Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Sex-specific compensatory model of suicidal ideation: a population-based study (Urban HEART-2)

INTRODUCTION

Suicidal ideations (SI), also known as suicidal thoughts, refer to impulses, desires, and obsessions related to death. Prevalence of suicidal ideation was 14 percent. The current study assumed that identifying the true predictors of SI would allow for a greater understanding of suicide risk.

METHODS

In this cross-sectional population-based study, 17,644 residents aged from 15 to 90 years were selected through a multi-stage sampling method from 22 districts of Tehran. Using hypothesized causal models, the pathways through which various variables influenced the components of SI were identified. Also, the applicability of the compensatory and risk-protective models of resiliency for the prediction of SI was tested by using the interaction multiple regression analyses.

RESULTS

SI was experienced by 13.44% of the study population. SI was more prevalent with individuals between the ages of 15 to 24. There are no differences between men and women when covariate analysis is used. The significant predictions by anxiety and physical activity (moderate) indicate support for the compensatory model for male and female, while the significant prediction by those indicates support for the risk-protective model for females.

CONCLUSION

PA would both lessen the detrimental impact of anxiety on suicidal thoughts and potentially reduce the probability of SI. It's important to develop and evaluate PA-enhancing treatments, especially for woman who are experiencing anxiety.

Sociodemographic Factors Associated with Suicide Outcomes in Transgender and Gender Diverse Young Adults

OBJECTIVE

Transgender and gender diverse (TGD) populations have a higher prevalence of suicide outcomes compared to cisgender peers. Further, among TGD groups, young adults frequently demonstrate a higher risk compared to other age cohorts. While evidence supports sociodemographic differences in suicide risk, these relationships are not well-established for TGD young adults.

METHOD

A secondary data analysis of the young adult (18-24 years) subpopulation of the 2015 U.S. Transgender Survey was conducted. Predicted probabilities of 12-month and lifetime suicide outcomes by gender identity, sexual orientation, race/ethnicity, homelessness, and poverty were estimated comparing fully adjusted models.

RESULTS

Gender identity, race/ethnicity, and homelessness were significantly associated with all suicide outcomes. Comparisons of gender identities were significant for all outcomes and varied based on the outcome. American Indian/Alaska Native TGD young adults had the highest predicted probabilities compared to other race/ethnicity groups. Further, having a heterosexual/straight sexual identity was among the lowest predicted probabilities for suicide outcomes and significantly differed from several of the other sexual identities.

CONCLUSIONS

Findings underscore the importance of heterogeneity among TGD young adults and the need for intersectional research within this population. Elucidating sociodemographic characteristics that contribute to differential suicide risk is necessary for effective intervention strategies and policy advocacy.

Driver's Licensure and Driving Outcomes Among Youths With Mood Disorders

Importance

Mood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited.

Objective

To examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.

Design, Setting, and Participants

This cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver's license from 2004 to 2017, and patients of the Children's Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023.

Main Outcomes and Measures

Acquisition of a driver's license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure.

Results

Among 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]).

Conclusions and Relevance

This study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.

Examining area- and individual-level differences in suicide ideation severity and suicide attempt among youth

Youth suicide is a pressing problem and suicide rates are not equally distributed across geographic areas or socioeconomic status (SES). Death by suicide is often preceded factors including hopelessness and suicide ideation, planning, and attempt. The current study examined area- and individual-level differences in suicide ideation severity and suicide attempt in a state-representative sample of youth from 2019 (N = 78,740) and 2021 (N = 61,396). Youth from higher SES and rural areas showed lower suicide ideation severity and odds of suicide attempt. After including individual-level covariates, SES differences in ideation severity and suicide attempt persisted for 2019 but not 2021. Rural differences for ideation severity persisted across years but not for suicide attempt. Further research on geographic variation in suicide risk is needed.

Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities

The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.

Social-geographic disparities in suicidal ideations among methamphetamine users in the USA

IMPORTANCE

Methamphetamine use is a growing public health concern nationwide. Suicide is the second leading cause of death in 2019 for US citizens aged 10-14 years and 25-34 years and is also a significant public health concern. Understanding the intersection of methamphetamine use and suicidal ideation (SI) is necessary to develop public health and policy solutions that mitigate these ongoing severe public health issues.

