Sex, racial/ethnic disparities apparent among adolescents with suicidal ideation

Sex and racial/ethnic disparities in temporal trends were apparent among adolescents with suicidal ideation, according to results of a cross-sectional analysis published in JAMA Network Open.

“Previous studies have reported increasing rates of suicide death, nonfatal suicidal ideation, plan attempts and injury due to attempts,” Yunyu Xiao, PhD, of the School of Social Work at Indiana University–Purdue University, and colleagues wrote. “However, most work to date did not separate youths who attempted suicide from those who had suicidal ideation but no attempts. This step is needed, because theoretical and empirical evidence suggests that the risk factors associated with suicidal ideation and suicide attempts are likely to differ.”

According to the researchers, it is currently unknown whether disparities in suicide death extend to groups targeted for suicide prevention efforts, particularly individuals with suicidal ideation or nonfatal suicide attempts. In the current study, they aimed to assess differences in temporal trends between suicidal ideation and suicide attempts among U.S. adolescents between 1991 and 2019 according to sex and race/ethnicity subgroups. They conducted a cross-sectional analysis of the national Youth Risk Behavior Survey, which was weighted to represent U.S. adolescents in the desired timeframe, and they included 183,563 U.S. high school students in grades 9 to 12. Calendar year, sex, race/ethnicity and interactions of sex and race/ethnicity served as exposures.

Main outcomes and measures included survey-weighted prevalence estimates, annual percentage changes and average annual percentage change in the survey-weighted prevalence of suicidal ideation and nonfatal suicide attempts. They constructed these outcomes/measures using self-reported suicidal ideation, plan and attempts in each survey year according to sex, race/ethnicity and their interactions.

Results showed a decrease in the prevalence of suicidal ideation from 19.4% in 1991 to 15.8% in 2019. However, the prevalence of nonfatal suicide attempts increased from 7.3% in 1991 to 8.9% in 2019. Joinpoint regression showed a 3.1% annual decrease in suicidal ideation between 1991 and 2009, and then a 3.4% annual increase between 2009 and 2019. The researchers noted modestly different turning points in female, white, Hispanic and Black adolescents based on decreasing followed by increasing trends in suicidal ideation. Further, they observed no significant trends in suicide attempts between 1991 and 2019; however, male and Black adolescents exhibited greater increases in the prevalence of suicide attempts, for a 68.4% and 79.7% increase, respectively. Interaction of sex and race/ethnicity showed increases in suicidal ideation among white females from 2009 to 2019, with an annual percentage change of 4.3%; Black females from 2005 to 2019, with an annual percentage change of 3.4%; and Hispanic females from 2009 to 2019, with an annual percentage change of 3.3%. The researchers also noted an increase in suicide attempts among white females between 2009 and 2019, for an annual percentage change of 3.1%.

“Males, particularly Black male adolescents, appear to have the greatest need in terms of prevention of suicidal behaviors,” Xiao and colleagues wrote. “Both groups have underperformed in help-seeking capacity and there may be stigma and racial barriers to getting psychiatric treatment for young Black males. Strategies that prioritize monitoring the trends in risk factors for suicidal behaviors in racial/ethnic subgroups, design culturally appropriate prevention programs, alleviate structural inequality, reduce mental health stigma and barriers to health care and promote help-seeking should be ethnically and sexually diversified for effective suicide prevention.”