Suicidal Ideation and Behaviors Among High School Students — Youth..
Asha Z. Ivey-Stephenson, PhD1; Zewditu Demissie, PhD2; Alexander E. Crosby, MD1; Deborah M. Stone, ScD1; Elizabeth Gaylor, MPH1; Natalie Wilkins, PhD2; Richard Lowry, MD3; Margaret Brown, DrPH1 (View author affiliations)
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Suicide is the second leading cause of death among high school-aged youths 14–18 years after unintentional injuries. This report summarizes data regarding suicidal ideation (i.e., seriously considered suicide) and behaviors (i.e., made a suicide plan, attempted suicide, and made a suicide attempt requiring medical treatment) from CDC’s 2019 Youth Risk Behavior Survey.
Results are reported overall and by sex, grade, race/ethnicity, sexual identity, and sex of sexual contacts, overall and within sex groups. Trends in suicide attempts during 2009–2019 are also reported by sex, race/ethnicity, and grade. During 2009–2019, prevalence of suicide attempts increased overall and among female, non-Hispanic white, non-Hispanic black, and 12th-grade students.
Data from 2019 reflect substantial differences by demographics regarding suicidal ideation and behaviors. For example, during 2019, a total of 18.8% of students reported having seriously considered suicide, with prevalence estimates highest among females (24.1%); white non-Hispanic students (19.1%); students who reported having sex with persons of the same sex or with both sexes (54.
2%); and students who identified as lesbian, gay, or bisexual (46.8%). Among all students, 8.9% reported having attempted suicide, with prevalence estimates highest among females (11.0%); black non-Hispanic students (11.8%); students who reported having sex with persons of the same sex or with both sexes (30.3%); and students who identified as lesbian, gay, or bisexual (23.4%).
Comprehensive suicide prevention can address these differences and reduce prevalence of suicidal ideation and behaviors by implementing programs, practices, and policies that prevent suicide (e.g., parenting programs), supporting persons currently at risk (e.g., psychotherapy), preventing reattempts (e.g.
, emergency department follow-up), and attending to persons who have lost a friend or loved one to suicide.
Suicidal behavior presents a major challenge to public health in the United States and globally (1). Although fatal (i.e., suicide) and nonfatal (e.g., suicide attempts) suicidal behaviors are a public health concern across the life span, they are of particular concern for youths and young adults aged 10–24 years.
During 2018, a total of 48,344 persons (all ages) died from suicide, and suicide was the 10th leading cause of death overall in the United States, accounting for approximately 1.7% of all deaths (2).
Among high school–aged youths (14–18 years), 2,039 suicides occurred that year, making it the second leading cause of death for this age group after unintentional injuries (n = 2,590). Suicide accounted for approximately 33.9% or approximately one of every three injury-related deaths among this age group (2).
During 2009–2018, suicide rates among youths aged 14–18 years increased by 61.7% from 6.0 to 9.7 per 100,000 population (2). Although suicide is a major public health problem, many more youths make suicide attempts and struggle with suicidal ideation.
For example, during 2018, according to data from a nationally representative sample of emergency departments (EDs), approximately 95,000 youths aged 14–18 years visited EDs for self-harm injuries (2).
One objective of the Healthy People 2020 Mental Health and Mental Disorders is to reduce suicide attempts by adolescents that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse (3).
The Youth Risk Behavior Survey (YRBS) monitors six categories of priority health behaviors and experiences among adolescents, with four questions specifically related to suicide (4).
This report summarizes 2019 YRBS data regarding suicidal ideation and behaviors among high school students and presents trends in suicide attempts among this population during 2009–2019.
The report is intended for decision-makers, prevention program practitioners, and those who work in youth-serving organizations so that they can identify vulnerable youths and take appropriate action to direct prevention resources to those young persons.
This report includes data from the 2009–2019 cycles of the YRBS, a cross-sectional, school-based survey conducted biennially since 1991. Each survey year, CDC collects data from a nationally representative sample of public and private school students in grades 9–12 in the 50 U.S. states and the District of Columbia.
Additional information about YRBS sampling, data collection, response rates, and processing is available in the overview report of this supplement (4). The overview report also includes information about the classification of sexual identity and sex of sexual contacts and standard data analysis methods.
The prevalence estimates for all suicidal ideation and behavior questions for the overall study population and by sex, race/ethnicity, grade, and sexual orientation are available at https://nccd.cdc.gov/youthonline/App/Default.aspx. The full YRBS questionnaire is available at https://www.cdc.
Four suicidal ideation and behavior variables are included in this report.
Suicidal ideation was measured with the question, “During the past 12 months, did you ever seriously consider attempting suicide?” Making a suicide plan was measured with the question, “During the past 12 months, did you make a plan about how you would attempt suicide?” (These two questions had “yes” or “no” response options.
) Suicide attempts were measured with the question, “During the past 12 months, how many times did you actually attempt suicide?” Suicide attempts were assessed by frequency of attempts, but the variable was dichotomized into yes or no responses for analytic purposes.
Lastly, students were asked, “If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse?” This question is referred to in this report as, “made a suicide attempt requiring medical treatment.” The response options for the last question were, “I did not attempt suicide during the past 12 months,” “yes,” or “no”; however, this variable was also dichotomized into yes or no responses for analysis.
Analyses of these suicidal ideation and behavior variables included examining associations between each item and demographic characteristics, including sex (male/female), race/ethnicity (non-Hispanic white [white], non-Hispanic black [black], or Hispanic), grade (9, 10, 11, or 12), sexual identity (heterosexual; lesbian, gay, or bisexual [LGB]; or not sure), and sex of sexual contacts (sexual contact with only the opposite sex, sexual contact with only the same sex or both sexes, or no sexual contact). Associations by race/ethnicity, grade, sexual identity, and sex of sexual contacts were calculated for the overall study population but also separately for male and female students. Statistical differences were determined by using chi-square analyses at the p