OBJECTIVE

Our objective was to examine SI in methamphetamine users to allow us to determine prevalence and trends by age, sex, race, and geographical region.

DESIGN, SETTINGS, AND PARTICIPANTS

Using data collected between 2008 and 2019 from the National Inpatient Sample (NIS) database, we identified hospital admissions (HA) of patients ≥18 years of age with a primary or secondary diagnosis of SI who were also diagnosed as methamphetamine users. Those who used other substances with methamphetamine were excluded from the analysis.

MAIN OUTCOME AND MEASURES

To determine the trend and prevalence of hospital admissions due to SI and SI among methamphetamine users, we used trend weights to calculate the national estimates and performed design-based analysis to account for complex survey design and sampling weights on data collected between 2008 and 2019 in the US.

RESULTS

The prevalence ratio (PR) of hospitalizations with concurrent SI and methamphetamine use increased 16-fold from 2008 to 2019. The most significant increase occurred between 2015 and 2016; the PR doubled from 6.07 to 12.14. The PR of hospitalizations with concurrent SI and methamphetamine use was highest in patients aged 26-40 (49.08%) and 41-64 (28.49%). Patients aged 41-64 showed the most significant increase from 2008 to 2019 (15.8-fold). While non-Hispanic White patients comprised most of these hospitalizations (77.02%), non-Hispanic Black patients showed the highest proportional increase (39.1-fold). The Southern and Western regions in the US showed the highest PR for these hospitalizations (34.86% and 34.31%, respectively).

CONCLUSION AND RELEVANCE

Our findings indicate that SI in methamphetamine users has been increasing for some time and is likely to grow. In addition, our results suggest that these patients are demographically different. Both conditions are associated with a lesser likelihood of seeking and receiving care. Therefore, when addressing increased SI or methamphetamine use, learning more about patients who share both conditions is necessary to ensure proper care.

Evidence for Altered Electroencephalography Coherence in Depressed Adolescents with Suicidal Ideation and Behaviors

Introduction: Major depressive disorder (MDD) is a primary risk factor for suicide, which is one of the leading causes of death among adolescents worldwide. Understanding the heterogeneity of suicidality in adolescents with MDD is critical for suicide prevention and intervention discovery. Quantitative electroencephalography (EEG) is a promising tool to address the knowledge gaps related to the neurophysiological characteristics of depression and suicidality. This study sought to examine resting-state EEG coherence differences in adolescents with MDD and suicidal ideation (SI)/behaviors (SB) and healthy controls (HC) to assess the utility of coherence as a biomarker of suicide. Methods: Twenty-six adolescents with MDD who were hospitalized for suicidality and 30 HC were recruited. The clinical sample was divided into SI (n = 9) and SB (n = 19) subgroups. Eyes closed resting-state EEG were recorded, and coherence was calculated. Depression severity and suicidality were assessed with the Children's Depression Rating Scale Revised and the Columbia Suicide Severity Rating Scale, respectively. Results: There were intrahemispheric differences in the right hemisphere across multiple electrode pairs. Delta, alpha, and beta coherence were higher in the SB group over the right prefrontofrontal and left parietooccipital electrode pairs, while alpha coherence was higher in the HC group over the right centroparietal electrode pair. There were no significant differences between HC and SI groups in any electrode pair. Conclusions: Patients with recent SB showed increased coherence in right frontal regions compared with patients with SI, suggesting altered cognitive states between those with SB and SI. These findings may have implications for suicide prevention in adolescents and could serve as useful biomarkers in clinical settings, but larger studies are needed to confirm the results.

