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Youth Suicide and Self-Inflicted Injury (see data for this topic)

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Why This Topic Is Important
Suicide is the third leading cause of death for young people ages 15-24 statewide and nationally, behind only unintentional injuries and homicide (1). Rates of youth suicide and self-injury hospitalization, even among younger adolescents, have risen over the past decade (2, 3). In 2018, the number of suicides among California youth ages 12-19 was 15% higher than in 2009, and incidents of youth self-harm requiring medical attention were 50% higher (2). While self-inflicted injuries typically are not the result of suicide attempts and do not involve intent to die, non-suicidal self-injury is a risk factor for suicide (3). A 2019 survey of U.S. high school students estimated that about one in five seriously considered suicide in the previous year, a figure more than 35% higher than findings from a decade earlier (4). Self-harm and suicides among young people have substantial emotional tolls on youth, families, and communities, as well as economic costs for society.

Suicide risk is higher for some groups than for others. While girls and young women more often seriously consider, plan, and attempt suicide, males are more likely than females to die by suicide—although the gap may be narrowing (4, 5). Nationally, American Indian/Alaska Native youth have the highest suicide rate among racial/ethnic groups with data (1). In addition, LGBTQ youth are more likely to engage in suicidal behavior than their non-LGBTQ peers (2, 4). Other common risk factors for youth suicide include prolonged stress, mental illness, disability, past suicide attempts, family history of suicide or mental disorders, poor family communication, stressful life events, placement in out-of-home settings, access to lethal means, and exposure to suicidal behavior of others (2).
Find more information about youth suicide and self-injury in kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (2022). Leading causes of death, 2020. Retrieved from: https://wisqars.cdc.gov/data/lcd

2.  California State Auditor. (2020). Youth suicide prevention: Local educational agencies lack the resources and policies necessary to effectively address rising rates of youth suicide and self-harm. Retrieved from: https://auditor.ca.gov/reports/2019-125/summary.html

3.  Centers for Disease Control and Prevention. (2020). Youth Risk Behavior Survey: Data summary and trends report 2009-2019. Retrieved from: https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm

4.  Westers, N. J., & Culyba, A. J. (2018). Nonsuicidal self-injury: A neglected public health problem among adolescents. American Journal of Public Health, 108(8), 981-983. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050854

5.  Ruch, D. A., et al. (2019). Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA Network Open, 2(5), e193886. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733430
Policy Implications
Youth suicide and self-inflicted injury are complex issues that are not caused by any single factor. Addressing these prevalent, preventable public health problems requires comprehensive, cross-sector commitments focused on risk and protective factors at the individual, family, community, and system levels (1, 2). Additionally, experts recommend that policy strategies go beyond preventing and treating problems to promoting positive mental health (1, 2).

Screening, early identification, access to services, and receipt of treatment are critical in preventing and reducing mental health problems associated with suicidal behavior (1, 3). Youth who hurt themselves without suicidal intent are at risk for suicide, and many do not seek help (2, 4). American Indians/Alaska Natives have the highest rates of youth suicide nationwide, and data show concerning increases in suicidal behavior among African American youth (1, 5). Research has shown that youth of color are less likely to receive mental health care compared with their white peers (4). Overall, most California youth who need mental health services do not receive them (6).

California law requires public school districts and charter schools to establish suicide prevention policies, and to address groups at elevated risk such as LGBTQ youth, youth in out-of-home settings, youth exposed to suicides of others, and youth with mental illness, disabilities, or substance use issues (1, 2, 3).

Policy and practice options to prevent suicide and self-injury and promote youth mental health include:
  • Continuing to support K-12 schools in creating positive school climates and implementing evidence-based approaches to address students’ physical, emotional, behavioral, and other needs; related to this, promoting efforts to integrate social-emotional learning—such as problem-solving, help-seeking, and coping skills—into PreK-12 education (2, 7, 8)
  • In accordance with state law, ensuring that schools implement effective suicide prevention policies that are aligned with best practices; also, encouraging schools to develop clear protocols for addressing non-suicidal self-injury (2, 3, 7)
  • Expanding mental health staff in schools (e.g., counselors) and providing teachers and other staff with training on how to assist students at risk of suicide and self-harm appropriately (3)
  • Assuring adequate training for those who work directly with youth outside of school—after-school program staff, coaches, clergy, juvenile justice staff, and others—to recognize signs of suicidal behavior and self-injury and to respond effectively, including helping youth access services (1, 8)
  • Promoting health care systems change, including enhanced medical education and workforce training, systematic screening and risk assessment, appropriate referrals to effective services, and improved coordination and continuity of care (1, 2, 9)
  • Ensuring that all youth with mental health needs have access to high-quality, culturally appropriate services with consistent coverage through insurance plans; as part of this, expanding the workforce of qualified mental health professionals, especially in rural and underserved areas (1, 8)
  • Ensuring that families have access to affordable, high-quality parenting and relationship skills programs (1, 8)
  • Promoting community efforts to provide youth with connections to caring adults and access to safe, positive activities, such as quality mentoring, after-school, and social norming programs, particularly in communities with limited resources (1, 8)
  • Empowering and engaging youth as partners in mental health initiatives and solutions (1, 2, 4)
  • Promoting local, state, and national strategies to reduce access to lethal means (e.g., bridges and railway tracks) and improve safe storage of medications, firearms, and other lethal items (1)
  • Supporting public education to reduce stigma associated with mental illness, increase help-seeking, and improve knowledge of warning signs and appropriate responses (1, 8)
  • Encouraging media to avoid sensationalizing youth suicide (e.g., by keeping coverage brief and not explicit) and to balance suicide coverage with prevention messages, stories of hope, and resources for help (1, 8)
For more policy ideas and information on this topic, see kidsdata.org’s Research & Links section or visit the Suicide Prevention Resource Center, Centers for Disease Control and Prevention, and Self-Injury Outreach and Support. Also see Policy Implications for related topics in kidsdata.org’s Emotional and Behavioral Health category.

