New research from Nationwide Children’s Hospital finds a disproportionate increase in youth suicide rates for females relative to males, particularly in younger youth aged 10-14 years.

The report, which describes youth suicide trends in the United States from 1975 to 2016, appears this week in JAMA Network Open.

Suicide is the second leading cause of death among youth aged 10-19 years in the U.S., with rates historically higher in males than females.

However, recent reports from the Centers for Disease Control and Prevention reveal female youth are experiencing a greater percent increase in suicide rates compared to males.

Donna Ruch, PhD, a post-doctoral researcher in the Center for Suicide Prevention and Research at the Research Institute at Nationwide Children’s Hospital, examined these trends by investigating suicide rates among U.S. youth aged 10-19 years from 1975 through 2016.

The researchers found that following a downward trend in suicide rates for both sexes in the early 1990s, suicide rates increased for both sexes since 2007, but suicide rates for females increased more.

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Suicide Mortality in the United States, 1999–2017

Data from the National Vital Statistics System, Mortality

• From 1999 through 2017, the age-adjusted suicide rate increased 33% from 10.5 to 14.0 per 100,000.
• Suicide rates were significantly higher in 2017 compared with 1999 among females aged 10–14 (1.7 and 0.5, respectively), 15–24 (5.8 and 3.0), 25–44 (7.8 and 5.5), 45–64 (9.7 and 6.0), and 65–74 (6.2 and 4.1).
• Suicide rates were significantly higher in 2017 compared with 1999 among males aged 10–14 (3.3 and 1.9, respectively), 15–24 (22.7 and 16.8), 25–44 (27.5 and 21.6), 45–64 (30.1 and 20.8) and 65–74 (26.2 and 24.7).
• In 2017, the age-adjusted suicide rate for the most rural (noncore) counties was 1.8 times the rate for the most urban (large central metro) counties (20.0 and 11.1 per 100,000, respectively).

Since 2008, suicide has ranked as the 10th leading cause of death for all ages in the United States (1). In 2016, suicide became the second leading cause of death for ages 10–34 and the fourth leading cause for ages 35–54 (1).

Although the Healthy People 2020 target is to reduce suicide rates to 10.2 per 100,000 by 2020 (2), suicide rates have steadily increased in recent years (3,4). This data brief uses final mortality data from the National Vital Statistics System (NVSS) to update trends in suicide mortality from 1999 through 2017 and to describe differences by sex, age group, and urbanization level of the decedent’s county of residence.

From 1999 through 2017, suicide rates increased for both males and females, with greater annual percentage increases occurring after 2006.

• From 1999 through 2017, the age-adjusted suicide rate increased 33% from 10.5 per 100,000 standard population to 14.0 (Figure 1). The rate increased on average by about 1% per year from 1999 through 2006 and by 2% per year from 2006 through 2017.
• For males, the rate increased 26% from 17.8 in 1999 to 22.4 in 2017. The rate did not significantly change from 1999 to 2006, then increased on average by about 2% per year from 2006 through 2017.
• For females, the rate increased 53% from 4.0 in 1999 to 6.1 in 2017. The rate increased on average by 2% per year from 1999 through 2007 and by 3% per year from 2007 through 2017.

Figure 1. Age-adjusted suicide rates, by sex: United States, 1999–2017

¹Stable trend from 1999 through 2006; significant increasing trend from 2006 through 2017, p < 0.001.
²Significant increasing trend from 1999 through 2017 with different rates of change over time, p < 0.001.
NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Age-adjusted death rates were calculated using the direct method and the 2000 U.S. standard population. Access data table for Figure 1 .
SOURCE: NCHS, National Vital Statistics System, Mortality.

Suicide rates for females aged 10–74 were higher in 2017 than in 1999.

• Suicide rates for females were highest for those aged 45–64 in both 1999 (6.0 per 100,000) and 2017 (9.7) (Figure 2).
• Suicide rates were significantly higher in 2017 compared with 1999 among females aged 10–14 (1.7 and 0.5, respectively), 15–24 (5.8 and 3.0), 25–44 (7.8 and 5.5), 45–64 (9.7 and 6.0), and 65–74 (6.2 and 4.1).
• The suicide rate in 2017 for females aged 75 and over (4.0) was significantly lower than the rate in 1999 (4.5).

Figure 2. Suicide rates for females, by age group: United States, 1999 and 2017

¹Significantly different from 1999 rate, p < 0.05.
²Significantly higher than rates for all other age groups in 1999, p < 0.05.
³Significantly higher than rates for all other age groups in 2017, p < 0.05.
NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0.Access data table for Figure 2.
SOURCE: NCHS, National Vital Statistics System, Mortality.

Suicide rates for males aged 10–74 were higher in 2017 than in 1999.

• Suicide rates for males were highest for those aged 75 and over in both 1999 (42.4 per 100,000) and 2017 (39.7) (Figure 3)
• Suicide rates were significantly higher in 2017 compared with 1999 among males aged 10–14 (3.3 and 1.9, respectively), 15–24 (22.7 and 16.8), 25–44 (27.5 and 21.6), 45–64 (30.1 and 20.8), and 65–74 (26.2 and 24.7).
• The suicide rate in 2017 for males aged 75 and over (39.7) was significantly lower than the rate in 1999 (42.4).