Perceived stress among Hispanic young adults: Impact of the coping with work and family stress program

Objective: To examine the effect of an evidence-based curriculum on stress perceptions across time. Participants: Hispanic college students from a Hispanic-serving institution in a U.S. southern border city. Methods: A permuted block design with repeated measures was used. Participants were randomly assigned to treatment and control groups. The treatment group received the Coping with Work and Family Stress (CWFS) evidence-based curriculum while the control group did not receive any programming. Data were collected from both the groups at baseline, exit, and at 3-month follow-up. Results: Stress reduction was observed among program participants however an unintended negative consequence of the intervention was found among those who experience intimate partner violence. Conclusion: The CWFS evidence-based intervention may be appropriate to use in reducing general types of stress but perhaps not stress resulting from intimate partner violence.

Expenditure patterns among low-income families in China: Contributing factors to child development and risks of suicidal ideation

Low-income families in urbsan China have been benefited from the Minimum Living Standard Guarantee Assistance (dibao) policy since 1999. However, little is known about how child-specific family expenditure patterns impact child outcomes. Based on 2531 children aged 8-16 years from the National Survey of Social Policy Support System for Low-Income Families in Urban and Rural China, this is the first study of its kind to (1) identify family expenditure patterns (food, apparel, housing, transportation, pocket money, after-school education, and other educational resources) among low-income families and (2) examine their relationship with child suicide risks and developmental outcomes (academic performance, mental health, and physical health) by sex and across the dibao and marginalized families (i.e., without dibao). Latent profile analysis identified two patterns. Profile 1 (97.59%) showed low expenditure on children. Profile 2 (2.41%) prioritized expenditure in after-school programs. Mixed-effects logistic regression showed male children from marginalized families in Profile 1 are 11 times (95% confidence interval 1.10-109.52) more likely to think about suicide than female children from dibao families in Profile 2. Social policies and interventions promoting educational expenditure support and addressing the social determinants of health have the potential to reduce child suicide and improve child developmental outcomes among the urban poor.

Twenty-Five Years of National-Level Research on Adolescent and Young Adult Mental Health in the United States

The longitudinal, population-level, biosocial data in the National Longitudinal Study of Adolescent to Adult Health (Add Health) have elucidated the developmental course of mental health across early stages of the life course. This data set also has been invaluable for documenting and unpacking disparities in these developmental patterns by race, ethnicity, socioeconomic status, gender, immigration, and sexuality. Reflecting the larger focus of this special supplement on Add Health as a tool for connecting adolescence to adulthood, this article reviews Add Health research since 2000 based on a search of key mental health terms, primarily describing patterns of two key markers of psychopathology (depressive symptoms, suicidal ideation) that were consistently measured across waves. It situates these patterns from adolescence into adulthood within the developmental ecology organized by the proximate settings of everyday life, the larger social structures organized by a highly stratified society, and the relations of these ecological and structural forces to biological processes. Major foci are the dynamic nature of mental health across the life course and the ways that ecological and physiological influences on mental health differ by group identity and social position.

Association of Social Determinants of Health and Vaccinations With Child Mental Health During the COVID-19 Pandemic in the US

IMPORTANCE

The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic.

OBJECTIVE

To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates.

DESIGN, SETTING, AND PARTICIPANTS

This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021.

EXPOSURES

Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH.

MAIN OUTCOMES AND MEASURES

Perceived Stress Scale, the National Institutes of Health-Toolbox emotion measures, and COVID-19-related worry.

RESULTS

The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19-related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic-related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19-related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = -1.78; 95% CI, -3.39 to -0.18; P = .03) among children.

CONCLUSIONS AND RELEVANCE

Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.

Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems

BACKGROUND

Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations.

METHODS

We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects.

RESULTS

Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant.

CONCLUSIONS

Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.

Structural indicators of suicide: an exploration of state-level risk factors among Black and White people in the United States, 2015-2019

Purpose –

Death by suicide among Black people in the USA have increased by 35.6% within the past decade. Among youth under the age of 24 years old, death by suicide among Black youth have risen substantially. Researchers have found that structural inequities (e.g. educational attainment) and state-specific variables (e.g. minimum wage, incarceration rates) may increase risk for suicide among Black people compared to White people in the USA. Given the limited understanding of how such factors systematically affect Black and White communities differently, this paper aims to examine these relationships across US states using publicly available data from 2015 to 2019.

