Most young people who die by suicide in the US do not have previous mental health diagnoses, study suggests

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Suicide is a leading cause of death among young people in the United States, and new research suggests that the majority of young people who have died by suicide did not have a documented mental health diagnosis in their medical history.

About 3 out of 5 young people who died by suicide between January 2010 and December 2021 had no previously diagnosed mental health condition, according to the study, published Tuesday in the medical journal JAMA Network Open. This suggests that mental health problems might be going missed or undiagnosed, and thus untreated, in some young people.

The new study included data on people ages 10 to 24 from the US Centers for Disease Control and Prevention’s National Violent Death Reporting System, and it included more than 40,000 suicides.

Only 40.4% of the young people who died had a documented mental health diagnosis, such as clinical depression, schizophrenia or anxiety disorders, among others.

“We discovered that certain youth who died by suicide were less likely to have a documented mental health diagnosis, including those who used firearms, were of minoritized race or ethnicity, males, and children younger than 14 years of age,” study co-author Dr. Jennifer Hoffmann, an emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, said in a news release.

“Our findings point to the critical need to increase equitable access to mental health screening, diagnosis, and treatment for all youth,” she said.

The data showed that the odds of having a documented mental health diagnosis varied across racial and ethnic groups and among youth who used firearms.

The odds of a diagnosis were lower among young people who were American Indian or Alaska Native and Black compared with White people and lower among Hispanic young people than non-Hispanics.

Hoffmann and her colleagues, from the Emory University School of Medicine and other US institutions, also found that the odds were lower among younger ages – 10 to 14 – compared with ages 20 to 24 and lower among men and boys compared with women and girls.

The researchers found that a mental health diagnosis was documented for 33.2% of young people who died by firearms, compared with 61.6% who died by poisonings; 45.8% who died by hanging, strangulation or suffocation; and 44.2% who died by other mechanisms.

“To reduce the risk of youth suicide by firearms, counseling is needed to encourage parents to store firearms in the home safely. These messages should be delivered in community and school settings, in addition to doctors’ offices,” Hoffmann said. “Secure storage laws, also known as child-access prevention laws, have also been demonstrated to reduce firearm suicide rates, and more states need to enact this type of life-saving legislation.”

The data also showed that most suicides, 64.8%, occurred at home, about half of the deaths – 46.8% – were caused by a firearm, and the most common precipitating circumstances were intimate partner problems and family relationship problems.

Dr. Nina Mena, an Atlanta-based psychiatrist who treats people 3 and older, said she sees it “all the time” in her practice: A child expresses thoughts of suicide after having an argument with their parents or another family member or having their devices taken away as a consequence.

“Many youth can get very upset given poor coping skills, poor emotional regulation and distress intolerance. They don’t know how else to feel, therefore, they resort to feeling or saying they are suicidal due to feelings of emptiness as if there’s nothing else for them in life,” said Mena, who also serves as chief medical officer of CHRIS 180, a nonprofit that provides trauma-informed behavioral health services.

When this happens, “you have to treat it seriously each time,” she said. “Make sure they’re in a safe space and that they don’t have access to firearms, sharp objects, medications or anything they might use to kill themselves. And when things calm down, ask them – ‘Hey, when you got angry, you mentioned that you wanted to kill yourself. Did you really feel that way?’ And even if they say they don’t really feel that way, still send them to therapy, because they still need the coping skills so that they know the right things to say.”

A rising suicide rate among preteens

A separate study, published Tuesday in JAMA Network Open, found that the suicide rate among US preteens increased significantly, by 8.2% annually, from 2008 to 2022. This rise followed a downward trend between 2001 and 2007.

Previous research has found that in 2021, suicide and homicide rates for children and young adults ages 10 to 24 in the US were the highest they’ve been in decade. And more people of all ages died by suicide in the United States in 2022 than any other year on record, dating to at least 1941.

For the new study, researchers from the National Institutes of Health and other US institutions analyzed data from the CDC’s Web-based Statistics Query and Reporting System in which suicide was listed as the underlying cause of death for more than 2,000 preteens, ages 8 to 12, from January 2001 to December 2022.

The data showed “a disproportionate increase in female suicide rates relative to male expand on existing evidence depicting a narrowing of the historically large gap in youth suicide rates between sexes,” the researchers wrote. “Suicide was the 11th leading cause of death in female preteens between 2001 and 2007 and the 5th leading cause of death between 2008 and 2022, while suicide in male preteens ranked consistently as the 5th leading cause of death.”

The researchers also found significant racial disparities, with Black preteens having the highest rates of suicide for both time periods and Hispanic preteens having the highest percentage increase in suicide rates.

The two new studies – detailing a growing suicide rate, racial disparities and potentially undiagnosed mental health conditions – highlight the need for better access to mental health care and services, especially for Black and brown young people, Mena said.

“Individuals are not always seeking treatment when experiencing discrimination or racism, because they are taught to ‘be strong’ and to just ‘deal with it,’” she said. “Since Black individuals may experience this as a community, it may not be recognized as a risk for mental illness when it is certainly considered a trauma that can lead to depression, anxiety, PTSD or more.”