The number of young American girls turning to self-harm is skyrocketing

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Suicide rates among American teens are rising, as are rates of depression and anxiety. A new study in JAMA shows the pattern is similar for self-harm, with alarmingly high rates among young girls.

Until 2008, the rate of self-inflicted injuries bad enough to land a young person in the emergency room was relatively stable. But since 2009, the rate of girls aged 10 to 14 arriving in American emergency rooms with self-inflicted injuries has increased by 19% per year, a pace far surpassing any other group.

The research did not say what was causing the spike, but mental health experts have suggested everything from a sharp rise in smartphone use, to increasing academic demands, to post-crisis economic stresses on families. Regardless of cause, public health experts, including the authors, point to a fairly compelling reason to care about the rise in kids overdosing on drugs, or cutting themselves with blunt objects: “Self-inflicted injury is one of the strongest risk factors for suicide—the second leading cause of death among those aged 10 to 24 years during 2015,” according to the report.

Researchers analyzed data from 2001 to 2015 on self-inflicted injuries among people aged 10 to 24, which did not result in death and were treated in emergency rooms. (All the injuries were intentional, but not all were suicide attempts, Melissa Mercado, one of the authors, told the Associated Press.) In total, the study included data from around 29,000 girls and about 14,000 boys, broken down into three age groups: 10-14, 15-19, and 20-24. The study also tracked the method of self-injury: drug overdoses and other self-poisonings were the most common method among girls and boys, followed by intentional cutting with sharp objects.

There are plenty of warning signs that rising stress levels among teens needs to be addressed and there seem to be few bright spots, with everything from anxiety to anorexia affecting girls earlier. “The illness is starting at a younger age,” said Mima Simic, joint head of child and adolescent eating disorder service at the Maudsley Hospital in West London, a clinic that’s responsible for changing the way eating disorders are treated around the world.

Awareness of the problem is rising, from Netflix’s controversial 13 Reasons to increased media coverage. But better access to and delivery of treatment is desperately needed. The report suggested better care for kids at risk of suicide, as well as efforts to create safer and more connected environments. And by connected, they do not mean on Snapchat.