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Teen emergency room visits for self-harm doubled in past decade: U of O, CHEO study

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Content warning: this article contains mention of self-harm and suicide. A list of mental health resources appears at the bottom of this article. 

A joint study from the University of Ottawa and CHEO says teen emergency department visits for self-harm have doubled over the last decade. 

Between 2003 and 2009, self-harm visits for teens aged 13–17 fell by a rate of 32 per cent. But between 2009 and 2017, those numbers increased to 135 per cent.

The study, published this month in the Canadian Journal of Psychiatry, found mental health visits rose 78 per cent by 2017. That means roughly 190,000 Ontario teens visited emergency departments each year during the 15-year time period of the study.

“It’s a distressing thing,” said. William Gardner, U of O epidemiology professor and CHEO Research Institute senior scientist. “These increases in kids coming into settings like the emergency department aren’t being met by increases in clinicians.”

The sudden spike in visits surprised researchers, said Gardner, noting most epidemiology data typically looks noisy and scattered compared to the recent self-harm findings.

Additionally, the study found that females have visited hospitals about 40 per cent more often than males since 2009.

“In some ways, girls may be more vulnerable,” said Gardner. After puberty, girls may experience physiological differences and have increased social pressure related to their physical appearance, he added.

When asked about the sex difference and whether socialization is a contributing factor, Gardner said girls may be encouraged to seek care in ways boys aren’t. “Females, at any age, are more likely to talk about what’s going on inside them, and so parents are more likely going to hear about emotional disturbance and distress from their daughters than their sons.”

No evidence or causes were indicated by the study because of protected and limited data. “Those records are fairly sparse⁠ — they will tell us a couple of diagnoses, the sex, the age, and not too much more,” said Gardner. 

However, the study points to two possible explanations for the sudden rise in rates of self-harm: the introduction of the iPhone in 2007, along with anti-stigma campaigns such as Bell Let’s Talk in 2010.

Increased cellphone and social media use may expose teens to emotionally-upsetting content, social pressure, and online bullying. Self-harm may also be being normalized online, say researchers.

“There’s just an immense amount of social pressure that, in a way, you’re always on stage,” said Gardner.

But, the study notes that social media exposure may also have positive effects, like providing teens with open channels for seeking treatment, encouraging peers to support one another, and reduce social isolation.

The new research highlights a broader trend across emergency departments in North America. According to a Canadian study published in the journal JAMA Pediatrics looking at US hospitalizations between 2007 and 2015, the number of children with suicidal ideation or suicide attempts between the ages of five and 18 also doubled. 

And in April of this year, CHEO reported a 53 per cent increase in emergency department visits for suicidal ideation and suicide attempts.

“High volumes can mean long waits and it is difficult for the community to keep up with the follow-up needs,” wrote Dr. Allison Kennedy, CHEO psychologist and U of O psychology professor in an emailed statement to The Fulcrum.

CHEO manages its emergency department flow by helping parents and youth determine whether they are best served by hospital or community resources.

“Some youth are helped over the phone by skilled counsellors — this prevents a trip to the emergency department,” said Kennedy.

If a student experiences a crisis at school, the school can work with CHEO for further recommendation. According to Kennedy, youth walk-in services also play a strong role in the community. 

But according to Gardner, youth mental health crisis care may not be adequate. For example, physicians may not know where to refer patients, and emergency departments may not have mental health beds or a child psychiatrist on staff. 

“If you’re injured or harmed in some way of course you can get medical treatment for that in the emergency department, but it’s not a place where you can engage in psychotherapy,” he added.

Though self-harm rates are on the rise, the uptick may be a positive sign. According to the study, “the increased rate of youths visiting the (emergency department) could be viewed as positive, compared with the potential consequences of distressed youths not seeking care at all.”

In order to curb the problem, teens and families can have more face-to-face time with friends and family, according to both Gardner and Kennedy.

“When youth are asked about coping strategies, they often reference activities that involve their personal devices like texting, social media, and Netflix,” said Kennedy.

But limiting screen-time and engaging in hobbies may help teens cope with social isolation. In addition to increasing quality family time, Gardner recommends parents seek advice from schools and family doctors.

For people seeking to help youth who express mental health concerns, Kennedy said “a conversation with a teen involves mostly listening.” Adding that parents, friends, and family can help by, “seeking to understand and avoid giving advice.” 

Crisis lines are also an effective way for people to find prompt support, both experts say.

A non-comprehensive list of youth and mental health resources appears below:

Youth services:

On-campus (free or covered by healthcare plan):

  • University of Ottawa Health Services (UOHS), 100 Marie-Curie Private
    • Offers counselling, psychiatric services, individual, couple or family therapy, access to psycho-educational groups and referrals to specialists off-campus
  • Student Academic Success Service (SASS), 100 Marie-Curie Private
    • Offers individual counselling, peer-counselling, workshops, online therapy and group counselling using new stepped model; referrals
  • Pride Centre, 85 University Private
    • Offers mentoring services and one-on-one consultation services
  • Faculty mentoring centres (locations differ by faculty)
    • Specialized mentoring services catered to the needs of students in each faculty

Off-campus:

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