Younger girls increasingly presenting to Australian hospitals in mental distress

Studies find rising emergency presentations for suicidal ideation and self-harm, as well as growing antidepressant use

Younger girls are increasingly attending emergency departments in mental distress or having self-harmed, Australian doctors say, while young women have the highest increase in antidepressant use.

Two new studies published in the Australian & New Zealand Journal of Psychiatry reveal alarming levels of mental illness among young people, particularly teenage girls who are least likely to be admitted to hospital when seeking treatment.

The first study, led by the New South Wales Ministry of Health, examined emergency presentations for suicidal ideation and self-harm by 10-to-24-year-olds between 2015 and 2021.

Presentations were increasing by 8.4% each year before the pandemic but the study found “growth accelerated since Covid to 19.2% per annum, primarily due to increased presentations by females aged 13–17  years”.

Presentations in males aged 10 to 24 years did not increase since Covid.

Meanwhile, a study led by the Centre for Big Data Research in Health at the University of NSW examined national prescribing data for people aged 10 and above between 2015 and 2021, finding antidepressant use continued to increase in Australia, especially among young people.

During the pandemic in 2020 and 2021, antidepressant use was “greater among females than males, and greater among young females than other age groups, suggesting an increased mental health burden in populations already on a trajectory of increased use of antidepressants prior to the pandemic,” the paper found.

The greatest increase in antidepressant use was in females aged 10 to 17  years old.

Youth psychiatrist Associate Prof Elizabeth Scott from the University of Sydney’s Brain and Mind Centre said she was seeing young people present to emergency “at much earlier ages”.

“Generally we saw 15-to-17-year-olds, and that went down to 13-to-15-year-olds especially during the pandemic,” she said. “Teenagers rely on social connection for their wellbeing, particularly young girls.”

Scott said it wasn’t just the pandemic to blame, with rates of youth distress increasing prior to Covid. But she said the pandemic exacerbated existing issues, such as loneliness and isolation, worry about the future, body image concerns often driven by social media, and difficulty seeking mental health help.

“Young people and their parents come looking for help, but the help isn’t there, with long waiting lists so it’s impossible to see a psychologist or psychiatrist and receive that consistent care,” Scott said.

“Young people end up presenting to emergency departments with no other care network available.”

Scott said young women were also more likely to be sent home from hospital given men have higher rates of suicide. “Young men are more likely to get admitted,” Scott said. “That’s often because of comorbidities like drug and alcohol use or aggressive behaviour and other behaviours that are more likely to lead to admission.”

Prof Susan Sawyer, the chair of adolescent health at the University of Melbourne and the director of the Royal Children’s hospital Centre for Adolescent Health, said there had rightly been a strong focus during the pandemic on the vulnerability of the elderly.

“But I think we really failed to, in any way, think about a focus on prevention and health issues in terms of what these might mean for younger people,” she said.

“The Royal Children’s hospital runs a major eating disorder service, and there have been very dramatic increases in those disorders over the course of the pandemic. But this was, in a sense, preventable. It’s not just something ‘in the air’ causing this.

“There are preventable causes of emotional distress. Whilst as a community there is increasing recognition of the importance of ageing well, we’re really failing as a community to think about the sorts of long-term investments we need to be making in our young people.”

Sawyer believes young people need to be given more credit and appreciation for their ideas and provided with opportunities to contribute to their communities.

Opportunities to participate in school, community sport, part-time work and recreation were limited during the pandemic, she said, but were critical for children and teenagers to develop social connections and life skills that build resilience.


Melissa Davey Medical editor

The GuardianTramp

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