There was a “dramatic’ doubling of the number of Ontario teenagers going to emergency rooms for self-harm between 2009 and 2017, according to a new study.

Researchers also found a 78 per cent spike in the rate of visits for mental health problems.

Over the nine-year period studied, there was a “sharp rise” in the rate of adolescents aged 13 to 17 going to the emergency room, which echoes similar results among U.S. teens.

Teams from the University of Ottawa and Children's Hospital of Eastern Ontario (CHEO) published their findings in the Canadian Journal of Psychiatry.

“We all knew something like this was happening but we didn’t know [it] was so dramatic,” the lead author and uOttawa senior research chair Dr. William Gardner told over the phone.

In the past several years, Gardner said, there have been “extraordinary” demands on CHEO-affiliated hospitals’ emergency departments and mental health services.

Teenagers who intentionally harm themselves by poisoning or injuring themselves are at greater risk for repeated self-harm or suicide.

Between 2003 and 2009, the number of teens going to the ER for self-harm had actually been steadily falling. During that same time period, ER visits for mental concerns were relatively unchanged.

But in 2009, all of this changed.

Gardner said the year was a “inflection point” when the rates of both ER visits for self-harm and mental health problems skyrocketed.


The team suspects this may be tied into the rise of social media and smartphone use; the increased prevalence of cyberbullying; and the strain of the 2008 financial crisis.

Gardner speculated there was a “group of vulnerable adolescents who are at risk of mental health disorders … for whom being constantly on camera -- so to speak -- is tremendously stressful.”

He said that “having all these phones in your pocket could be very difficult” for teens who were self-conscious about their social status or appearance, making them vulnerable to being rejected or emotionally bullied.

The study noted the spikes in ER visits were even greater for girls than for boys.

“There are much higher social expectations for beauty for girls,” he suggested, adding they could be more prone to changes emotionally. “They are more likely to be sensitive to acceptance and rejection inside [friendship] networks.”

“It could be that exposure to social media is more stressful,” Gardner said, adding that young women are more in tune with their feelings. “But girls are also able to better reflect on their inner states [than boys] … and they’re more willing to seek care and help if they need it.”

To compile their findings, the team tracked 170,000 visits to Ontario emergency departments from teens for self-harm or mental health concerns between 2003 to 2017.

He suggested the overall ER visit rates may have also spiked because of successful attempts to decrease the stigma around mental health.


But problems can occur when parents take their children to the emergency room rather than other resources, such as counseling or therapy.

“It’s not a suitable place to get mental health care. It’s sort of a last resort but for many people in many situations, it’s the only way they know how [to get it],” Gardner said, stressing that families need to relay their mental health concerns to their family doctors.

He urged the government and mental health facilities to better alert people about available resources “before they get to a crisis.”

Gardner, who focuses on child and adolescent psychiatry, said his team’s next study will examine teens after their emergency department visits.

“It’s a distressing picture,” he said, adding a “substantial number of these kids get into deeper health problems following these visits.”