Over the last 10 years, the rate of adolescents ages 15 to 19 committing suicide in the United States increased drastically, with an overall rate of 6.7 suicides per 100 000 per year in 2007 and a rate of 11.8 per 100 000 per year in 2017.1 The rate increased for both boys and girls as well as among white, black, and Hispanic adolescents (Table 1). The group with the most dramatic increase was black girls: 1.2 suicides per 100 000 per year in 2007 and 4.0 per 100 000 per year in 2017.
Suicide, nonetheless, is an infrequent event. Identifying adolescents at increased danger is aided by the use of suicide risk factors, such as depression and bipolar disorder; substance intoxication or use disorders; history of physical or sexual abuse; chaotic family life; lesbian, gay, bisexual, or questioning sexual orientation or transgender identification; and pathologic Internet use.2 Among risk factors, a suicide attempt is the most strongly associated with later death by suicide.3,4 Adolescents who have recently made a suicide attempt with a high probability of dying are at high risk, but low risk after a suicide attempt is difficult to determine.2 Consequently, all previous suicide attempts need to be taken seriously.
In this issue of Pediatrics, Lindsey et al5 examine the results of the Youth Risk Behavior Survey from 1991 to 2017 with regard to trends by sex and racial or ethnic subgroups. The Youth Risk Behavior Survey is a nationally representative, self-report survey of high school students that asked about suicidality over the previous 12 months. In the study, researchers found a significant increase in reported suicide attempts by black adolescents, while finding no significant change for white adolescents and a significant decrease for Hispanic, Asian American or Pacific Islander, and “other” adolescents. Broken down by sex, black boys showed a significant linear increase in suicide attempts, whereas black girls showed a significant quadradic increase, indicating an acceleration in the increase of self-reported attempts.
Despite the recent increases in rates of suicide, black adolescents continue to have a lower suicide rate than white adolescents.1 This finding is counterintuitive given the greater, long-standing difficulties encountered by black adolescents, including disparities in mental health treatment6–8 and disproportionately higher stressors, racial discrimination,9,10 and childhood abuse and neglect as well as other adverse experiences,11 such as poverty.12,13 Reasons for the lower reported rate of suicide among black adolescents are not known but may include misclassification14 ; undercount as a result of violence with suicidal intent, for example, “suicide by cop” (deliberately provoking a police officer to shoot) or other ways of getting into harm’s way15 ; and protective factors.12 One hypothesis for protective factors is that external attributional orientation (eg, blaming others or “the system” for difficulties) among blacks may have buffered this group from internalizing blame related to psychological stressors.12
The increased rate of suicide by black adolescents, particularly girls, and the findings of Lindsey et al5 of increases in the rate of black adolescent suicide attempts (accelerating among girls) suggest that protective factors have diminished. For example, the attributional orientation of black adolescents may have shifted toward an internal orientation, thus leading to an increase in suicide risk factors, particularly depression.12 Regardless of the reasons, the increases in rates of suicide and suicide attempts by black adolescents are concerning and should influence prevention and intervention efforts. Future research should be aimed at delineating the reasons for the increases and suggesting approaches useful for clinicians, schools, and leaders in charge of health care and social policy.
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COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-1187.
POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.