) and Primary Care, Public Health and Pharmacology (15).
More information and contact:
comunicacion@ibsal.es
