By Sarah Ovaska-Few

Child health experts are startled by the steady increase of adolescent suicides in North Carolina, with the state experiencing twice the rate of deaths among older children as it did a decade ago.

Suicide is now the second-leading cause of death of children from age 10 to 17, topped only by motor vehicle deaths, according to the joint annual report card on the health of North Carolina children released this week by the advocacy group N.C. Child and the N.C. Institute of Medicine, a think tank.

“This is something we need to be talking about,” said Whitney Tucker, N.C. Child’s research director and one of the report’s primary authors. “This really is an epidemic.”

The increase in suicides earned the state a “D” on the annual report card, which also pointed out that 8.2 percent of high schoolers reported having a suicide attempt, and nearly twice that number seriously considered suicide in 2017.

There was a total of 44 children between 10 and 17 who died in 2017 from suicide, the most recent calendar year data was available. Though those numbers may seem small, the fact that suicides doubled in frequency from a decade prior and mirror national increases in the teen and adult populations was reason to highlight in this year’s report on child health, said Adam Zolotor, a family doctor who is president of  the N.C. Institute of Medicine and co-author of the annual report card.

While those involved with youth are well aware of the challenges related to teenagers’ mental health, the issue hasn’t gotten as much attention on the state policy level, Zolotor said.

“We’re trying to shine a light on it,” he said.

Mental health resources an issue

The release of the report cards, and focus on suicide as a worrying trend, comes on the heels of a national study  published in JAMA Pediatrics this month that found North Carolina has the poorest record in the country in providing mental health services to children with behavioral health diagnoses. That study found most (72 percent) of North Carolina children diagnosed with a behavioral health condition were unable to meet with a licensed mental health provider within the last year.

Washington, D.C. did the best in the country at connecting kids with mental health services.

The lack of mental health provision has been well documented in North Carolina and a continuing challenge, especially in rural areas of the state that suffer from health provider shortages of all types, said Marian Earls, a Greensboro pediatrician who heads pediatric practices for Community Care of North Carolina, which has coordinated the care for Medicaid patients for the past two decades.

With youth, more so than in the general population, suicide is not always a direct result of documented depression or observable mental illness but can occur after a sudden shock or emotional event, Earls said. That’s why many in the public health field are also looking at reducing access to lethal devices, such as encouraging the use of gun locks for firearms and restricting access to prescription drugs, to reduce the chances a young person has access to things that could quickly cause irreparable harm.

“It is something we really need to be paying attention to,” she said.

CCNC has been encouraging practitioners it works with who treat children who use Medicaid to screen for depressive episodes or other mental health issues and then have resources already identified in the community to refer children and their families to.

CCNC has seen the effort to encourage screenings increase, with more than half of pediatricians now screening for depression and other behavioral risks, up from just 12 percent in 2016. Earls hopes those screening rates will continue to climb, as more pediatricians join school districts, parents and others in supporting struggling adolescents.

It’s a challenge to get the help they need, because of a lack of resources as well as the continuing stigma against mental health needs. And then, there’s also the cost, said N.C Child’s Tucker. Not every insurance plan covers behavioral health, and the expense can add up quickly for a family.

“In our state, mental health care is particularly expensive,” Tucker said.

Most at risk of suicidal ideation or attempts are students identified as LGBTQ, with a staggering 43 percent of those adolescents considering harm to themselves, according to the report. Among those identifying as heterosexual, the rates were only 12 percent.

It’s a signal that those who work and care about youth – school employees, parents, pediatricians and health care workers – should be making attempts to address and ease the social isolations that many of those youth experience, Tucker said.

North Carolina’s struggling to meet children’s health needs

Among the report card’s other findings were dismal rankings for the number of children living in poverty, earning the state an “F” with 43 percent of the state’s children living in low-income households, which were defined as earning twice the federal poverty level, or roughly $51,500 for a family of four.

The report also pointed out the racial inequities when it comes to household resources. Black and Hispanic children are much more likely to live in low-income households than their white and Asian counterparts. Of the state’s Hispanic children, 71 percent live in a low-income household, while 64 percent of black children, 31 percent of white children and 29 percent of Asian children live in homes that have household incomes of less than $51,500 for a family of four.

Infant mortality rates continued to be high for black children, with 13.4 deaths for every 1,000 births. That’s more than twice what the rate for white children (5) and Hispanic babies (6.0). It also puts the fate of black infants in North Carolina on par with infants in Jamaica, Malaysia and Tunisia.

Vaccination rates dropping

The state is also experiencing a concerning drop in vaccination rates on the schedules recommended by public health officials and pediatrician, Tucker said.

Fewer than three-quarters of North Carolina toddlers between 19 and 35 months had their full recommended suite of vaccinations completed in 2017, according to the annual report card. The current vaccination rate of 73.6 percent is a substantial drop from 2014 when 83 percent of young children in the same age group were immunized.

Though North Carolina still tops national rates for vaccinations, the drops are worrisome and pulls North Carolina closer to states in the western part of the country where vaccination rates are lower. That’s also where recent outbreaks have received attention, including a recent measles outbreak in Oregon, which has the highest number of unvaccinated kindergarteners in the country.

North Carolina isn’t immune to the issue. A chickenpox outbreak in December at a private school in Asheville was the state’s biggest in years.

Some bright spots

There were some areas where the state is doing well by its children, Tucker said.

Among the favorable rankings was the high number of North Carolina children on a health insurance plan, with 95 percent of the smallest Tar Heels enrolled in a some type of insurance program.

Also encouraging was a drop in the number of children with an asthma diagnosis, which is often a sign of concerning environmental conditions. The state saw a drop of nearly 14 percent from the beginning of the decade to now. And more than a quarter – 27 percent – of the state’s infants were breastfed for their first six months, an increase from prior years.

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