Publications - Self-Injury

When Teens Visit Doctors, Increasingly the Subject is Mental Health, by Matt Richtel, The New York Times, Mar 7 2024.

“Increasingly, doctor visits by adolescents and young adults involve mental health diagnoses, along with the prescription of psychiatric medications. That was the conclusion of a new study that found that in 2019, 17 percent of outpatient doctor visits for patients ages 13 to 24 in the United States involved a behavioral or mental health condition, including anxiety, depression, suicidal ideation, self-harm or other issues. That figure rose sharply from 2006, when just 9 percent of doctor’s visits involved psychiatric illnesses. The study, published Thursday in JAMA Network Open, also found a sharp increase in the proportion of visits involving psychiatric medications. In 2019, 22.4 percent of outpatient visits by the 13-24 age group involved the prescription of at least one psychiatric drug, up from 13 percent in 2006. The latest study does not posit a reason for the shift. But the pandemic alone was not to blame, it noted. “These findings suggest the increase in mental health conditions seen among youth during the pandemic occurred in the setting of already increasing rates of psychiatric illness,” wrote the authors, a pediatrician and psychiatrist at Harvard Medical School. “Treatment and prevention strategies will need to account for factors beyond the direct and indirect effects of the pandemic.” ”

One Twin Was Hurt, the Other Was Not. Their Adult Mental Health Diverged., by Ellen Barry, The New York Times, Mar 6 2024.

“Why do twins, who share so many genetic and environmental inputs, diverge as adults in their experience of mental illness? On Wednesday, a team of researchers from the University of Iceland and Karolinska Institutet in Sweden reported new findings on the role played by childhood trauma. Their study of 25,252 adult twins in Sweden, published in JAMA Psychiatry, found that those who reported one or more trauma in childhood — physical or emotional neglect or abuse, rape, sexual abuse, hate crimes or witnessing domestic violence — were 2.4 times as likely to be diagnosed with a psychiatric illness as those who did not. If a person reported one or more of these experiences, the odds of being diagnosed with a mental illness climbed sharply, by 52 percent for each additional adverse experience. Among participants who reported three or more adverse experiences, nearly a quarter had a psychiatric diagnosis of depressive disorder, anxiety disorder, substance abuse disorder or stress disorder. To disentangle the effects of these traumas from genetic or environmental factors, the researchers narrowed the pool to “discordant” pairs, in which only one twin reported maltreatment in childhood. An analysis of 6,852 twins from these discordant pairs found that childhood maltreatment was still linked with adult mental illness, though not as strongly as in the full cohort. A twin who reported maltreatment was 1.2 times as likely to suffer from a mental illness as the unaffected twin in identical twin pairs, and 1.7 times as likely in fraternal twin pairs. This effect was especially pronounced among subjects who reported experiencing sexual abuse, rape and physical neglect. ”

Mental health-related emergency department visits and revisits are on the rise among children, study finds, by Jacqueline Howard, CNN, Dec 27 2022.

“Emergency department visits and revisits in children’s hospitals that are related to mental health are “increasing rapidly,” a new study suggests.  Between 2015 and 2020, mental health visits in pediatric emergency departments increased by 8% annually, with about 13% of those patients revisiting within six months, according to the study published Tuesday in the journal JAMA Pediatrics. Whereas, all other emergency department visits increased by 1.5% annually.  Mental health revisits increased by 6.3% annually, but in general, the percentage of mental health visits that had a subsequent revisit remained stable, “which may reflect that the factors associated with revisit did not change substantially during the study period, even as the pediatric mental health crisis worsened,” wrote the researchers, from Children’s Hospital Los Angeles, the University of Southern California and Boston Children’s Hospital.  The ongoing surge in pediatric mental health emergency department visits may be associated with “a combination of factors, including a worsening crisis of pediatric mental illness and shortage of mental health clinicians,” the researchers wrote.  The most common diagnoses among the mental health emergency department visits were suicidal ideation or self-harm, representing 28.7% of patients; mood disorders at 23.5%; anxiety disorders at 10.4%; and disruptive or impulse control disorders at 9.7%. ”

10 ways to get mental health help during a therapist shortage, by Lindsey Bever, The Washington Post, Oct 29 2022.

