Children’s & Teens’ Suicides Related to the School Calendar
Psychiatric emergencies and youth suicides rise sharply with the school year.
Posted May 31, 2018
We get very upset by school shootings, as well we should. Every such instance is a national tragedy. We should be ashamed of ourselves for not doing something about gun control, as essentially every other developed nation has. But as serious as this tragedy is, it is dwarfed by another school-related tragedy: suicide.
Suicide is the third leading cause of death for school-aged children over 10 years old, and the second leading cause (behind accidents and ahead of homicides) for those over 15 (here).
Four years ago I posted data (here)—from a mental health facility in Connecticut—showing the relationship between pediatric emergency mental health visits and the school year over a three-year period (2011-2013). Those data revealed that the average monthly number of emergency mental health intakes for school-aged children declined from 185 in May (the last full month of school), to 102 in June (the month in which school lets out), and then down to 74 and 66, respectively, in July and August (the full months of freedom from school). In September the rate started its climb back up again. Overall, the rate of such visits during the school months was slightly more than twice what it was in July and August. When I wrote that article, I did not know of any other studies assessing mental health breakdowns as a function of the school calendar. Since that time, more research has emerged.
Psychiatric Breakdowns and Suicide Attempts as a Function of the School Year
Collin Lueck and his colleagues (2015) examined the rate of psychiatric visits for danger to self or others at a large pediatric emergency mental health department in Los Angeles on a week-by-week basis for the years 2009-2012. They found that the rate of such visits in weeks when school was in session was 118% greater than in weeks when school wasn’t in session. In other words, the rate of emergency psychiatric visits was more than twice as high during school weeks as it was during non-school weeks. It’s interesting to note that the sharp decline in such emergencies occurred not just during summer vacation, but also during school vacation weeks over the rest of the year.
The researchers also found a continuous increase in the rate of psychiatric emergencies during school weeks, but not during vacation weeks, over the 4-year period of the study. This result is consistent with the hypothesis that the increase in suicidal ideation and attempts over time is the result of the increased stressfulness of school over this time period rather than some factor independent of schooling. In another, more recent study, Gregory Plemmons and his colleagues (2018), found that the rate of hospitalization of school-aged children for suicidal ideation and attempts increased dramatically—by nearly 300%—over the seven years of their study, from 2008 to 2015, and each year the rate of such hospitalizations was significantly higher in the school months than in the summer.
Actual Suicides as a Function of the School Year
On the basis of the data I’ve described so far, someone could argue that the school-year increase in emergency psychiatric admissions is a result of attentive behavior on the part of school personnel, who referred children for admissions and thereby, perhaps, saved children’s lives. According to that view, parents are less perceptive of children’s problems than are teachers. There are no data suggesting that this is true, however, and there are very strong reasons to believe it is not. If this hypothesis were true, then the rate of actual suicides—as opposed to suicide ideation or attempts—should be lower when school is in session than when it is not. But, in fact, the actual suicide data parallel the data for suicide ideation and attempts.
Benjamin Hansen and Matthew Lang (2011) used data collected from state agencies to analyze suicides for teenagers across the US between 1980 and 2004. This is an older study, with data largely from a time when school was at least somewhat less stressful than it is today and the total teen suicide rate was lower than today. Yet, they found a much higher rate of suicides during the school year than during the summer vacation months. They also—unlike any of the other studies I’ve found—analyzed the data separately for boys and girls. For boys, the suicide rate was, on average, 95% higher during the school months than during summer vacation; for girls, it was only 33% higher. This finding is consistent with the general observation that boys have a more difficult time adjusting to the constraints of school than do girls.
Hansen and Lang also found that the school-year increase in teen suicide rate held only for those of school age. For 18-year-olds, most of whom would be finished with high school, the increase was barely present, and for 19- and 20-year-olds it had vanished. Other research shows that suicides and suicide attempts for adults vary only slightly by season and are somewhat higher, not lower, in the summer than in the fall and winter (Miller et al, 2012; Cambria et al, 2016)—a trend that is opposite to the finding for school-aged children and teens.
Just the Tip of the Iceberg
Actual suicides and emergency mental health admissions are just the tip of the iceberg of the distress that school produces in young people. I have summarized some of the other indicators of that stress elsewhere (here and here). One finding that bears repeating comes from a large survey conducted a few years ago by the American Psychological Association, which revealed that teenagers are the most stressed, anxious people in America; that 83% of them cite school as a cause of their stress; and that, during the school year, 27% of them reported experiencing “extreme stress” compared to 13% reporting that during the summer.
The tragedy is that we continue to make school ever more stressful, even though research shows that none of this is necessary. Young people learn far more, far better, with much less stress (and at less public expense) when they are allowed to learn in their own natural ways, as I have pointed out in many of my previous posts and in my book, Free to Learn.
And now, what insights and experiences do you have about the relation between children’s mental health and schooling? This blog is a forum for discussion, and your stories, comments, and questions are valued and treated with respect by me and other readers. As always, I prefer if you post your thoughts and questions here rather than send them to me by private email. By putting them here, you share with other readers, not just with me. I read all comments and try to respond to all serious questions, if I feel I have something useful to add to what others have said. Of course, if you have something to say that truly applies only to you and me, then send me an email.
Cambria, D. G., et al (2016). Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. Journal of Affective Disorders, 196, 125-137. Note—this a study of all suicides, not specifically children’s and teens.
Hansen, B. & Lang, M. (2011). Back to school blues: Seasonality of youth suicide and the academic calendar. Economics of Education Review, 30, 850-851.
Lueck, C., et al (2015). Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance? American Journal of Emergency Medicine, 33, 682-684.
Miller, T. R., et al (2012). Suicide deaths and nonfatal hospital admissions for deliberate self-harm in the United Sates. . Crisis, 33, 169-177.
Plemmons, G., et al (2018), Hospitalization for suicide ideation or attempt: 2008-2015. Pediatrics, 141 #6.