Design/methodology/approach –

Data were aggregated from various national sources including the National Center for Education Statistics, the Department of Labor, the FBI's Crime in the US Reports and the Census Bureau. Four generalized estimating equations (GEE) models were used to examine the impact of state-level variables on suicide rates: Black adults suicide rate, Black youth (24 years and younger) suicide rate, White adult suicide rate and White youth suicide rate. Each model includes state-level hate group rates, minimum wage, violent crime rates, gross vacancy rates, and race-specific state-level poverty rates, incarceration rates and graduation rates.

Findings –

Across all GEE models, suicide rates rose between 2015-2019 (ß = 1.11 - 2.78; ß = 0.91 - 1.82; ß = 0.52 - 3.09; ß = 0.16 - 1.53). For the Black adult suicide rate, state rates increased as the proportion of Black incarceration rose (ß = 1.14) but fell as the gross housing vacancy rates increased (ß = -1.52). Among Black youth, state suicide rates rose as Black incarcerations increased (ß = 0.93). For the adult White suicide rate, state rates increased as White incarceration (ß = 1.05) and percent uninsured increased (ß = 1.83), but fell as White graduation rates increased (ß = -2.36). Finally, among White youth, state suicide rates increased as the White incarceration rate rose (ß = 0.55) and as the violent crime rate rose (ß = 0.55) but decreased as state minimum wages (ß = -0.61), White poverty rates (ß = -0.40) and graduation rates increased (ß = -0.97).

Originality/value –

This work underscores how structural factors are associated with suicide rates, and how such factors differentially impact White and Black communities.

Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991-2019

Importance

Disparities by sex and racial/ethnic group in suicide death rates are present in US adolescents. Whether disparities in suicide death extend to groups targeted for suicide prevention efforts, namely, those with suicidal ideation or nonfatal suicide attempts, is unknown.

Objective

To examine differences in temporal trends between suicidal ideation and suicide attempts in US adolescents from 1991 through 2019 by sex and race/ethnicity subgroups.

Design, Setting, and Participants

A cross-sectional analysis of the national Youth Risk Behavior Survey, weighted to represent US adolescents from 1991 to 2019, included 183 563 US high-school students in grades 9 to 12. Data were analyzed from September 16, 2020, through April 12, 2021.

Exposures

Calendar year, sex, race/ethnicity, and interactions of sex and race/ethnicity.

Main Outcomes and Measures

Survey-weighted prevalence estimates, annual percentage changes (APCs) and average APC in the survey-weighted prevalence of suicidal ideation and nonfatal suicide attempts, constructed from self-reported suicidal ideation, plan, and attempts in each survey year, by sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian or Pacific Islander and Native Hawaiian, American Indian/Alaska Native), and their interactions (sex × race/ethnicity).

Results

In 183 563 (unweighted) included adolescents (mean [SD] age, 16.07 [1.23] years; 94 282 females [weighted percentage, 49.4%; 95% CI, 48.8%-50.1%]), the prevalence of suicidal ideation decreased from 1991 to 2019 (from 19.4% to 15.8%; 95% CI, 0.7%-0.9%), whereas the prevalence of nonfatal suicide attempts increased from 1991 to 2019 (from 7.3% to 8.9%; 95% CI, 1.0%-1.4%). Joinpoint regression indicated a -3.1% (95% CI, -3.7% to -2.6%) annual decrease in suicidal ideation between 1991 and 2009, followed by a 3.4% annual increase (95% CI, 1.9% -4.8%) between 2009 and 2019. Decreasing followed by increasing trends in suicidal ideation showed modestly different turning points in female (1991-2009, 2009-2019), White (1991-2009, 2009-2019), Hispanic (1991-2007, 2007-2019), and Black (1991-2005, 2005-2019) adolescents. Although no significant trends were observed in suicide attempts from 1991 through 2019, male (68.4% increase; 95% CI, 0.2% -1.2%) and Black (79.7% increase; 95% CI, 0.1%-1.5%) adolescents had greater increases in the prevalence of suicide attempts. Interaction of sex and race/ethnicity revealed increases in suicidal ideation in White females from 2009 to 2019 (APC, 4.3%; 95% CI, 1.5%-7.1%), Black females from 2005 to 2019 (APC, 3.4%; 95% CI, 1.4%-5.4%), and Hispanic females from 2009 to 2019 (APC, 3.3%; 95% CI, 1.0%-5.6%) and suicide attempts in White females from 2009 to 2019 (APC, 3.1%; 95% CI, 0.3%-6.0%).

