By Iris Smith, Ph.D.
*The September 18 version of this newsletter mistakenly reported the sentence below in percentages. The data has been corrected to reflect the age adjusted rates per100,000 population.
Suicide is one of the leading causes of death in the U.S. In 2022, over 49,000 people died by suicide. Suicide rates in the U.S. increased 37% between 2000 and 2018, decreasing by 5% between 2018 and 2020 and returning to their peak in 2022.1 In 2022 the rates among males were approximately 4X higher than the rate among females. Males make up 50% of the population but nearly 80% of suicides. *Age adjusted rates of suicide (per 100,000 population) was 13.6 for 15-24 year olds and 2.4 for youth 10-14, the leading cause of death for this age group. Ethnic and gender minority and multi-racial youth may be at higher risk compared to White youth.
In 2019, suicide was the third leading cause of death for Black youth 5-19 years old. Between 2003 and 2019 rates of suicide in this group increased by 131%, with rates for black girls two times that of boys. A study by Bridge et al. (2018) found that Black children were twice as likely to die by suicide compared to White youth and more likely to commit suicide at younger ages.2 Among American Indian/Alaskan Native youth it is the leading cause of death for 15-19 years old, and the second leading cause of death for those 10-14. Suicide is also the leading cause of death for Asian/Pacific Islander youth and the second leading cause of death for Hispanic youth between 15 and 19 years old. Although data is limited, some studies have also reported higher rates among gender minority and multi-racial youth.3,4
The root causes of youth suicide are complex and are associated with individual behaviors. mental and physical health as well as factors at the community and societal level. Bullying, discrimination, racism and other adverse childhood experiences (ACEs) have been identified as contributing factors. Among Hispanic youth, fear of deportation and xenophobia are also associated with the likelihood of depression and suicide. One study found that 25% of Hispanic adolescents who had experienced the deportation of a family member had a 2.63 greater likelihood of suicide compared to non-immigrant peers. Among young Black adults the most frequently reported reasons for considering suicide were “feeling hopeless about the future” and experiencing feelings of “ failure”, “hopelessness” and “being overwhelmed by a lack of accomplishment”. In this study, young Black women were more likely to report that they considered suicide because they felt they “were unable to live up to the expectations of others.”5
Early drug use is also associated with suicidal behavior. A recent systematic review and meta-analysis of research studies published between 1991-2020 found that youth who misused drugs were 3.32 times more likely to consider or attempt suicide compared to non-users. Fifteen of the 78 studies reviewed found an increased suicide risk for adolescents who used cannabis or cocaine.6 Studies of adult patients diagnosed with substance use disorders (SUDs) have also found a strong association between alcohol and other substance use, previous history of sexual abuse, depression and suicidal behaviors.7 Findings from these studies highlight the importance of cross training mental health and substance use treatment providers in the use of screening tools for depression, suicide risk and substance use.
Preventing suicide requires a multi-pronged approach that addresses the known risk factors at the individual, family and community level. For example, training primary care providers to recognize the signs of depression and suicide risk in adolescent patients, conduct active outreach and follow-up of individuals who have recently experienced or been treated for depression or a suicide crisis. There are several validated screening tools for both suicide risk and depression however, few have been evaluated for effectiveness with ethnic and gender minority youth, immigrants or multi-racial youth. There is also a need for additional research on evidence-based targeted interventions for these groups. Universal prevention strategies can also be effective in raising community awareness of the signs of depression and risks factors associated with self-harm and action steps to take including, restricting access to lethal means such as firearms, which has become one of the frequently used means among youth in the U.S.
Resources
National Institute on Minority Health and Health Disparities HD Pulse An Online Resource for Interventions to Reduce Health Disparities and Improve Minority Health.
Intersection of Addiction and Racism: A Curated Bibliography : A collection of resources related to racism, anti-racism and advancing health equity for Black, Indigenous and other marginalized communities affected by unhealthy substance use. Centers for Disease Control and Prevention (CDC): Suicide Prevention Tools for Public Health Professionals.
2 Bridge et al. (2018). Age-Related Racial Disparity in Suicide Rates Among U.S. Youths From 2001-2015. JAMA Pediatrics: 172 (7); pg. 607-609.
3 Benton T. D. (2022). Suicide and Suicidal Behaviors Among Minoritized Youth. Child and adolescent psychiatric clinics of North America, 31(2), 211–221. https://doi.org/10.1016/j.chc.2022.01.002
4 Marconi, E., Monti, L., Marfoli, A., Kotzalidis, G. D., Janiri, D., Cianfriglia, C., Moriconi, F., Costa, S., Veredice, C., Sani, G., & Chieffo, D. P. R. (2023). A Systematic Review on Gender Dysphoria in Adolescents and Young Adults: Focus on Suicidal and Self-Harming Ideation and Behaviors. Child and Adolescent Psychiatry and Mental Health, 17(1), 110. https://doi.org/10.1186/s13034-023-00654-3
5 Goodwill J. R. (2024). Reasons for Suicide in Black Young Adults: A Latent Class Analysis. Journal of racial and ethnic health disparities, 11(1), 425–440. https://doi.org/10.1007/s40615-023-01530-8
6 Oliveira Gracini, C. L., Nascimento, G. G., Vidigal, M. T. C., Oliveira, M. N., Herval, Á. M., Blumenberg, C., Vieira, W. A., Lima, R. R., & Paranhos, L. R. (2024). Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis. Sao Paulo medical journal = Revista paulista de medicina, 142(4), e2022641. https://doi.org/10.1590/1516-3180.2022.0641.R2.23012024
7 Armoon, B., SoleimanvandiAzar, N., Fleury, M. J., Noroozi, A., Bayat, A. H., Mohammadi, R., Ahounbar, E., & Fattah Moghaddam, L. (2021). Prevalence, Sociodemographic Variables, Mental Health Condition, and Type of Drug Use Associated with Suicide Behaviors Among People with Substance Use Disorders: a Systematic Review and Meta-Analysis. Journal of addictive diseases, 39(4), 550–569. https://doi.org/10.1080/10550887.2021.1912572
