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National Emergency Declared in Child and Adolescent Mental Health

There is a crisis in the mental health of young people across the United States. On Tuesday, October 19, 2021, The American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA) declared a National State of Emergency in Children’s Mental Health [1]. The professionals in these organizations have witnessed a sharp increase in the rates of mental health challenges in children and adolescents during the pandemic. These mental health challenges could come in the form of depression, anxiety, trauma responses, and/or suicidality (i.e., suicidal ideation, plans, and attempts), among other features. For example, a recent study from the Centers for Disease Control and Prevention (CDC) found that in February and March of 2021, the number of girls aged 12-17 who visited the emergency department (ED) for suicide attempts was a startling 50% higher than the same time period in 2019 [2]. Suicide prevention measures in our country, where they exist, are failing.


Unfortunately, this emergency is not coming out of the blue. Even before the pandemic, the mental health of young people was a looming concern, with 6,500 people of ages 5-24 years old in the U.S. having completed suicide in 2019 [3]. This number has steadily increased from around 4,100 deaths by suicide in the same age group in 1995 [3]. In 2018, suicide was the second leading cause of death for youth ages 10-24 [1]. The U.S. has been experiencing high rates of suicide and mental health challenges for decades; the COVID-19 pandemic has only exacerbated an existing problem.


As we all know, the COVID-19 pandemic has affected our mental health in many ways. Perhaps the most striking effect has been the experience of social isolation. Extended separation from friends, family members, loved ones, and society in general is a difficult circumstance to deal with, and can have lasting consequences after the pandemic. Studies in animal models show that social isolation affects the brain, behavior, and increases the likelihood of developing a mental health condition [4,5,6]. For children and adolescents with developing minds, isolation can have even more pronounced long-term consequences. Research shows that social isolation early in life could have effects on the brain at a cellular level that hinders learning and memory [7]. Plus, adolescents may perceive their feelings and emotions at a different scale to adults so that their personal situation becomes magnified [8], which could make them more likely to take the next steps toward suicide.


All of this research suggests that isolation during early life is harmful for the brain and mental health prognoses. We must have more funding and programs in place to protect children and adolescents from reaching the point of suicidality. The CDC and National Institute of Mental Health (NIMH) have proposed comprehensive programs that can prevent suicide [9,10]. Now, more than ever, our country needs to embrace these policies and programs, fund them, and ensure that they are implemented nationwide in order to protect the next generation.


If you or someone you know need support or are experiencing suicidality, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “HOME” to 741741.



References:


1. American Academy of Pediatrics. (2021, October 19). AAP-AACAP-CCHA Declaration of a national emergency in child and Adolescent Mental Health. Retrieved October 21, 2021, from https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/

2. Centers for Disease Control and Prevention. (2021, June 17). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID-19 pandemic - United States, January 2019–May 2021. Retrieved October 21, 2021, from https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm?s_cid=mm7024e1_w

3. Population Reference Bureau. (n.d.). Number of youth suicides, by age group. Kidsdata.org. Retrieved October 21, 2021, from https://www.kidsdata.org/topic/211/suicides-age/trend#fmt=123&loc=1&tf=13,124&ch=787&pdist=7.

4. Begni, V., A. Sanson, N. Pfeiffer, C. Brandwein, D. Inta, S. R. Talbot, M. A. Riva, P. Gass and A. S. Mallien (2020). "Social isolation in rats: Effects on animal welfare and molecular markers for neuroplasticity." PLOS ONE 15(10): e0240439.

5. Malkesman, O., R. Maayan, A. Weizman and A. Weller (2006). "Aggressive behavior and HPA axis hormones after social isolation in adult rats of two different genetic animal models for depression." Behavioural Brain Research 175(2): 408-414.

6. Mudra Rakshasa, A. and M. T. Tong (2020). "Making “Good” Choices: Social Isolation in Mice Exacerbates the Effects of Chronic Stress on Decision Making." Frontiers in Behavioral Neuroscience 14(81)

7. Cinini, S., G. Barnabe, N. Galvao-Coelho, M. Medeiros, P. Perez-Mendes, M. Sousa, L. Covolan and L. Mello (2014). "Social isolation disrupts hippocampal neurogenesis in young non-human primates." Frontiers in Neuroscience 8(45).

8. Hazler, R. J. and S. A. Denham (2002). "Social Isolation of Youth at Risk: Conceptualizations and Practical Implications." Journal of Counseling & Development 80(4): 403-409.

9. Centers for Disease Control and Prevention. (2021, September 7). Suicide prevention. Retrieved October 21, 2021, from https://www.cdc.gov/suicide/index.html.

10. U.S. Department of Health and Human Services. (n.d.). Suicide prevention. National Institute of Mental Health. Retrieved October 21, 2021, from https://www.nimh.nih.gov/health/topics/suicide-prevention.


Cover image from https://labblog.uofmhealth.org/rounds/why-pediatricians-should-screen-for-depression-young-patients

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