Conclusions and Relevance

The findings of this study show apparent sex and racial/ethnic differences in trends in suicidal ideation and suicide attempts. Increases in suicidal ideation since 2009 were observed in female individuals; changes in male and Black adolescents represented the largest increase in the prevalence of suicide attempts between 1991 and 2019. Evidence-based suicide prevention programs need to be tailored by sex and race/ethnicity, calling for greater diversification of health care system, school, and community prevention approaches.

Temporal Trends and Disparities in Suicidal Behaviors by Sex and Sexual Identity Among Asian American Adolescents

IMPORTANCE

Although suicide is the second leading cause of death among Asian American adolescents, there is a dearth of studies examining overall and possible sex and sexual orientation disparities in the trends in suicidal behaviors among Asian American adolescents. Such information is crucial to inform targeted efforts of suicide prevention among Asian American adolescents.

OBJECTIVE

To examine temporal trends and sex and sexual orientation disparities in trends of nonfatal suicidal behaviors in Asian American adolescents from 1991 through 2019.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the national Youth Risk Behavior Survey from 1991 through 2019, analyzing a representative sample of US adolescents in grades 9 through 12 using a 3-stage cluster-sampling design. Data were analyzed from October through November 2020.

EXPOSURES

Calendar year, sex, sexual identity, sex of sexual contact, and interaction terms of these factors.

MAIN OUTCOMES AND MEASURES

Crude prevalence and annual percentage changes (APCs) in self-reported suicidal ideation, suicide plan, suicide attempts, and injury by suicide attempt for the overall sample and by sex, sexual identity, and sex of sexual contacts were calculated. Sexual minorities were defined as individuals whose sexual identity was gay or lesbian, bisexual, or not sure.

RESULTS

Among 7619 Asian Americans who participated in the Youth Risk Behavior Survey from 1991 to 2019 (mean [SD] age, 16.09 [1.29] years; 3760 [47.1%] female adolescents), 1576 individuals completed the sexual identity and behaviors questions after 2015 (mean [SD] age, 15.97 [1.28] years; 810 [49.2%] female adolescents). From 2009 through 2019, there was a 1.3-fold (95% CI, -0.8 to 3.3; P = .22) increase in suicide attempts and a 1.7-fold (95% CI, -2.6 to 5.9; P = .45) increase in injury by suicide attempt among Asian American female adolescents, although these increases were not statistically significant. Among 39 Asian American adolescents who identified as gay, lesbian, or bisexual or who were attracted to and had sexual contact with partners of the same sex or both sexes, compared with 1556 Asian American adolescents who were heterosexual, prevalence was greater for suicidal ideation (24 individuals [68.2%] vs 223 individuals [15.0%]; P < .001), suicide plan (15 individuals [57.7%] vs 179 individuals [11.9%]; P < .001), suicide attempts (14 individuals [41.0%] vs 74 individuals [5.5%]; P < .001), and injury by suicide attempt (5 individuals [17.6%] vs 23 individuals [1.7%]; P < .001) between 2015 and 2019. These sexual minorities identified by sexual identity and sexual contact also had an increasing rate over this period in suicide plan (APC, 10.5%; 95% CI, 4.4% to 16.9%; P < .001).

CONCLUSIONS AND RELEVANCE

This study found significant increases in rates of suicide plan among Asian American adolescents who were sexual minorities identified by sexual identity and sexual contact together. These findings suggest that suicide screening needs to inquire about sexual minority status in terms of sexual identity and sex of sexual contact when identifying Asian American adolescents who are at risk for suicidal behaviors. Culturally relevant suicide-prevention programs addressing unique risk and protective factors, racial discrimination, and sexual orientation-related stigma may be needed for Asian American adolescents.