Figure 3. Suicide rates for males, by age group: United States, 1999 and 2017

¹Significantly different from 1999 rate, p < 0.05.
²Significantly higher than rates for all other age groups in 1999, p < 0.05.
³Significantly higher than rates for all other age groups in 2017, p < 0.05.
NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Access data table for Figure 3.
SOURCE: NCHS, National Vital Statistics System, Mortality.

The difference in age-adjusted suicide rates between the most rural and most urban counties was greater in 2017 than in 1999.

• In both 1999 and 2017, the age-adjusted suicide rate increased with decreasing urbanization (Figure 4). In 1999, the age-adjusted suicide rate for the most rural (noncore) counties (13.1 per 100,000) was 1.4 times the rate for the most urban (large central metro) counties (9.6). This difference increased in 2017, with the suicide rate for the most rural counties (20.0 per 100,000) increasing to 1.8 times the rate for the most urban counties (11.1).
• The age-adjusted suicide rate for the most urban counties in 2017 (11.1 per 100,000) was 16% higher than the rate in 1999 (9.6).
• The age-adjusted suicide rate for the most rural counties in 2017 (20.0 per 100,000) was 53% higher than the rate in 1999 (13.1).

Figure 4. Age-adjusted suicide rates, by county urbanization level: United States, 1999 and 2017

¹Significantly increasing suicide rates by decreasing urbanization, p < 0.05.
²Significantly higher than 1999 rate for each level of urbanization, p < 0.05.
NOTE: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of death codes U03, X60–X84, and Y87.0. Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is based on the 2006 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_154.pdf. Categories are presented from most urban (large central metro) to least urban (small metro), and from rural (micropolitan) to most rural (noncore). Access data table for Figure 4.
SOURCE: NCHS, National Vital Statistics System, Mortality.

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There was a significant and disproportionate increase in suicide rates for females relative to males, with the largest percentage increase in younger females.

These trends were observed across all regions of the country.

“Overall, we found a disproportionate increase in female youth suicide rates compared to males, resulting in a narrowing of the gap between male and female suicide rates,” said Dr. Ruch.

When the researchers looked at the data by method, they found the rates of female suicides by hanging or suffocation are approaching those of males.

This is especially troubling in light of the gender paradox in suicidal behavior, according to Jeff Bridge, PhD, director of the Center for Suicide Prevention and Research at Nationwide Children’s and co-author of the new study.

Dr. Bridge emphasized that asking children directly about suicide will not trigger subsequent suicidal thinking or behavior. The image is in the public domain.

Dr. Bridge said females have higher rates of non-fatal suicidal behavior, such as thinking about and attempting suicide, but more males die by suicide than females.

“One of the potential contributors to this gender paradox is that males tend to use more violent means, such as guns or hanging,” said Dr. Bridge.

“That makes the narrowing of the gender gap in suicide by hanging or suffocation that we found especially concerning from a public health perspective.”

The researchers called for future work to examine whether there are gender-specific risk factors that have changed in recent years and how these determinants can inform intervention.

“From a public health perspective, in terms of suicide prevention strategies, our findings reiterate the importance of not only addressing developmental needs but also taking gender into account,” said Dr. Ruch.

Dr. Bridge emphasized that asking children directly about suicide will not trigger subsequent suicidal thinking or behavior.

“Parents need to be aware of the warning signs of suicide, which include a child making suicidal statements, being unhappy for an extended period, withdrawing from friends or school activities or being increasingly aggressive or irritable,” he said.

“If parents observe these warning signs in their child, they should consider taking the child to see a mental health professional.”

Responsible reporting on suicide and the inclusion of stories of hope and resilience can prevent more suicides. You can find more information on safe messaging about suicide here. 

If you or someone you know is feeling suicidal, it’s important to talk to somebody. The National Suicide Prevention Lifeline is available at 1-800-273-8255 or by texting “START” to the Crisis Text Line at 741-741.

Because kids don’t wear their thoughts on their sleeves, we don’t know what they might be going through.

That’s why Nationwide Children’s Hospital launched On Our Sleeves to build a community of support for children living with mental illness through advocacy, education and fundraising for much-needed research.

For more information about children’s mental health and to help break the silence and stigma around mental illness, visit OnOurSleeves.org.

Note: The National Suicide Prevention Lifeline offers a free, online chat service for those who need to talk to a suicide prevention specialist.

Source:
Nationwide Children’s Hospital
Media Contacts: 
Shreya Bhola – Nationwide Children’s Hospital
Image Source:
The image is in the public domain.

Original Research: Open access
“Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016”. Donna A. Ruch, PhD; Arielle H. Sheftall, PhD; Paige Schlagbaum, BS; Joseph Rausch, PhD; John V. Campo, MD; Jeffrey A. Bridge, PhD.
JAMA Network Open. doi:10.1001/jamanetworkopen.2019.3886