Mental Illness in Pre-teens, A Growing Trend.

The COVID-19 pandemic is one that we all would like to forget! During these unprecedented times, we’ve witnessed a sharp rise in mental health illnesses, particularly in children. Studies show 2 in every 100 child between the ages of 9 and 10 years old attempted suicide. One observational study represented nearly 8000 children and identified risk factors and contributing exposures. The findings were disturbing at best and noted to be modifiable. Most studies regarding suicidal thoughts and attempts in children are in those over the age of 14. Clearly we are neglecting a cohort of children and finding that these mental health disturbances begin at a much younger age opening a cavernous abyss. We do not have ample mental health research within this “golden child” stage of development. Knowing that mental health disturbances leading to suicide is trending as the second leading cause of death in children ages 10-14, it is imperative that we address it directly. Children are our future and deserve all the protections we can afford to safeguard physical and mental health wellness that leads to thriving adults. We owe it to them!

Modifiable contributing factors found to be linked were common activities and environmental exposures known to occur in the common every day house holds of the 21 century. Screen time was directly linked to increased thought or attempt of suicide especially in households where parental conflict is elevated and the child “escapes” online for extended periods of time.

Another major contributing element was protective factors. Parental supervision directly contributed to the rate of a child’s suicidal ideation or attempt. The study showed more interaction by parents directly involved in their child’s lives by taking genuine interest in their daily activities and friend groups, led to decreased incidence of suicidal thought or attempt.

As we continue to search for additional underlying contributing factors, I’m reminded of a previous patient . We’ll call her Ellie. Ellie presented with tickborne illnesses that triggered autoimmune encephalopathic symptoms. As I worked with the mom to tease thru Ellie’s social and medical history, something about her symptom presentation didn’t sit well with me. There didn’t appear to be any red flags during the historical interview portion of the exam. Ellie was from a wealthy family with a younger sibling and two doting parents. Ellie was an “A” student and participated in many age appropriate social activities with peers. Ellie’s labs showed positive Babesia and Bartonella. At the time, I chucked it all up to the tickborne illnesses understanding the neurological hijacking that both of these infections can trigger.

As we trudged forward with treatment, Ellie had typical “herxing” or die-off reactions as expected. Her physical symptoms improved but there were lingering behavioral components that didn’t appear to related to her disease process. I referred Ellie to a reputable child psychiatrist who diagnosed her with generalized anxiety, depression, suicidal/intrusive thoughts and questionable bi-polar disorder. Several medications and natural supplements were prescribed along with cognitive behavioral therapy sessions. Ellie’s mental health symptoms appeared resistant. I referred Ellie to a well known neurologist in NYC. Sadly, the neurologist took it upon himself to tell the mom that the child, in his opinion, was “making this up and that her infectious disease provider (me) agreed!” I couldn’t believe that this neurologist would say such a thing and from that day forward never referred to him again. Sadly, the mother was distraught by his comment and would not return to my office to discuss. Later, Ellie found her way to another Lyme disease colleague of mine. It was discovered after further discussion that Ellie was being sexually abused by her babysitter and had been since the age of 7. Ellie was 10 years old at the time of evaluation.

As I reflect, it took four providers. Four well trained providers to finally determine the root cause of Ellie’s mental health crisis. I had always suspected an additional environmental/social component as a driving factor but Ellie’s autoimmune encephalopathy and tickborne illness symptoms clouded the picture. I was hopeful that another specialist evaluating from their unique lens would also see it. Fortunately, Ellie’s case had a positive outcome. After discovering and validating the sexual abuse, Ellie’s parents took action. Today, Ellie is a thriving, happy teenager.

Unlike Ellie’s case, it frightens me to think about the children that do not have professional eyes on them to support overall growth and development as Ellie did. How many children are suffering from psychiatric mood disorders as a result of neglect, physical, emotional or sexual abuse? As with adults, suicidal thoughts and attempts are a cry for help.

My hope with this post is that we bring to light and accept that mental health disorders begin at far younger ages and should continue to identify risk factors. We must be diligent in our surveillance and better trained to recognize crisis in younger children rather than brush it off as a parenting issue or tantrum. Just food for thought.

Be Well!

Somer

REFERENCES

Janiri,D., Doucet, G., Pompili, M. et al. (2020). Risk and protective factors for childhood suicidality: a US population-based study. The Lancet Psychiatry, 7 (4), 317-326. DOI: http://doi.org/10.1016/S2215-0366(20)30049-3

Burstein, B., Agostino, G., Greenfield, B. (2019). Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015. JAMA Pediatrics, 173; 598-600.

National Institute of Mental Health. Health information statistics, suicide. http://www.nimh.nih.gov/health/statistics/suicide