Trigger warning: This story describes self-harm and suicide. If you are at risk, please stop here and contact the National Suicide Prevention Lifeline for support at 800-273-8255.
When Isabella "Izzy" Tichenor died by suicide last month, what shocked many, including her mother, was her tender age. She was 10.
Many people have long been aware that teenagers can be subject to suicidal thoughts and attempts, but such thinking is increasingly affecting young children.
Child suicides grew by 15% a year between 2012 and 2017, according to a July study published on JAMA Network Open. At emergency rooms in 38 children's hospitals across the nation, the number of suicide and self-injury cases in the first three quarters of 2021 was 47% higher among 5- to 8-year-olds and 182% higher among 9- to 12-year-olds than they were for the same period in 2016, according to statistics compiled by the Children's Hospital Association.
Especially for the 9- to 12-year-olds, who accounted for 22% of suicide and self-injury visits for children and teens at those hospitals, "those numbers are kind of startling," Children's Hospital Association President Amy Wimpey Knight said. Children 8 and younger make up a much smaller portion of emergency room visits for suicide or self-injury, but still accounted for about one incident per hospital every month, she said.
The National Institute of Mental Health reported that nearly one-third of children 10 to 12 screened positive for suicide risk in a 2019 report and it held workshops this year to address what amounts to the fifth-leading cause of death for those 5 to 12 and second for adolescents.
In the past, "we tended to see that suicide increased dramatically at around the time of puberty onset," roughly when children turn 12 or 13, said Mitch Prinstein, a child and adolescent psychologist and the chief science officer at the American Psychological Association. "Now, those rates are increasing even in pre-pubertal children. So 8-, 9-, 10-year-olds are more often attempting, which is horrible."
Increases among children reflect a growth in the suicide rate among Americans of all age groups, which rose every year from 2006 to 2019, when more than 47,000 people died from suicide, according to the American Psychiatric Association.
The COVID-19 pandemic, as a health emergency accompanied by disruption and isolation for families and children, has aggravated mental health issues for both adults and children, research shows.
The number of mental health emergencies involving children "was a fire before and the pandemic was a can of gas we poured on that fire. I’ve practiced over 30 years (and) I’ve never seen anything like this,” said Heather Huszti, the chief psychologist at Children's Health of Orange County, a pediatric health care system in Southern California.
Compared to teens, younger children can be more impulsive and less likely to understand the permanence of suicide, Huszti said.
"When those thoughts come to kids, that this is a way to end my pain, they don't quite get that the pain ends but then they are no more, that death is permanent," she said.
Black preteen suicide rates grow
Among younger children, the increase has been noticeable among preteen Black children, particularly boys. It's the only age group in which the rates for Black Americans are higher than they are for white Americans, said Sean Joe, a professor at Washington University in St. Louis who specializes in suicidal behavior, especially among Black men and boys.
In other age groups, Native American/Alaska Natives and white Americans have higher suicide rates. Experts cite intergenerational trauma, including genocide and forced removal, as a factor in higher Native American rates.
Even before the pandemic, "there was increasing suicidal ideation and behavior in younger children, but that appeared to be more common among minoritized youth, particularly Black youth," said Dr. Tami Benton, psychiatrist-in-chief at Children's Hospital of Philadelphia who has a special focus on children from ethnically diverse backgrounds. For Black boys, the rise "has been pretty striking over the last few years."
Donna Ruch, a research scientist at Nationwide Children's Hospital in Columbus, Ohio, said the problem is serious but should be kept in perspective.
Pre-adolescent suicide is "still a rare event and we don't want to cause alarm or panic, especially with this age group," said Ruch, the lead author of a July study exploring the circumstances of suicides involving 5- to 11-year-olds. "On the other hand, we are seeing trends that the rates of suicide are increasing" among younger children.
Ruch's study found that risk factors include mental health status, earlier suicidal behavior, trauma and relationships with peers, with most suicides occurring by hanging or suffocation in the child's bedroom. Firearms constituted the next most common means of suicide and, in cases with detailed information, it was found that the children used guns stored unsafely in the home.
Bullying, family woes seen as factors in suicide risk
Medical professionals are still trying to determine reasons for the growth rate, although they cite such potential factors as higher expectations and pressures; family economic difficulties; and bullying, including its amplification via social media.
Better reporting of suicide attempts may contribute to rising numbers too, Prinstein said.
Bullying has long been a hazard for children, but "cyberbullying has made a big increase in not only the frequency but also how harsh the bullying is because it's done in a way that's permanent (and) often anonymous," said Prinstein, who specializes in child and adolescent suicide and self-injury. "And there are many instances where kids are actually goaded into suicidal behavior by their peers."
In an Associated Press interview published last week, Izzy's mother, Brittany Tichenor-Cox, spoke about bullying endured at school by her daughter, who had autism and was the only Black student in her class.
Tichenor-Cox said she told her daughter's teacher, school and school district officials about the bullying, but nothing was done to make the situation better. On Nov. 6, Izzy died by suicide at the family's home near Salt Lake City.
”It just hurts to know that my baby was bullied all day throughout school – from the time I dropped her off to the time I picked her up,” Tichenor-Cox said.
