Home Mental Health & Well-Being Adolescent Suicide Rates Increased Across All Methods in the US from 1999 to 2020

Adolescent Suicide Rates Increased Across All Methods in the US from 1999 to 2020

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Recent research published in JAMA Network Open reveals a troubling increase in adolescent suicide rates in the US, with notable variations in methods and demographic characteristics from 1999–2020. This comprehensive study underscores the growing public health crisis and the need for tailored interventions to address the complex factors contributing to this trend.

Cameron K. Ormiston, a researcher from the National Institutes of Health, provided insights on the motivations behind this study. He said: “A lot of work has been looking at adolescent suicide trends overall and by age and sex. However, little is known about the methods used for suicide, even though the method and access to means are important predictors of lethality.”

The study analysed national death certificate data for adolescents aged 10–19 years. The findings indicate a significant increase in suicide rates across all methods, including firearms, poisoning, hanging, and other means. Specifically, the average annual percent change (AAPC) for firearm suicides was 1.0%, for poisoning it was 2.7%, for hanging and asphyxiation it was 2.4%, and for other means it was 2.9%.

The study highlights stark demographic disparities in suicide methods. Among female adolescents, poisoning and hanging suicides increased sharply, with an AAPC of 4.5% and 5.9%, respectively. From 2007 to 2020, firearm suicides rose significantly among both female (7.8% APC) and male (5.3% APC) adolescents. Racial and ethnic disparities were also evident, with Black adolescents experiencing the highest average increase in hanging and asphyxiation suicides (4.2% AAPC) .

Wayne R. Lawrence, also a researcher from the National Institutes of Health, noted: “It was known that suicide rates have increased among racial and ethnic minoritised adolescents, but detailed trends by method remain poorly understood. While striking, we expected to see increases in poisoning among female youth but not among male youth. The rapidly rising rates of suicides by firearm among Asian and Pacific Islander youth also especially stood out to us.”

Firearm suicides showed notable increases among several racial and ethnic groups. Black adolescents saw a 14.5% APC increase from 2012 to 2020, while Asian and Pacific Islander adolescents experienced a 12.0% APC rise from 2008 to 2020. American Indian and Alaska Native adolescents had a 10.6% APC increase from 2014 to 2020, and Hispanic or Latino adolescents saw a 10.2% APC rise from 2011 to 2020.

The study points to several contributing factors and risks associated with the rising adolescent suicide rates. The increase in firearm suicides is partly attributed to higher gun ownership and unsafe storage practices in homes with adolescents. Male adolescents are particularly at risk due to a higher likelihood of residing in gun-owning homes and carrying guns, which are strongly associated with suicide risk and mortality. The sharp increase in firearm suicides since 2007 may reflect a surge in new gun owners and youth exposure to gun violence.

One of the co-authors, Faustine Williams, highlighted the importance of addressing these factors: “There is a critical need to address discrimination, anti-Black violence, and race-based traumatic stress, as they are increasingly implicated in rising suicide rates among racial and ethnic minoritised youth – a dimension currently lacking in the literature. Understanding how these factors can influence suicide and suicide methods is important. Regional or state differences would also be an important area to focus on given the heterogeneity in gun ownership culture, policy, and practices by state.”

Poisoning suicides, particularly drug poisoning, have also risen, with female adolescents showing a significant increase in suicide attempts involving antipsychotic or sedative-hypnotic medications. The study suggests that sex- and age-specific interventions are crucial to address the unique factors contributing to these trends.

Cultural and societal influences play a significant role in adolescent suicide rates. Among Asian and Pacific Islander adolescents, acculturative stress, cultural reconciliation conflicts, and disparities in follow-up care for at-risk youth are potential contributors to increasing suicide rates. Additionally, cultural stigma towards mental health problems can hinder early identification and intervention.

For Black adolescents, implicit biases in clinical settings often lead to under-recognition, misdiagnosis, and undertreatment of mental health conditions, creating barriers to effective suicide prevention. Black youth are frequently mislabeled as having behavioural problems rather than being identified as needing mental health services, which can result in failures to provide adequate care.

The authors also emphasised the significance of integrating mental health and injury prevention efforts: “Suicide mortality is a combination of mental health and injury prevention. Strengthening our infrastructure for early detection and treatment of mental health issues is essential. Simultaneously, it is demonstrably important to prevent fatality when suicide attempts occur. It is important to understand how the recent surge in new gun ownership and the increased exposure of youth to gun violence influence adolescent suicide attempts and mortality rates.”

Addressing the rising adolescent suicide rates requires a multifaceted and demographic-specific approach. Effective interventions must incorporate policy changes, public health initiatives, and recognition of the impact of structural racism, systemic inequities, and social determinants of health on suicide. Improving screening and early identification of suicide risk in primary care visits, school-based prevention programmes, and awareness campaigns is paramount.

Ormiston added: “Emerging evidence has linked unsafe gun storage at home to youth attempted suicide and fatalities. Unfortunately, unsafe gun storage practices are highly prevalent. Effective policy (such as mandating safe storage classes upon firearm purchase) and education on the dangers of guns in the home and the importance of safe gun storing practices are therefore vital.”

For racial and ethnic minoritised adolescents, particularly those in communities with high firearm ownership, effective state and tribal child access protection laws and improved household gun storage practices are critical. Interventions that emphasise cultural continuity and leverage the strengths of American Indian and Alaska Native communities may also reduce adolescent suicide rates.

The authors pointed out the barriers to mental health care: “Presently, significant barriers to mental health that hinder help-seeking behaviours among racial and ethnic minoritised youth continue to persist and may have been exacerbated by the pandemic, including a lack of providers of racial and ethnic minoritised identity, limited cultural humility, historical medical trauma, and continued bias and discrimination in healthcare settings, as well as financial and structural-level factors and mental health stigma.”

Restricting access to lethal means, such as disposing of surplus medications, using lockboxes for prescription medications, and blister-packing opioids, can help reduce poisoning suicides. Understanding the underlying reasons for the increase in hanging and asphyxiation suicides, especially among Asian and Pacific Islander and female youth, is crucial for developing effective prevention strategies.

The authors also mentioned the role of primary care providers and paediatricians: “Primary care providers and paediatricians can also play a crucial role in addressing firearm suicides, including improving the identification of children at risk of suicide, referring for counselling for gun-owning families on gun safety and safe storage practices.”

Lastly, the authors highlighted a critical resource: “The 988 Suicide & Crisis Lifeline provides 24/7, free, and confidential support for people in distress, as well as prevention and crisis resources.”

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