There are those who choose the pills. Benzodiazepines, but also the unsuspected paracetamol. And who gets to drink half a bottle of bubble bath, or worse, bleach. In the wardrobes of the house, the material is not lacking if the obsession is to get hurt, sometimes not with the intention of ending it all but to launch a desperate cry for help. At 12, 14, 18, when difficulties can seem like chasms capable of swallowing. From here on, the script repeats itself: the ambulance lights, the rush to the emergency room, the doctors’ game to save a life, the phone call with the Poison Control Center.
“After the darkest months of the Covid emergency one thing has changed – he explains Carlo Locatelli, responsible of Poison Control Center and National Toxicological Information Center of the Irccs Maugeri of Pavia – It is the frequency with which there have been reported episodes of poisoning for self-harm in which the perpetrators are minors: almost doubled “. I
n an analysis carried out for time.news Health, the expert compared the data of the first 4 months of several years, before and after the pandemic.
If in 2014, 2015 and 2016, between January and April people traveled at the rate of about 48-50 intoxications for self-harm per month in adolescents, “in the same period of 2021 this figure rose to 86 monthly cases, with peaks of 100 ad April”.
The observatory of the Pavia center covers the national territory from North to South. In 4 cases out of 5 they are girls, in 80% the absence of known risk factors is striking. “The majority of patients are 15-18 years old, but there are many between 13 and 14 (they are half the 18-year-olds), a fair minority of 12-year-olds, exceptional cases of 10-11 year-olds”. These numbers, explains Locatelli, should be seen as a red light that must turn attention to the discomfort of children. Not just on the eve of the World Mental Health Day which is celebrated on 10 October. Of the total confirmed episodes of intoxication, 22-23% occurs with the use of household products (bleach, muriatic acid), 4% with cosmetic products (such as shampoo, “which is dangerous because the foam it produces invades the lungs”).
The bulk, 75%, are drug intoxications: in particular for 50-60% neurosuppressants, benzodiazepines and so on, and for 22-25% paracetamol, the latter share “growing“. This drug is considered by the most harmless, but in reality if taken in overdose it can cause for example very serious liver damage.” In the first 24 hours the intoxication from paracetamol gives banal vomiting – explains Locatelli – but the problem is that after 24-48 hours the transaminases rise and acute hepatitis begins. It is paradoxically something more subtle. If the patient does not admit to having taken it, doctors risk not realizing it immediately and finding himself two days later with hepatitis that can no longer be treated. While if a person takes an antidepressant and does not say it, it has effects on the heart and nervous system, which lead to more easily discover it “.
“In the emergency room there are children who show psychopathological symptoms or who have committed self-damaging gestures. The problem has increaseda “, confirms Carlo Fraticelli, director of the Mental Health and Addiction Department of Asst Lariana.” We too in our facility have seen an increase in access to pediatric emergency rooms, with an increase in consultations from child and adolescent neuropsychiatry specialists . From January to June 2021 we had 166 accesses, in all of 2019 there were 280, so we see an increase of about 30% compared to the pre-pandemic year. “The basin served by Asst is an area of 600 thousand inhabitants (almost 100 thousand under 18).
Children and adolescents “were significantly affected emotionally by the pandemic condition and the restraining measures that were necessary to contain the infection”, reflects the expert, and this ‘lockdown effect’ “was confirmed both at national and international level. The remote outcomes still need to be explored: there has been emotional distress and we are not yet able to see what will happen. Those who have lost a family member certainly have a greater chance of presenting depressive conditions in the future, those who have been infected or have gone through moments of serious difficulty have had to face high levels of stress “.
Dad, fear, isolation and boredom weighed on young people, long-term effects still to be understood
The fear of infection, then, “weighed heavily on the little ones, who feared for their parents (especially the children of health workers)”. There were, continues Fraticelli, “the frustration and boredom associated with being forced home without knowing what to do, the lack of face-to-face contact with friends, classmates and teachers, information that was not always adequate, situations of limited space, economic and financial losses of families. Dad was a vulnus “.
And certainly the pandemic has exacerbated the problems of “isolation, attachment to social networks, sleep loss and alteration of the sleep-wake rhythm”, Fraticelli lists. The Net has played a role, “but not only in a negative way, even if the use of the Internet and mobile phones by children requires close supervision”. In any case, between the first wave and the following ones, “the picture has changed”, points out the expert. In 2020 during Covid, Patrizia Conti, head of the complex operating unit of Child and Adolescent Neuropsychiatry of Asst Lariana, retraces “we had a clear reduction in minors, especially in new accesses. There was fear” also of going to hospital.
“However, we kept in touch with our patients who, locked up at home without school, were in great difficulty. The infantile neuropsychiatrists worked a lot with telemedicine interventions even for very young children. It was also helpful for the parents, to deal with the lockdown “. In the summer of 2020 “there was a reactivation of resources, a recovery of social relations and we did not have that increase in accesses in child neuropsychiatry that we expected after the lockdown”, continues the expert. Fraticelli also remembers the “feeling of illusion that the storm was over”.
Eating disorders and self-harm are on the rise, as is the age of children in the emergency room
Then there was the second closure, in October-November 2021, and this “caused an explosion in the accesses – reports Conti – And while before the minors who arrived they tended to have anxiety disorders from school resumption or a series of fatigue, in this phase the most depressive aspect prevailed, which in children is expressed with behavioral disorders, self-harm, suicide attempts. We have seen many disorders of eating behavior. There has been a huge demand, both as access to First aid and outpatient “.
Conti reports that he also observed “a lowering of age, we are talking about middle school or the last year of elementary school. The accesses are still very high: we have about 30 outpatient emergencies a month, normally we had less than 10. We are trying to answer, first on the emergency and then with the overall outpatient care that follows the times of the waiting lists “. Covid, Fraticelli reflects, also had “an unexpected twist: it shed light on the difficulties and reactivated attention to these services and their importance”.
To parents, he concludes, “I say that now we need to focus on the aspects that create trust. It should be described as a sort of ‘normality’ the fact of being in a condition of discomfort. If we look instead at cases of clinical severity, it is necessary to work to grasp precociously the signs of these conditions, for example depressive. And refer to specialists without problem. This country still suffers a great stigmatization of those who ask for help. And it is the biggest block to the possibility of getting better. Finally I believe that vaccination is opening a new phase, it is giving confidence. The kids have understood this. It is no coincidence that they are the first who went to get vaccinated, when the chance to do so came for them “.