O3219: Evaluating Mental Health Characteristics and Precipitating Circumstances for Youth Suicide

Background: Suicide is the third leading cause of death among U.S. youth; 51% are from firearms. Although mental health (MH) conditions have been associated with youth suicide, a variety of precipitating circumstances may contribute to suicide risk. An understanding of risk factors is critical for prevention efforts. Our objective was to compare MH characteristics and precipitating circumstances of youth suicides by presence and absence of a known MH problem.

Methods: Retrospective cohort study of suicides by youth ages 10-24 years from 2010-2020 in the CDC National Violent Death Reporting System. Descriptive statistics and chi-square tests were utilized to compare MH characteristics and precipitating circumstances by documented MH problem. MH problem is coded for decedents identified as having MH problem or MH diagnosis and/or receiving MH treatment. Variables were selected based on completeness in the dataset.

Results: During the study period, 34,393 youth suicides were captured in the dataset. The highest number were from firearms (46%,), and occurred in White (76.4%), non-Hispanic (86.8%), aged 20-24 years (57.9%), male (79.3%) youth. MH problems were present in 40.4% of cases, and more prevalent in: White youth (42.6%) compared to Black youth (32.6%) and other racial ethnic groups; older youth (40.6%) compared to younger children (36.5%); and in females (52.6%) compared to males (37.2%) (all p<.001, Table 1). Documented MH problems were most frequent in suicides by poisonings (61.9%), followed by hanging (45.8%), other (44.1%), and then firearms (32.8%) (p < .001). Of the 19.3% youth suicide decedents with prior suicide attempt, 73.2% had a documented MH problem. 32.1% of youth suicide decedents had a prior history of suicidal thoughts and of these 62.4% had a documented MH problem. Among the 15.9% of youth with a substance abuse problem who died by suicide, 53.4% had a documented MH problem. Regarding precipitating circumstances (Table 2), 26.2% of youth suicide decedents had experienced known intimate partner violence, of which 38.7% had a documented MH problem. Among youth that died by suicide, 2.4% were victims of child abuse, of which 70.5% had a documented MH problem.

Conclusion: Most youth suicide decedents have not had a MH problem documented and many with family/life stressors do not have a documented MH problem. Differential access to MH services for different populations may play a role. These findings underscore the critical need to embed universal mental health screening and services in non-traditional settings with a population-based approach for youth suicide prevention. Additionally, youth who died by firearm suicide, the most common mechanism, had lowest rate of known mental health problems, highlighting the importance of universal lethal means counseling.