Suicide and suicidal thoughts among high school students who have accumulated adverse childhood experiences (ACEs) became a concern among health care professionals before 2020. But the “social and educational disruptions during the COVID-19 pandemic have exacerbated concerns about adolescents’ mental health and suicidal behavior,” according to a study by the Centers for Disease Control and Prevention (CDC).
ACEs are preventable, potentially traumatic events that occur before age 18 and can include neglect, divorce, and witnessing or experiencing violence. The connection between the number of ACEs and suicide is strong, says the CDC report published in the Oct. 14 Morbidity and Mortality Weekly Report.
About 73.1% of U.S. high school students reported at least one ACE during the pandemic while 53.2% reported two, 12% reported three, and 7.8% reported four or more, the study says.
“These students were more likely [than those not reporting ACEs] to report poor mental health and suicidal behavior,” the authors wrote.
The risk of suicide rises sharply along with the number of ACEs, they add. Children reporting four or more ACEs were about 25 times more likely to report poor current mental health and suicide attempts compared to those without ACEs.
Also, exposure to specific types of ACEs – like emotional abuse – were associated with a higher prevalence of poor mental health and suicidal behaviors. The data came from the Adolescent Behaviors and Experiences Survey conducted January-June 2021 among students in grades 9-12.
Many physicians who worked with young people during the pandemic have personal experience that matches the report’s conclusions, says Jeff Hutchinson, MD, an adolescent medicine specialist at People’s Community Clinic, an Austin Federally Qualified Health Center.
“A lot of the patients we have taken care of come from either neglect or abuse, or witness trauma all the time,” he said. “And our population’s rate of suicide, anxiety, and depression seems to have really increased since the pandemic.”
Compared to pre-pandemic data from CDC, the number of young people with just one ACE rose, while those with four or more declined. That pre-pandemic data shows 60.9% of young people had at least one ACE before age 18 and about 15.6% had four or more ACEs.
CDC notes the comparable pre-pandemic data is limited and has been collected retrospectively among adults, CDC says. Nevertheless, the apparent rise in the number of young people with one ACE remains a cause for concern.
“ACEs were common among U.S. adolescents during the pandemic and often resulted in acute consequences for mental health and suicidal behaviors, even among some adolescents who reported one to two ACEs,” authors wrote.
Their recommendation: Combatting the problem requires a comprehensive approach to prevention and intervention that includes connecting young people and parents to community-and school-based resources. The report also calls for “comprehensive, cross-sector approaches” among medical professionals and other stakeholders to combat the problem.
For physician offices, that includes trauma-informed care – treatment that factors in the impact of past and ongoing trauma on patients, Dr. Hutchinson says. This type of care starts with making sure mental health services are close at hand.
“We have our behavioral health people at the clinic, so we can reach out to them pretty quickly,” he said. “Our resources are still limited. Not everyone who needs to see someone can see someone at that moment, that day. But we definitely try to integrate behavioral health into all we do.”
As a statewide measure, the 2019 Texas Legislature created the Texas Mental Health Care Consortium to provide some school-based psychological counseling, as well as free telemedicine-based training and consultation for physicians. The CDC report is not the first to raise an alarm about the impact of COVID-19 on mental health among young people. Also because of pandemic fallout, the U.S. Preventive Services Task Force recently recommended children and adolescents aged 8 to 18 be screened for anxiety.
Physicians should not make the mistake of assuming all patients with multiple ACEs will necessarily be at risk for suicide, Dr. Hutchinson cautions. Instead, he suggests using this data to change policies – when needed – to provide comprehensive screening and mental health services. That approach will identify and treat those who truly are in need.
“It should change what you do as policy, not [just] what you do for individuals,” he said.