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Three of 5 youth suicide decedents did not have a documented preceding mental health diagnosis, according to a study published in JAMA Network Open. The study aimed to examine the association of documented mental health diagnosis with sociodemographic and clinical characteristics, precipitating circumstances, and mechanism among youth suicide decedents.¹

Background

Suicide was among the top 9 leading causes of death for people aged 10 to 64 years, and was the second leading cause of death for individuals aged 10 to 14 years and 25 to 34 years in 2022, respectively, according to data from the Centers for Disease Control and Prevention (CDC).²

Investigators of the study, led by Sofia Chaudhary, MD, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, noted that knowledge about potential sociodemographic differences in documented health diagnoses could guide prevention efforts. The investigative team noted that as suicide rates have increased, so have disparities.¹

"American Indian and Alaska Native youths have the highest rate of suicide overall (41.9 per 100 000 youths in 2020) while the rate of suicide has risen the fastest among Black youths (6.9 per 100 000 youths in 2010 and 12.9 per 100 000 youths in 2020, an 87% increase)," stated Chaudhary and authors.¹

"These disparities persisted and widened after the onset of the COVID-19 pandemic, which brought social isolation and stressors at home, decreased access to timely [mental health] services, and increased access to firearms," the authors added.¹

Study details and results

In a retrospective and cross-sectional approach, the study used data from the CDC National Violent Death Reporting System from 2010 to 2021 for youth suicide decedents aged 10 to 24 years. Previously documented presence of a mental health diagnosis was the primary outcome of the study, with associations evaluated by multivariable logistic regression.¹

In all, there were 40,618 youth suicide decedents aged 10 to 24 years (79.2% male), with 58.1% aged 20 to 24 years. Demographic data included:¹

• American Indian or Alaska Native - 2.9%
• Asian, Native Hawaiian, or Other Pacific Islander - 4.2%
• Black - 12.7%
• Hispanic - 13.2%
• White - 76.1%

There were 16,426 individuals (40.4%) who had a documented mental health diagnosis, while 19,027 (46.8%) died by firearms. Compared to White youths, the adjusted odds of having a mental health diagnosis were lower among youths who were:¹

• American Indian or Alaska Native - adjusted odds ratio (aOR), 0.45; 95% CI, 0.39-0.51
• Asian, Native Hawaiian, or Other Pacific Islander - aOR, 0.58; 95% CI, 0.52-0.64
• Black - a OR, 0.62; 95% CI, 0.58-0.66

aOR of having a mental health diagnosis were also, "lower among Hispanic youths (aOR, 0.76; 95% CI, 0.72-0.82) compared with non-Hispanic youths; lower among youths aged 10 to 14 years (aOR, 0.70; 95% CI, 0.65-0.76) compared with youths aged 20 to 24 years; and higher for females (aOR, 1.64; 95% CI, 1.56-1.73) than males," the investigators found.¹

For those who died by firearms (19,027), a mental health diagnosis was documented for 6308 (33.2%) youth. Documentation was available for 1691 of 2743 youths who died by poisonings (61.6%), 7017 of 15,331 youths who died by hanging, strangulation, or suffocation (45.8%), and 1407 of 3181 youths who died by other mechanisms (44.2%).¹

Conclusion

According to study results, where 3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis, the odds of having this diagnosis were lower for racially and ethnically minoritized youths compared to White youths, as were odds for youth who died of suicides by firearm compared to other mechanisms.¹

"These findings underscore the critical need to increase equitable access to mental health screening, diagnosis, and treatment for all youths," the authors wrote.¹

"Given the low rates of [mental health] diagnoses among youth suicide decedents, prevention efforts must also address family and life stressors in tandem with [mental health] risk factors. Both increased identification of unmet [mental health] needs and universal, community-based approaches are needed to prevent youth suicide," concluded the investigative team.¹

References:

1. Chaudhary S, Hoffmann JA, Pulcini CD, et al. Youth suicide and preceding mental health diagnosis. JAMA Netw Open. 2024;7(7):e2423996. doi:10.1001/jamanetworkopen.2024.23996
2. Facts about suicide. Centers for Disease Control and Prevention. Updated April 25, 2024. Accessed August 6, 2024. https://www.cdc.gov/suicide/facts/index.html