“Anxiety and depression have been on the rise in the United States since the start of the pandemic. This has led to a crisis in mental health that has been worsened by the shortage of mental health counselors.  A significant number of mental health professionals are not accepting new clients. Others have long waiting lists.  The Washington Post asked mental health professionals what advice they would give people who are struggling to find a therapist. About 300 experts from across the country responded with advice on getting an appointment — and tips on what people can do in the meantime to try to help themselves. Here are their recommendations. ”

Long waiting lists, long drives and costly care hinder many kids’ access to mental health care, by Brenda Goodman, CNN, Oct 6 2022.

“Norris is one of more than 2,000 adults surveyed this summer by CNN and the Kaiser Family Foundation about mental health issues in America. The nationally representative sample included more than 500 parents.  Nearly half of those parents, 47%, say the pandemic has negatively affected their kids’ mental health, with 17% saying it had a major negative impact.  More than 8 out of 10 parents said they’re at least somewhat worried about depression, anxiety, alcohol and drug use negatively affecting the life of US teens, while roughly three-quarters said they were worried about self-harm or pandemic-related loneliness and isolation.  More than 4 in 10 said they were very worried about alcohol and drug use, anxiety and depression affecting teens. Lower-income parents – those making less than $40,000 a year – were more likely than those in higher-income households to say they’re very worried about self-harm, eating disorders, depression and alcohol and drug use.  According to the survey, more than half of Americans (55%) think most children and teenagers in the US aren’t able to get the mental health services they need. ”

As school starts, teachers add a mental-health check-in to their lesson plans, by Rhitu Chatterjee, NPR, Sep 2 2022.

“As the new school year begins, teachers at many schools across the country are adding a new component to their routines: a mental health check-in with their students. The idea is to open up conversations around how kids are feeling emotionally, and to connect them to help before issues escalate to a crisis. [...] The new approach comes after two and a half rocky years of pandemic, with kids' lives disrupted by bouts of remote schooling and many families in economic stress, which worsened the already shaky state of children's mental health in the U.S. In 2020, the CDC reported a greater proportion of kids showing up at emergency rooms in a mental health crises: serious suicide attempts, eating disorders, aggressive behaviors. "The thing that's most concerned us was really the number of significant self-harm and suicidal ideation that we've seen in an emergency room," says Dr. Smriti Khare, pediatrician and the chief mental and behavioral health office at Children's Wisconsin, in Milwaukee, which saw a 40% rise in visits to the ER after the start of the pandemic in 2020 compared to the year before. ”

Why It’s So Hard to Find a Therapist Who Takes Insurance, by Andrea Petersen, The Wall Street Journal, Oct 5 2021.

“Finding a therapist who takes insurance was tough before the pandemic. Now, therapists and patients say, an increase in the need for mental-health care is making the search even harder. Especially in big cities such as Los Angeles, New York and Washington, D.C., demand for mental-health care is so strong that many experienced therapists don’t accept any insurance plans, they say. They can easily fill their practices with patients who would pay out of pocket, they add. Therapists who do take insurance are often booked up. And in many smaller towns and rural areas, there are few mental-health professionals at all. Finding a provider who takes insurance, or lowering your rates in other ways, is possible but often takes legwork that can be draining when you are already grappling with mental-health issues. About 34% of people with private insurance said they had difficulty finding a therapist who would accept their coverage, according to a 2016 survey—the most recent data available—of more than 3,100 participants conducted by the National Alliance on Mental Illness, a national mental-health advocacy group. By comparison, 9% said they had difficulty finding an in-network primary-care provider.  Office visits to mental-health providers are more than five times more likely to be out of network than are visits to primary-care providers, according to a 2019 report from Milliman, a consulting firm, which analyzed insurance-claims data. In 2017, 17.2% of mental-health office visits were out of network, compared with 3.2% of primary-care visits, the Milliman report found. ”

How A Hospital And A School District Teamed Up To Help Kids In Emotional Crisis, by Rhitu Chatterjee, NPR, Jun 11 2021.

“The concerning rise in mental health issues noticed by school administrators mirrors national trends. Roughly 1 in 5 U.S. children meet criteria for a mental health disorder, and the rate of suicide attempts among youth has risen over the past decade, according to the U.S. Centers for Disease Control and Prevention.  Around the country, most kids who have mental health issues don't get treatment. There's a shortage of providers who work with children and it can take months to get an appointment.  "The wait times on an average to see a mental health specialist on an emergency basis is somewhere between two to three months, and for regular basis is up to 12 months, which is an unacceptable wait time," says Dr. Ujjwal Ramtekkar, a child and adolescent psychiatrist at Nationwide Children's Hospital. ”

Lesbian, Gay Youth at Higher Risk for Self-Harm, by Richard Liu., 2019.