After Izzy's death, her Utah school district authorized an independent investigation into bullying, calling the girl's death "tragic and devastating."
Tichenor-Cox pointed to the problem of racism in Utah, a predominantly white state, saying racist slurs she was subjected to as a child in the 1990s can still be heard today.
“No parent should have to bury their 10-year old,” she said. “I’m still in shock.”
Benton, of Children's Hospital of Philadelphia, said it's not clear why suicidal thoughts and attempts are up among Black children, particularly boys, but racial factors likely play a role in hurting overall mental health. Although racial discrimination and trauma don't cause suicide, they could be contributing factors for those inclined to think about it.
"There are likely multiple factors. What does it mean to be a Black boy in the United States? The other issue is what happens in schools. There's so much data that Black boys tend to be disciplined more harshly," said Benton, who also is president-elect of the American Academy of Child & Adolescent Psychiatry. "Some of it is discrimination. We know that perceived discrimination is a major contributor to poor mental health for Black Americans" and other groups subjected to such treatment.
Black youths may also suffer trauma from seeing violence committed against those who look like them, Benton said, citing the frequent airing of video of George Floyd's murder in May 2020 and harm done to other Black people.
"We've had a reckoning in our country where we're having conversations about a lot of things, but for the people who have been experiencing (violence) for many years, it also still generates quite a bit of negative emotions that we've not adequately learned to address, particularly as it relates to mental harm," she said.
One reason for the rising rate among Black preteens compared to earlier generations may be that contemporary messages about opportunity contradict racist behavior and bullying that they experience, Joe said.
It amounts to a "change (in) the coping mechanism," Joe said. In the past, "it was essentially important for Black (parents) to train children to understand that they might not get a fair shot. Now, when our children are taught that we are all equally wanted in the country and they experience such unwantedness, it's a challenge for young people to cope because they're going to internalize that 'It must be something about me.'"
Pandemic adds to mental health strain
Some professionals are seeing more mental health emergencies resulting from the COVID-19 pandemic. The effects have been particularly harsh on school-age children, who have had to deal with the isolation of not attending school and then later being thrust back into social situations when schools reopened, said Dr. Benjamin Shain, who heads the child and adolescent psychiatry division at NorthShore University Health System in Chicago.
The pandemic "certainly increased drastically emergency room visits for suicidal behavior or ideation. It went up by 30%. Huge," said Shain, referring to adolescent age groups. As for ongoing pandemic effects, "my belief is that a lot of the vulnerable kids will be damaged on a long-term basis."
Children have also felt the effects of loss of family income and lives due to COVID-19, Knight of the Children's Hospital Association said.
"With the pandemic, you can just see the loss that these kids have experienced, being shut off from school and their friends," she said. "Oftentimes, school is a safe haven for many kids whose home life may not be great. … Schools provided the place where a teacher could identify an issue that was starting to develop early and (children) no longer had access to those resources."
Professionals say there are a number of ways to try to prevent suicidal behavior, including improving mental health services for children overall; bringing services for children of color to parity; and conducting mental health assessments at a younger age.
"We're doing education and we're trying to do prevention. (It) used to be high school kids. Now, we're at the middle school level," Ruch said.
Prinstein, of the American Psychological Association, said parents should discuss suicide with children "in the same way that we have the sex talk and the drug talk with our kids" and the myth that talking about suicide or asking directly about it might give children ideas is wrong.
"We know that talking about suicide actually saves lives and creates an opportunity for kids who are thinking about it to feel like it's OK to tell their parents," he said. And "if they are not thinking of it they have friends who are – 20% of adolescents in high school report they have seriously considered suicide in the past year. That's data from the CDC."
Carson Molle, an 18-year-old college student from Seymour, Wisconsin, attempted suicide in 2017 when he was 14. Molle said his suicidal thoughts started just shortly before his attempt with a gun, but that he had been struggling with mental health issues, including stress, anxiety and depression since he was much younger.
Molle, who is awaiting his 17th surgery for injuries suffered in the attempt, advised parents to learn more about mental health and talk to their kids. "I encourage parents … to be open, available and educated," he said.
A couple of years ago, Molle decided to share his experience and try to help others via social media, including TikTok. He has received thousands of responses, with most coming from teens but also from 9- and 10-year-olds.
"It doesn't surprise me at all. I was having some of those same issues when I was young," said Molle, adding that pressure is a big factor in young people's lives. "What I like to tell them is that there are other people out there that are feeling the same thing that they are, that they are not alone. I was once that kid who was sitting in his room alone thinking, 'I want to kill myself.'"
Trying to help others has helped Molle heal from what he acknowledges is "a pretty life-changing event."
"I have a peace with it that I didn't have before I started sharing my story," he said. "I've come to peace with the fact that this has happened and I know I can only move forward and make the most of it. And I'm doing that right now."
Contributing: Associated Press
The American Psychiatric Association encourages anyone feeling severe symptoms of depression or suicidal thoughts to contact a doctor immediately.
This article originally appeared on USA TODAY: Pre-teen suicide numbers are up, especially for younger Black children