Mental Health: A Public Health Crisis and the Role of Pediatricians
Column Author: Theodore Brisimitzakis, DO | Clinical Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine
Column Editor: Sara J Anderson, MD, MPH | Assistant Professor, Psychiatry
Youth suicide is a critical public health crisis, with pediatricians uniquely positioned to play a pivotal role in prevention. As primary care providers for children and adolescents, pediatricians often serve as the first point of contact for young patients who may lack access to mental health specialists. They are at the forefront of identifying and addressing suicide risks.
The Scope of the Problem
Suicide among young people is a complex issue. According to the Centers for Disease Control and Prevention (CDC), individuals aged 10–24 account for 15% of suicides in the United States. Mental health disorders, particularly depression and anxiety, are significant contributors, often exacerbated by life stressors such as family conflicts, loss, or major transitions. Social challenges, like bullying and struggles with identity, further intensify feelings of isolation and hopelessness. In 2021, for instance, 9% of high school students reported attempting suicide within the previous year. Rates were disproportionately higher among girls (12.4% vs. 5.3% for boys) and non-Hispanic American Indian or Alaska Native youth (20.1%). Alarmingly, LGBTQ+ youth face an even greater risk, with 26.3% of high school students identifying as lesbian, gay, or bisexual reporting suicide attempts—five times higher than their heterosexual peers (5.2%)
Recognizing Risk Factors and Warning Signs
Identifying risk factors is essential in suicide prevention:
- Personal and Family History: A family history of mental health issues or suicide increases vulnerability. Similarly, a personal history of previous suicide attempts is a significant risk factor.
- Environmental Factors: Easy access to lethal means (e.g., firearms or medications) significantly heightens risk, emphasizing the need for means restriction as a preventive measure.
- Biological and Developmental Changes: Adolescents experience shifts in brain chemistry and hormonal fluctuations that can amplify emotional distress.
- Social Influences: Exposure to suicide through media or personal connections can increase susceptibility, while cultural pressures and societal expectations add complexity.
- Substance Use: Alcohol and drug misuse are strongly linked to suicidal behavior in adolescents.
Protective Factors
While risk factors are critical to recognize, protective factors can mitigate these risks:
- Strong social support networks
- Effective coping strategies
- Engagement in mental health treatment
- Positive connections with peers and schools
- Religious or spiritual beliefs fostering resilience
The Pediatrician’s Role in Prevention
Pediatricians are uniquely positioned to intervene through both primary and secondary prevention strategies:
- Routine Screening: Universal suicide risk screening during medical visits can identify at-risk youth who might otherwise go unnoticed.
- Safety Planning: Collaborative safety plans that involve families can be lifesaving interventions.
- Means Restriction Counseling: Educating families on securing firearms, medications and other potential means of self-harm is critical.
Responding to Acute Suicide Risk
For patients experiencing acute suicidal ideation with a plan or intent to commit suicide:
- Immediate psychiatric evaluation at a mental health facility or emergency room is necessary.
- Families should be advised to restrict access to lethal means within the home (e.g., locking up sharp objects, firearms, medications).
- Emergency resources such as 911 or 988 (National Suicide Prevention Lifeline) should be readily accessible.
Conclusion
Youth suicide is preventable when addressed through comprehensive strategies involving early identification, intervention and collaboration among health care providers, families, schools, and communities. Pediatricians play a vital role in this effort by integrating routine screening, fostering resilience in their patients and connecting families to critical resources. For more information on suicide prevention resources, visit the CDC’s Suicide Prevention Resource for Action page. The CDC has a resource for suicide prevention on their website: Suicide Prevention Resource for Action | Suicide Prevention | CDC.
References:
- Data and statistics on children’s mental health. Centers for Disease Control and Prevention. Published August 19, 2024. https://www.cdc.gov/children-mental-health/data-research/
- Facts about suicide. Centers for Disease Control and Prevention. Published July 23, 2024. https://www.cdc.gov/suicide/facts/
- Costantini L, Pasquarella C, Odone A, et al. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): a systematic review. J Affect Disord. 2021;279:473-483. PMID: 33126078. doi:10.1016/j.jad.2020.09.131
- Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021;5(5):CD013674. PMID: 34029378. PMCID: PMC8143444. doi:10.1002/14651858.CD013674.pub2
- Health disparities in suicide. Centers for Disease Control and Prevention. Published January 30, 2025. https://www.cdc.gov/suicide/disparities/