Health Care Providers Face Rising Preteen Suicide Rates

When she was getting ready for her first day as a mental health therapist at an elementary school near Washington, D.C., Stacey Baxter—now a senior associate with The Pew Charitable Trusts’ suicide risk reduction project, which is working to improve suicide screening and care—thought she was prepared.

“I’d been working with children for years before I joined the school, so I wasn’t necessarily surprised when the kids told me they were experiencing negative thoughts,” she said. “What was jarring was how quickly they felt comfortable enough to share these very personal feelings with me. There was a lot of sadness and anxiety just below the surface, and it felt like they were just waiting for someone to ask.”

Childhood suicidality—seriously thinking about, planning, attempting, or dying by suicide—has increased significantly in recent years. According to the Children’s Hospital Association, “Between 2016 and 2022, children’s hospitals saw a 166% increase in emergency department visits for suicide attempts and self-injury among children from age 5 to 18.”

Rates of childhood suicide are highest among teenagers, but they increased rapidly among children age 8 to 12 between 2001 and 2023, the most recent years for which complete data is available. Suicide is more common among boys, but is increasing faster among girls. And across race and ethnicity, suicide rates are highest among Black children while rising fastest among Hispanic kids.

Research shows that children may be at heightened risk of suicidal thoughts and mental health issues if they live in poverty and experience trauma at home. It also indicates that childhood suicide is more common during the school year.

To help pediatric health care providers identify and care for more children experiencing suicidality and prevent more youth suicides, the American Academy of Pediatrics (AAP) and the American Foundation for Suicide Prevention (AFSP) in 2022 first published a Blueprint for Youth Suicide Prevention. Among its strategies, the blueprint recommends universal suicide screening for all patients 12 and older regardless of the reason for their visit to a health care setting—and includes recommendations for safety planning and other interventions for youth at risk of suicide.

With support from Pew, AFSP, and CVS Aetna, the American Academy of Pediatrics also launched the Suicide Prevention Project ECHO (Extension for Community Healthcare Outcomes) in January 2023 to help doctors, nurses, and other providers implement the blueprint. The project’s first cohort of providers convened in January 2023, working with more than 40 pediatric specialists across 11 states to adopt youth suicide screening and care protocols. Hundreds more providers in more than 40 states have participated since.

“The spirit of Project ECHO is to build up champions and start a positive cascade, and it’s working,” said Dr. Janet Lee, an associate professor of pediatrics at the Lewis Katz School of Medicine at Temple University. “Providers are feeling empowered and informed to change their suicide screening practices, and they’re then inspiring colleagues in their institutions to do the same.”

Although multiple studies have found that asking kids if they think about suicide does not increase suicidal thoughts and behavior, the myth persists that it does. Lee explained that the project helps providers allay concerns that asking about suicide could plant the idea in a child. “It's nice to have parent-friendly materials to explain what the guidelines are and why asking questions doesn't do harm,” she said.

AAP-AFSP surveys found that 85% of participants in the first Project ECHO cohort reported knowing more about suicide prevention, including risk factors and warning signs for suicide, after taking part in the workshop; 77% reported increased confidence that they could apply the lessons to their work; and 93% said they were committed to applying the lessons.

Although the AAP recommends that all children age 12 and up be screened for suicide risk at least once a year, it has different guidelines for younger children—who are still developing and often express their feelings differently than older children or adults. “Part of the challenge is that we know a lot less about suicidality in grade-school children than in adults and teens,” Baxter said.

And as Lee notes, “Even as adults, we don't always have the language to describe what we're feeling in our emotions and how that might manifest in our bodies. But for younger children, it’s about looking for warning signs: They may be behaving differently, withdrawn, or sad, or [have] enormous amounts of stress [that] may manifest as stomach pain.”

Because suicidality is more common among teens, there’s less research on suicidality among younger kids. Researchers and experts in the field say that needs to change and that more data is needed to develop smarter strategies that can better protect children of all ages.

Josh Wenderoff works on Pew’s health programs.