Suicides had jumped 29% among American adolescents aged 15 to 19 over the previous decade, rising from 8.4 per 100 000 during the 2012-2014 timeframe to 10.8 deaths per 100 000 in 2018-2020, according to the latest America's Health Rankings Health of Women and Children Report from the United Health Foundation, showing figures rising particularly significantly in 10 states.
The report captures 121 health measures based on the most recently available public health data from 30 different sources, with experts saying the pandemic was possibly an exacerbating factor for the climb in statistics.
On a state-by-state basis, Nevada, Colorado and South Carolina saw the greatest relative increases in teen suicides during the time periods studied:
• Nevada: 82% increase (8.3 to 15.1 per 100 000)
• Colorado: 67% increase (12.9 to 21.5 per 100 000)
• South Carolina: 55% increase (8.7 to 13.5 per 100 000)
In the 2018-2020 period, Alaska had the highest rate of adolescent suicides, at 40.4 per 100 000; that was almost eight times the rate of suicide in Massachusetts, with the lowest ranking at 5.0.
Rhonda Randall, DO, chief medical officer at UnitedHealthcare Employer and Individual, described the rise in suicides among youth as “incredibly sobering”. However, looking at the most affected subgroups provides a sense of where the opportunities and “calls to action” are, she said.
Medpage Today reports that the suicide rates were nearly five times higher among American Indian/Alaska native teenagers than among black teens (38.9 vs 8.0 per 100 000) during 2018-2020, and teen suicides were 3.2 times higher among males compared with females during that time. (Males historically complete suicide at higher rates than females.) Comparing 2012-2014 and 2018-2020 data, suicide rates increased 28% among both females (4.0 to 5.1 per 100 000) and males (12.7 to 16.3 per 100 000) between those two time periods.
The COVID pandemic possibly exacerbated the situation, said Alison Malmon, citing “the struggle, the anxiety, depression, social isolation experienced by youth and young adults”. Malmon, whose brother died by suicide in 2000, is the founder and executive director of Active Minds, which supports mental health awareness and education for students.
She added that youngsters weren’t given “enough credit” for what they endured. “Being away from friends, trying to come into your own while not having that social connection and network so many youth (and) young adults … need” had lasting effects, she said.
At the same time, the increase in mental health issues among young people began before COVID and stemmed from various challenges. From climate change to gun violence, they are “internalising all of what is around them, which is becoming a part of their well-being and overall health”, she said.
With regard to specific mental health conditions for youth aged three to 17, the percentage with anxiety increased from 7.5% in 2017-2018 to 9.2% in 2020-2022, while depression rose from 3.3% to 4.2%. By state, anxiety in this age group was found to be highest in Vermont (16.9%) and lowest in Hawaii (4.6%); depression was highest in Kentucky (7.3%) and lowest in Hawaii (2.4%).
Asked what surprised her most, Randall highlighted the pervasiveness of trends related to anxiety and depression. “It’s rising in all sub-populations, for all genders, and for adolescents across all socioeconomic statuses,” she said.
Frequent mental distress rising in women
The report also captured trends related to women’s health. Countrywide, numbers of women reporting “frequent mental distress” rose from 17% in 2017-2018 to 19.4% in 2019-2020 – an increase of 14%, or more than 1.2m women. Frequent mental distress is defined as 14 or more days of poor mental health in a month, reflective of “persistent, possibly severe, mental health issues”, according to the report.
By demographic, the largest increases in frequent mental distress during those periods were among American Indian/Alaska Native women, for whom the measure increased from 17.3% to 26.6% and among college graduates, where it rose from 10.2% to 13.5%.
Mortality also jumped 21% (from 97.2 to 117.3 deaths per 100 000) for women ages 20 to 44 during the time period from 2019 to 2020.
The “interconnectedness” of families really stood out in the report, particularly as it applied to women and children, Randall said. The increase in frequent mental distress among women of child-bearing age, many of whom are mothers, has downstream impacts on their family. Similarly, children experiencing depression, anxiety, or suicidality can affect their family’s mental health, as well as that of friends and others in the community, Randall added.
The report ranked Minnesota the “healthiest state” overall for women and children, and Louisiana the “least healthy state”, based on the states’' physical environment, behaviours, health outcomes, and social and economic factors.
A way forward
In response to rising suicide rates among young people, the American Academy of Paediatrics (AAP) changed its policy in 2022, now recommending universal screening for suicide for anyone 12 years and older, said Dr Arethusa Kirk, vice president of clinical strategy for United Healthcare Community & State.
AAP also recommends screening children aged 8 to 11 for suicide when clinically indicated, and assessing for suicidal thoughts in younger children if they exhibit warning signs. “The symptomatology really presents differently for kids,” she said. “They often might not have the language to describe their feelings."
If you ask if they’re depressed, they may not understand what that means, Kirk noted. “And they may actually present with more somatic symptoms, like headache or stomach ache, or just changes in mood irritability, which may come off as anger and explosive behaviour when it's really underlying anxiety and depression.”
Studies have shown a significant number of people who committed suicide visited a provider in the preceding weeks or months, she added. But because more than two-thirds of young people struggling with their mental health will tell friends before they tell anyone else, Malmon stressed the importance of teaching young people how to have conversations with those who may be in crisis.
The V-A-R model – which stands for validate, appreciate, and refer – is one way to help prevent a crisis. “This basic idea of ‘I hear you, I believe you. Thank you for sharing with me and how can I be helpful to you?’ is something to which young adults respond, Malmon said.
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Medpage Today article – Teen Suicides Jump 29% Over the Past Decade, Report Finds (Open access)
See more from MedicalBrief archives:
Cannabis smoking in teenage years linked to adulthood depression
Cannabis use may be associated with suicidality in young adults – NIH
Helping teens channel stress, improve resilience – New York study
Young women’s mental health worst hit by COVID – UCT and MRC
Social media's impact on mental health: An 8-year longitudinal study