Study: Adolescent suicides increased by all methods since 1999

Key takeaways:

• Firearm suicides from ages 10 to 19 increased across genders, races and ethnicities.
• Black adolescent and female adolescent suicides by hanging also increased.

Adolescent suicides increased by all methods — including firearms — from 1999 to 2020, according to a study published in JAMA Network Open.

“A lot of work has been looking at adolescent suicide trends by age, sex, and a general population, but little is known about the methods used for suicide, even though the method and access to means are important predictors of lethality,” authors Cameron K. Ormiston, BS; Wayne R. Lawrence, DrPH and Faustine Williams, PhD — all from the Division of Intramural Research at the NIH’s National Institute on Minority Health and Health Disparities — told Healio in joint email responses.

They studied death certificates for 10- to 19-year-olds who died between Jan. 1, 1999, to Dec. 31, 2020, compiled by the National Center for Health Statistics. Among 47,217 adolescents who died by suicide, they calculated age-standardized mortality rates and annual percent change in mortality rates by suicide method, and examined trends by age, sex and race and ethnicity.

From 1999 to 2020, suicide by firearm (average annual percent change [AAPC] = 1; 95% CI, 0.1-1.9), poisoning (AAPC = 2.7; 95% CI, 1-4.4), hanging and asphyxiation (AAPC = 2.4; 95% CI, 0.2-4.6), and other means (AAPC = 2.9; 95% CI, 1.2-4.6) all increased. The authors also identified rapidly increasing rates for poisoning (AAPC = 4.5; 95% CI, 2.3-6.7) and hanging and asphyxiation (AAPC = 5.9; 95% CI, 5-6.8) among females. During the study period, Black adolescents had the highest average increase in hanging and asphyxiation suicides (AAPC = 4.2; 95% CI, 3.2-5.2).

Most notably, firearm suicides sharply increased among all groups from 2007 to 2020, with growth beginning among females (annual percent change [APC] = 7.8; 95% CI, 6-9.5) and males (APC = 5.3; 95% CI, 4.3-6.3) beginning in 2007, among Black adolescents beginning in 2012 (APC = 14.5; 95% CI, 9.7-19.5), Asian and Pacific Islander adolescents beginning in 2008 (APC = 12; 95% CI, 9.7-14.5), Hispanic and Latino adolescents beginning in 2011 (APC = 10.2; 95% CI, 6.3-13.8) and American Indian and Alaska Native adolescents beginning in 2014 (APC = 10.6; 95% CI, 2.6-19.3).

Two years ago, the AAP issued a policy statement recommending that firearms — which remain the leading cause of death among youth in the United States — be regulated on the level of motor vehicles, with requirements for training, licensing, insurance coverage and registration.

“It was known that suicide rates were increasing among racial and ethnic minoritized adolescents. However, we did not know these trends by method as research in this area is still lacking,” the authors told Healio. “While striking, we also expected to see increases in poisoning among female youth but not in male youth. The rapidly rising rates in suicides by firearm among Asian and Pacific Islander youth also especially stood out to us.”

According to the authors, the early identification of suicide risk is “paramount.” They said primary care physicians and pediatricians can “play a crucial role in addressing firearm suicides.”

“Providers and the health care system urgently need to collaborate with racial and ethnic minoritized communities to effectively address high suicide rate among youth in these communities,” the authors said. “Presently, significant barriers to mental health care that hinder help-seeking behaviors among racial and ethnic minoritized youth continue to persist and may have been exacerbated by the pandemic, including a lack of providers of racial and ethnic minoritized 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.”

Ormiston, Lawrence and Williams also noted “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 minoritized youth,” which they called “a dimension currently lacking in the literature.”

“Understanding how these factors can influence suicide and suicide methods is important,” the authors said. “Regional or state differences would also be an important area to focus on given the heterogeneity in gun owning culture, policy, and practices by state.”

The authors added that suicide prevention comprises “a combination of mental health care and injury prevention.”

“Given the increase in gun ownership during the pandemic, it is important to understand how the recent surge in youth exposure to gun violence and new gun owners and guns impacts on adolescent suicide attempt and mortality rates,” the authors said. “Emerging evidence has linked unsafe gun storing at home to youth attempted suicide and fatalities. Unfortunately, unsafe gun storing 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 importance of safe gun storing practices [are] therefore vital.”