Case dilemma
The researchers give the example of a 10-year-old patient who was found unconscious in her bedroom. The psychiatric team was called in to discuss a suicide attempt by hanging. But when the girl was evaluated, she was in tears, denied previous or recent suicide attempts, and said she was merely participating in the blackout challenge. Yet she reported being in a depressed mood, having feelings of hopelessness, having suicidal thoughts since the age of 9, being bullied, and having no friends. Family members reported unstable housing, busy or absent parental figures, and a family history of suicide attempts.
If the girl's injuries were unintentional, due to the poor choice to participate in the life-threatening TikTok challenge, doctors would send the patient home with a recommendation for outpatient mental health care to address underlying psychiatric conditions and stressors. But if the injuries were self-inflicted with the intent to die, doctors would recommend inpatient psychiatric treatment for safety reasons, which would allow further risk assessment, monitoring and treatment of the suspected suicide attempt.
It is crucial to make the right choice here. Children and teens who attempt suicide are at risk for more attempts, both immediately and in the future. But to make matters even more complex, injuries from social media challenges can cause depression and post-traumatic stress disorder. These in turn could increase the risk of suicide attempts.
To keep children and teens safe, the Ataga and Arnold are calling for more awareness about the dangers of TikTok challenges, as well as empathetic psychiatric assessments using child-appropriate measures. They also call for more research. While there are a handful of case studies on TikTok that challenge injuries and deaths among children and teens, there is a lack of large-scale data. More research is needed to “demonstrate the role of challenges as precipitating factors in unintentional and intentional injuries, suicidal behavior, and deaths among children in the US,” the psychiatrists write.
If you or someone you know is in crisis, call or text 988 for the Suicide and Crisis Lifeline or contact the Crisis Text Line by texting 741741.
