Thread by @tylerblack32

THEAD:
What's really "Driving" the mental health crisis in kids?

Lets discuss the article by @hotzthoughts in @sciam, which unfortunately propagates mistakes.

I will say this loudly to the headline writer, however:

"COVID IS NOT DRIVING SOMETHING THAT WAS ALREADY THERE"

/1

The CDC MMWR is quoted, showing an "increase in suicide attempts among people younger than 18." That report combines "non suicidal self injury" with "suicide attempts," which is a huge no-no. On top of this, I have addressed this report and its flaws

https://twitter.com/tylerblack32/status/1405385585544482825

/2

While it *IS* important that distress presentations to the ER increased (it is looking from embargoed data that it was jan-may spiking in girls), it is also crucial that this was NOT suicide attempts, or even, as the CDC authors wrongly stated "suspected serious attempts."

/3

As well, it wasn't up among "people" <18, it was ONLY increased in girls and not boys, and the reasons for this are likely because it was NSSI that dominated the presentations, not serious suicide attempts.

So yes, distress was up, but suicide attempts likely not.

/4

Why does this matter to me so much? A) the stigma of NSSI that we've worked so hard to erase is that it's NOT SUICIDAL. It's right there in the name.

/5

Incidentally, I wrote the CDC Authors of the MMWR report about this, and their response was not impressive. They quoted a study of geriatric suicides to say that only a small % were nonsuicidal. Yikes. Kids are FAR more likely to use NSSI than seriously attempt suicide.

/6

B) NSSI is a (maladpative) coping strategy indicating a desire to cope with distress, not a desire to die. When the words "suicide attempt" are put together, an entirely different stigma. We see a swath of children wanting to die. Instead, it's children coping with distress.

/7

In the article, @hotzthoughts also quotes the AWFUL FAIR report, which made incredibly **serious** statistical errors to turn the reality (suicide presentations were DOWN in 2020) into the opposite (the headlines proclaimed an increase).

see:

https://twitter.com/tylerblack32/status/1368245025667158022

The FAIR thing frustrates me so much because the statistical error is so egregious I can only conclude that FAIR *KNEW* that if they published their report by distorting, they would get more headlines for themselves, and would be cited by reporters exactly like Ms. Hotz did.

/8

The rest discusses ACEs (which are not as slam dunky, and the research still is very correlational and difficult to do much with), but that's fine! It's widely accepted in mental health that negative childhood experiences affect us, and the programs sound interesting.

/9

BUT. and a biiiiiiiggggggg (peach-emoji-ish) butttttt:

COVID IS NOT DRIVING A MENTAL HEALTH EMERGENCY IN KIDS.

Kids have been having a mental health emergency for over a decade, and COVID has *exacerbated it*.

/10

We now have the full data for suicide in kids for 2020 .

This is the rate of suicide for kids 8-12.

Note where the increase starts? my eyeballs tell me 2013. NOT 2020. In fact, 2020 entirely average compared to the past 3 years.

/11

This is the rate of suicide for kids 13-18.

Again, I do not see a new crisis in 2020. I see a worsening rate of teen suicide since about 2008 or so, and actually 2019-2020 seem down a bit.

/12

Here is the graph for:

boys 8-18
girls 8-18
white kids 8-18
nonwhite/hispanic kids 8-18

and i keep seeing the same thing. 2020 didn't DRIVE anything. 2020 was pretty average/in keeping with PREVIOUSLY DRIVING suicide escalation

[/13]

But, suicide isn't mental health and mental health isn't suicide. What about sadness?

The @CDCgov asks tens of thousands of kids high school every 2 years about a number of things. Check out the question they asked in sadness - this is the DEPRESSION criteria of MDD!!

[/14]

Once again, we see an increase PREPANDEMIC. sure, 2021 might very well show a worse number (i suspect it will) but does that mean the pandemic drove it? 2019 went up by 5.2% absolutely but 16.5% relatively! that's a huge leap.

/15

What about "considering suicide" - this survey question was getting better in the US until about 2009, then things have steadily been heading in the wrong direction. 2019 the highest in 20 years.

/16

Burstein et al found a rise in suicide attempts in ER since 2007.
jamanetwork.com/journals/jamap…

/17

Heck, @QdQwerty and I found the increase in MH presentations was concerning *BACK IN 2012!!!* in BC, Canada. We've been sounding the alarm together for a DECADE.

(sorry for potato graphics, i'm old. embarrassingly, that is the "large graphic"!)

jpeds.com/article/S0022-…

/18

So while I'm grateful that authors like @hotzthoughts tackle mental health & kids (and really, I enjoyed the article despite my hairpulling to see the initial paragraphs on pandemic-related changes), can we please NOT pretend that this is being "driven" by the pandemic?

/19

Solving the pandemic will help our kids' mental health, because pandemics stress and kill and change our lives in a very big way.

But solving the pandemic will NOT end our mental health emergency for kids. It's been here for a while, and we need HUGE SYSTEMIC CHANGE.

/20

We need:
more MH professionals
to end child poverty
to ensure all children get quality health care
smaller class sizes
more mental health curriculum
mothers and fathers healthy and secure
to end child abuse.

Get it? The pandemic stuff is EXTRA to what we already needed.

/21

The pandemic EXPOSED our children, already crumbling under distress, TO MORE DISTRESS. I know for sure I would be loudly advocating for children's mental health in 2021 even if COVID didn't happen. How do I know? Because I was doing it for years prior to COVID.

/fin

The @sciam article by @hotzthoughts (which again, aside from the initial propogated mistakes, is a better look at the larger, truer effects of the pandemic than a lot of the "did masks ruin our kids brains?" articles I've been reading!)

scientificamerican.com/article/covid-…