Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017

Abstract

OBJECTIVES: To determine if racial and ethnic subgroups of adolescents are at high risk for engagement in suicidal behaviors.METHODS: Using the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, we conducted logistic regression analyses to examine trends by different racial and ethnic groups, with each suicide indicator serving as a dichotomous outcome. Participants included 198 540 high school students.RESULTS: Across all sex and race and ethnic groups, there were significant linear decreases in self-reported suicidal ideation and suicide plans from 1991 to 2017. Female adolescents (odds ratio [OR], 0.98; P , .001) had significant decreases in attempts over time. Black adolescents had positive linear trends for suicide attempts among both boys (OR, 1.04; P , .001) and girls (OR, 1.02; P = .003). Black adolescent boys (OR, 1.04; P = .048) had a significant linear increase in injury by attempt. CONCLUSIONS:The results suggest that, over time, black youth have experienced an increase in suicide attempts, which is troubling because attempts are the most prominent risk factor associated with suicide death. For black boys, a significant increase in injury by attempt occurred, which suggests that black boys may be engaging in increasingly lethal means when attempting suicide. Examining trends of suicidal thoughts and behaviors over time by sex and race and ethnicity allow us to determine where to focus prevention and intervention efforts. Future research should examine the underlying reasons for these changes observed in US high school students.WHAT'S KNOWN ON THIS SUBJECT: Suicide is the second leading cause of death among adolescents. Racial and ethnic disparities have been discovered in suicide deaths. Racial and ethnic differences in trends of youth suicidal ideation, plans, and suicide attempts, however, remain understudied.WHAT THIS STUDY ADDS: This study uncovered racial and ethnic differences in trends of suicidal behaviors. Suicide ideation and suicidal plans decreased among US adolescents between 1991 and 2017. Subgroup findings indicate suicide attempts increased only among black adolescents.

Sexual Identity–Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents

“…Accordingly, there is need to consider the multiple minority stressors that these SMY of color might face. Future research should assess how these experiences might impact any increased suicidal thoughts and behaviors among SMY of color, especially given recent research that indicates increasing rates of attempted suicide among Black adolescents (Lindsey, Sheftall, Xiao, & Joe, 2019). Finally, youth within the profiles representing SMY (by different combinations of nonexclusive heterosexual identity and behavior) more frequently endorsed experiencing bullying and feelings of sadness/hopelessness.…”

Increases in Rates of Suicide and Suicide Attempts Among Black Adolescents

“…12 One hypothesis for protective factors is that external attributional orientation (eg, blaming others or "the system" for difficulties) among blacks may have buffered this group from internalizing blame related to psychological stressors. 12 The increased rate of suicide by black adolescents, particularly girls, and the findings of Lindsey et al 5 of increases in the rate of black adolescent suicide attempts (accelerating among girls) suggest that protective factors have diminished. For example, the attributional orientation of black adolescents may have shifted toward an internal orientation, thus leading to an increase in suicide risk factors, particularly depression.…”

“…In this issue of Pediatrics, Lindsey et al 5 examine the results of the Youth Risk Behavior Survey from 1991 to 2017 with regard to trends by sex and racial or ethnic subgroups. The Youth Risk Behavior Survey is a nationally representative, self-report survey of high school students that asked about suicidality over the previous 12 months.…”

Psychological and neurobiological aspects of suicide in adolescents: Current outlooks

“…Recent research examining trends of suicidal behaviors among adolescents of different racial and ethnic groups in the United States has shown an increase in suicide attempts among black youth with a significant increase in injury by attempts among black males ( Lindsey et al., 2019 , Pediatrics). The rise in the number of suicidal attempts is thought to be related to mental health and socio etiologic factors incommensurately experienced by black youth, including poverty and racial discrimination ( Lindsey et al., 2019 , Pediatrics). Stress-related to the aforesaid ethnicity groups including victimization is expected to account for their increased risk of suicidality (Thoma et al., 2019; Pediatrics).…”

“…Research has found substantial gender and racial/ethnic differences in suicide risk factors among youth underscoring the need for this ( Lee and Wong, 2020 ). Recommendations for interventions tailored to the black community include efforts to increase access to mental health care by reducing stigma and increasing help-seeking behavior ( Lindsey et al., 2019 ). Researchers examining risk and protective factors related to adolescent suicide attempts recommend psychotherapy aimed at treating persistent depression and increasing productive coping skills ( Mirkovic et al., 2020 ).…”