Rate of pediatric suicide higher in areas with more poverty
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NEW ORLEANS — Counties with higher levels of poverty have higher levels of pediatric and adolescent suicide, according to research presented at the AAP National Conference & Exhibition. The rate of suicide by firearm also increased as poverty levels increased, researchers found.
“Further work needs to be done to explain why children living in high poverty areas are at increased risk for suicide,” Jennifer Hoffmann, MD, a fellow in pediatric emergency medicine at Boston Children’s Hospital, told Infectious Diseases in Children. “More research is needed to figure out whether children living in high poverty areas have decreased access to mental health care services. We need to find out if there are differences in availability of firearms or safe firearm storage practices in high poverty areas.”
The findings were presented on the heels a CDC report that showed an accelerating suicide rate among people aged 10 to 24 years in the United States. Researchers reported that the rate nearly tripled between 2007 and 2017.
Hoffmann and colleagues conducted a retrospective, cross-sectional analysis of suicides occurring between 2007 and 2016 among children aged 5 to 19 years found in the CDC Compressed Mortality File. They gathered geographic and socioeconomic data — including county-level poverty and the percentage of residents living below the federal poverty level — from U.S. Census data.
During the study period, nearly 21,000 pediatric suicides occurred. Most (85%) were reported for adolescents aged 15 to 19 years, 76% were male and 82% were white. The overall rate of suicide per year was 3.4 per 100,000 children aged between 5 and 19 years.
The researchers identified higher suicide incidence in counties with a poverty concentration of more than 10% compared with counties with a poverty concentration between 0% and 4.9%. As poverty concentrations increased, suicide rates also increased. For counties with a poverty concentration between 10% and 14.9%, the adjusted incidence rate ratio (aIRR) was 1.33 (95% CI, 1.11-1.54). The rate increased for counties with a poverty concentration between 15% to 19.9% (aIRR = 1.38; 95% CI, 1.17-1.62) and counties with a poverty concentration of 20% or higher (aIRR = 1.6; 95% IC, 1.34-1.91).
“As a pediatric emergency medicine physician, I am seeing more and more children visiting the ED over time due to having thoughts of wanting to kill themselves,” Hoffmann said. “I have personally seen children sustain devastating injuries from suicide attempts. I know that connecting children who are having suicidal thoughts to the right resources can really help save lives.”
The researchers noted a higher rate of suicide by suffocation in counties with poverty concentrations of 20% or higher (aIRR = 1.33; 95% CI, 1.04-1.69) compared with counties with poverty concentrations between 0% and 4.9%. The rate of suicide by firearm also increased with increasing poverty concentrations (5%-9.9%: aIRR = 1.45 [95% CI, 1.11-1.9]; 10%-14.9%: aIRR = 1.89 [95% CI, 1.44-2.47]; 15%-19.9%: aIRR = 2.15 [95% CI, 1.64-2.82]; 20% or higher: aIRR = 2.44 [95% CI, 1.84-3.23]).
“Parents and pediatricians can both play an important part in suicide prevention by talking to children openly about mental health,” Hoffmann said. “To prevent teen suicide, parents should safely store any guns in the home locked and unloaded, with the ammunition locked separately, because this is a proven way to prevent teen suicide by firearms.”
The researchers found no association between suicides by poisoning and poverty concentration.
“The next step to address this issue will be more research to determine why children living in high poverty areas are at increased risk for suicide,” Hoffmann said.
References:
Curtain SC, Heron M. NCHS Data Brief. October 2019;No. 352.
Hoffmann J, et al. Pediatric suicide rates and community-level poverty in the United States, 2007-2016. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.
Disclosure: Hoffman reports no relevant financial disclosures.