“An alarming number of teens practice self-harm, but lesbian, gay and bisexual teens may be more than twice as likely as their straight peers to cut, hit or bruise themselves, new research warns. LGBT youth -- particularly those of color -- are often subject to "emotional isolation" as a result of blame, shame and criticism of their core identities and feelings. They are also much more likely to end up homeless, in foster care or involved with the juvenile justice system, and they face a harder time finding work ”

ER visits for physical ailments tied to self-harm risk, by Lisa Rapaport , Reuters, Dec 20 2018.

“Teens and young adults who visit emergency rooms for injuries or physical illnesses may be more likely to harm themselves afterward, a U.S. study suggests. Emergency room (ER) visits for mental health disorders or substance misuse have long been linked to an increased risk for self-harm and suicidal thoughts and behaviors among teens and young adults. The current study focused on teens and young adults, ages 15 to 29, who visited an ER for more common reasons: physical illnesses and injuries. It found that these individuals were much more likely to harm themselves after being treated for a wide range of conditions including epilepsy, back pain, headaches and dental problems. ”

Doctors struggle to help older gun owners, by Carolyn Crist, Reuters, Dec 14 2018.

“Doctors who work with seniors are grappling with ways to prevent gun-related suicides and accidents, often among gun-owning older patients with dementia or depression, according to a recent review article. People older than 65 have the highest rates of gun ownership, depression and suicide in the U.S., and while they’re less likely to be victims of violent crimes, they are more likely to become victims of their own guns, the authors write in the Journal of the American Osteopathic Association. ”

Even with insurance, getting mental health treatment is a struggle in Mass., study says, by Liz Kowalczyk, Boston Globe, Dec 11 2018.

“Massachusetts residents who need health care are colliding with a hard reality: Having medical insurance doesn’t guarantee you can get treatment, particularly for psychiatric problems. More than half of adults who sought mental health or addiction treatment in recent months had difficulty getting that care, according to a survey of 2,201 residents by the Blue Cross Blue Shield of Massachusetts Foundation in Boston...The obstacle wasn’t a lack of insurance; the vast majority of patients were insured. Rather, the problem was that providers either did not accept their insurance or their practices were closed to new patients. ”

U.S. deaths from self-injury surpass those from diabetes, by Linda Carroll, Reuters, Aug 29 2018.

“More people in the U.S. are dying from self-inflicted harm, including suicide and drug overdose, than from diabetes, a new study suggests. In 2016, for every 100,000 people, 29 deaths were due to self-injury and 25 were due to diabetes, researchers found when they looked at data from the Centers for Disease Control and Prevention...The surge in self-injury deaths was largely driven by increases among men, whose rates of self-inflicted death had already outstripped diabetes deaths by 2002, the researchers note. Among women, diabetes deaths continued to exceed self-inflicted ones during the study period, but the gap narrowed dramatically over time. In 2000, there were four diabetes deaths among women for every self-injury death; in 2016, that ratio shrank to 1.6 diabetes deaths for every self-injury death. ”

Communication Issues Among Kids With Autism May Lead to Self-Harm, by Rick Nauert PhD, Psych Central, May 2 2018.

“A new study discovers communication problems among children can lead to depression and increase the risk of self-harm and suicidal intent during adolescence...The review comes in response to new findings that teen suicidality is under-recognized among children with ASD. Until now, community-based studies on suicidal thoughts and behaviors among children with symptoms of ASD have been limited...'Our study suggests that children who have difficulties with social communication are at higher risk for suicidal ideation and behavior in late adolescence,' said Dr. Iryna Culpin, senior research associate in the Bristol Medical School (PHS). 'Depressive symptoms in early adolescence partially explain this association.' ”

Guns tied to high suicide risk for teens with self-harm history, by Lisa Rapaport, Reuters, Mar 20 2018.

“Teens and young adults who harm themselves without suicidal intent often kill themselves soon afterward, and the increased risk of death is greatest when guns are involved, a U.S. study suggests...Nonfatal self-harm is common among young people, and suicide is the second leading cause of death among Americans aged 15 to 24, researchers note in Pediatrics. Nearly one-third of young people who die of suicide have nonfatal self-harm events in their final three months of life. ”