Sources for this narrative:

1.  U.S. Surgeon General, & National Action Alliance for Suicide Prevention. (2021). The Surgeon General's call to action to implement the National Strategy for Suicide Prevention. Retrieved from: https://www.hhs.gov/surgeongeneral/reports-and-publications/suicide-prevention

2.  Substance Abuse and Mental Health Services Administration. (2020). Treatment for suicidal ideation, self-harm, and suicide attempts among youth. Retrieved from: https://www.samhsa.gov/resource/ebp/treatment-suicidal-ideation-self-harm-suicide-attempts-among-youth

3.  California State Auditor. (2020). Youth suicide prevention: Local educational agencies lack the resources and policies necessary to effectively address rising rates of youth suicide and self-harm. Retrieved from: https://auditor.ca.gov/reports/2019-125/summary.html

4.  Daniello, S., et al. (n.d.). Addressing the youth mental health crisis: The urgent need for more education, services, and supports. Mental Health America. Retrieved from: https://mhanational.org/addressing-youth-mental-health-crisis-urgent-need-more-education-services-and-supports

5.  Centers for Disease Control and Prevention. (2022). Leading causes of death, 2020. Retrieved from: https://wisqars.cdc.gov/data/lcd

6.  As cited on kidsdata.org, Youth needing help for emotional or mental health problems, by receipt of counseling. (2022). California Health Interview Survey.

7.  Joshi, S. V., et al. (n.d.). K-12 toolkit for mental health promotion and suicide prevention. HEARD Alliance. Retrieved from: https://www.heardalliance.org/help-toolkit

8.  Stone, D. M., et al. (2017). Preventing suicide: A technical package of policy, programs, and practices. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf

9.  Kemper, A. R., et al. (2021). Depression and suicide-risk screening results in pediatric primary care. Pediatrics, 148(1), e2021049999. Retrieved from: https://publications.aap.org/pediatrics/article/148/1/e2021049999/179934/Depression-and-Suicide-Risk-Screening-Results-in
How Children Are Faring
In 2017-2019, an estimated 16% of California 9th and 11th graders and 17% of non-traditional students seriously considered attempting suicide in the previous year. At least 20% of girls in each grade level seriously considered suicide, compared with less than 13% of boys. Students with low levels of school connectedness were much more likely to have serious suicidal thoughts (32%) than their peers with medium (19%) or high (9%) connectedness. The proportion of gay, lesbian, and bisexual youth who seriously considered attempting suicide (44%) was about one and a half times the estimate for students unsure of their sexual orientation (29%) and more than three times the estimate for straight youth (13%).

The rate of hospitalization for non-fatal self-inflicted injuries among California children and youth ages 5-20 was 37 per 100,000 in 2015, down from 49 per 100,000 in 1991. While the state's rate of self-inflicted injury hospitalization has fluctuated over time, it has remained lower than the U.S. rate since 2010. Across counties with data in 2015, hospitalization rates for self-injury ranged from 22 per 100,000 young people (San Bernardino) to 68 per 100,000 (San Mateo). Youth ages 16-20 account for the majority of discharges for self-inflicted injuries statewide: 1,949 of 3,136 in 2015 (62%).

In 2020, 174 California teens ages 15-19 and 299 young adults ages 20-24 were known to have committed suicide. Statewide, the rate of suicide among youth ages 15-24 in 2018-2020 was 8.7 per 100,000, compared with a national rate of 14.2 per 100,000. Following a decade of rising suicide rates—in which figures increased by more than 27% in California and more than 44% nationwide—neither the California nor the U.S. rate rose in 2018-2020.

Among younger children ages 5-14, there was an increase in suicides between 2019 and 2020 at both the national level and in California, where the number of suicides in this age group doubled (from 27 to 54). Statewide and nationally, many more boys and young men die by suicide than their female counterparts; in 2020, males accounted for three quarters of suicides among California youth ages 15-24.