The article recently published in the journal Anales de Pediatría entitled “Self-harm and suicidal behaviour in children and adolescents. What we have learned from the pandemic”1 is the kind of multidisciplinary project that is difficult to carry out at present. The barriers between the different medical specialities make this form of collaboration nothing short of heroic. In this case, members of different societies (emergency medicine, psychiatry, primary care, social paediatrics and adolescent medicine) succeeded in the endeavour through the Working Group on Paediatric Mental Health of the Asociación Española de Pediatría (AEP).
This article brings to light a reality that was already there, but that the COVID pandemic exacerbated: the mental health of children and adolescents is suffering, and the frequency of suicidal behaviour and suicide is increasing. The most recent data demonstrate this: in the group aged less than 15 years, 7 children died of suicide in 2019, 14 in 2020 and 22 in 2021, an exponential increase.2 Emergency visits by minors who had attempted suicide, with suicidal ideation or due to self-injury have increased in frequency, especially in girls, as described by the article in Anales de Pediatría cited above and a recent meta-analysis. The article in your journal emphasises the importance of prevention, integrating mental health services in community-based care settings and in schools.3
The factors involved in this increasing trend in suicidality, medical, social and educational, deserve thorough consideration. Some are not modifiable (temperament, heredity, etc.), but others are (abuse, mistreatment of any kind, access to care, etc.). Although some studies have found an association between the increase in suicidal behaviour and lifestyle habits, a causal relationship has yet to be established, although this aspect continues to be a priority in research.
Paediatricians are not trained adequately to manage issues related to mental health in general or suicidal behaviour in particular. This was reflected by the results of the online survey conducted by the Working Group on Paediatric Mental Health of the AEP in 2022, in which 1000 paediatricians participated. Table 1 presents the results of the survey. We ought to highlight that most respondents had noticed an increase in the number of visits related to mental health in the past 2 or 3 years and believed that the problem had worsened with the pandemic, that 85% did not feel adequately trained to manage this type of consultation and that only one third considered that it was easy to coordinate care with mental health care teams.
Results of the online survey of paediatricians.
| N = 1104 responses | Practice setting of paediatricians |
|---|---|
| 58% primary care | |
| 20% emergency care | |
| 17% hospital-based/inpatient care | |
| Questions | |
| 1. Have you noticed an increase in mental health-related visits in the past 2–3 years? | 95% yes |
| 2. Do you think this situation has become worse due to the COVID pandemic? | 96% yes |
| 3. Do you feel adequately trained or prepared to manage mental health consultations? | 86% no |
| 4. In the case that you do believe that mental health-related visits have increased, are you concerned about it? | 98% yes |
| 5. Do you find it easy to coordinate care with inpatient, outpatient or community-based mental health teams (psychiatrists or psychologists) in your catchment area? | 37% yes |
| 63% no (36% difficult access, 17% other reasons, 9% lack of time to coordinate care) | |
| 6. Which mental health problems generate visits most frequently? | Anxiety 89% |
| Behavioural disorder 78% | |
| ADHD 58% | |
| Depression 52% | |
| ED 50% | |
| ASD 40% | |
| Alcohol or substance abuse 20% | |
| OCD 9% | |
| PTSD 5% | |
| 7. What factors related to mental health do you think have increased? | Excessive screen use 77% |
| Somatization 72% | |
| Changes in eating 67% | |
| Non-suicidal self-harm 60% | |
| Suicidal ideation, thoughts of death 50% | |
| Insomnia 49% | |
| School refusal or absenteeism 38% | |
| Domestic violence and abuse 17% | |
| Complicated grief 11% | |
Online survey of paediatricians conducted in collaboration with the AEP.
ADHD, attention-deficit hyperactivity disorder; ASD, autism spectrum disorder; ED, eating disorder; OCD, obsessive-compulsive disorder; PTSD, posttraumatic stress disorder.
Society overall, and those of us that devote our lives to the care of children and adolescents in particular, must reflect on the influence of our environment in their health. All paediatricians, educators and other social agents must be trained in child and adolescent mental health, and a national suicide prevention plan needs to be established as a matter of urgency.
