CDC Report Shows Largest One-Year Increase in Youth Suicide Rate in 15 Years

Suicide rates for 10-19 year-old females and 15-19 year-old males increased significantly in 2004

WASHINGTON, Sept. 6, 2007-Following a decline of more than 28 percent, the suicide rate for 10- to-24-year-olds increased by 8 percent, the largest single-year rise in 15 years, according to a report released today in the Centers for Disease Control and Prevention?s (CDC) Morbidity and Mortality Weekly Report (MMWR).

The decline took place from 1990 to 2003 (from 9.48 to 6.78 per 100,000 people), and the increase took place from 2003 to 2004, (from 6.78 to 7.32), the report said

“This is the biggest annual increase that we?ve seen in 15 years. We don?t yet know if this is a short-lived increase or if it?s the beginning of a trend,” said Dr. Ileana Arias, director of CDC?s National Center for Injury Prevention and Control. “Either way, it?s a harsh reminder that suicide and suicide attempts are affecting too many youth and young adults. We need to make sure suicide prevention efforts are continuous and reaching children and young adults.”

The report is an analysis of annual data from the CDC?s National Vital Statistics System (NVSS). NVSS data are comprised of birth, death, marriage, divorce, and fetal death records in the United States. Researchers looked at trends during the 15-year period by gender, age group and suicide method. It did not examine reasons for the changes in suicide rates.

An increase in the suicide rates for three gender-age groups accounts for the increase in the overall suicide rate, the report said. Rates rose for 10- to-14-year-old females, 15 -to-19-year-old females and 15- to-19-year-old males from 2003 to 2004.
  • For 10- to-14-year-old females, the rate increased from 0.54 per 100,000 in 2003 to 0.95 per 100,000 in 2004
  • For 15-to-19 year-old females the rate increased from 2.66 to 3.52 per 100,000
  • For 15-to-19 year-old males, the rate increased from 11.61 to 12.65 per 100,000

Prior to 2003, the rates for all three groups were generally decreasing.

The analysis also found that changes had taken place in the methods used to attempt suicide. In 1990, firearms were the most common method for both girls and boys. However, in 2004, hanging/suffocation was the most common method of suicide among girls, accounting for 71.4 percent of suicides among 10- to-14-year-old girls and 49 percent among 15-to-19 year-old girls. From 2003 to 2004, there was a 119 percent increase in hanging/suffocation suicides among 10-to -14-year-old girls. For boys and young men, firearms are still the most common method.

“It is important for parents, health care professionals, and educators to recognize the warning signs of suicide in youth,” said Dr. Keri Lubell, a behavioral scientist in CDC?s Injury Center and lead author of the study. “Parents and other caring adults should look for changes in youth such as talking about taking one?s life, feeling sad or hopeless about the future. Also look for changes in eating or sleeping habits and even losing the desire to take part in favorite activities.”

A previously published CDC survey of youth in grades 9 to 12 in public and private schools in the United States found that 17 percent reported “seriously considering” suicide, 13 percent reported creating a plan and 8 percent reported trying to take their own life in the 12 months preceding the survey.

“This study demands that we strengthen our efforts to help parents, schools and health care providers prevent things that increase the risk of suicide,” said Dr. Arias. “We need to build on the efforts dedicated to education, screening and treatment and bridge the gap between the knowledge we currently have and the action we must take.”

CDC?s suicide prevention efforts include expanded surveillance systems for suicide through the National Violent Death Reporting System (NVDRS). NVDRS is a comprehensive, linked reporting system that collects and centralizes information on suicides and homicides from a variety of sources, such as medical examiners and coroners, law enforcement, hospitals, public health officials and crime labs. As this system evolves, it provides a promising approach to capture data that will help to better understand the circumstances surrounding suicide. Information from NVDRS is helping officials, organizations, and communities develop, implement, and evaluate effective prevention policies and programs.

CDC is also working with states and tribal governments to implement the National Strategy for Suicide Prevention. http://mentalhealth.samhsa.gov/suicideprevention/strategy.asp The plan is designed to further the dialogue and action that has already begun in communities and to serve as a springboard for changing attitudes, policies, and services.

For more information please visit http://www.cdc.gov/ncipc/dvp/Suicide/youthsuicide.htm

For more information about CDC work on suicide prevention, please visit the CDC Injury Center?s website at www.cdc.gov/injury.

A resource for helping to prevent suicide is the National Suicide Prevention Lifeline toll-free number, 1-800-273-TALK (273-8255).

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Note: The media can play a powerful role in educating the public about suicide prevention. CDC research shows stories about suicide can inform readers and viewers about the likely causes of suicide, its warning signs, trends in suicide rates, and recent treatment advances. They can also highlight opportunities to prevent suicide. Media stories about individual deaths by suicide may be newsworthy and need to be covered, but they also have the potential to do harm. Implementation of recommendations for media coverage of suicide has been shown to decrease suicide rates. For more information about these recommendations and tips for covering suicide visit Reporting on Suicide: Recommendations for the Media (http://www.afsp.org).


Contact: Gail Hayes
CDC, Injury Media Relations
Phone: (770) 488-4902

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Suicide Trends Among Youths and Young Adults Aged 10--24 Years --- United States, 1990--2004

In 2004, suicide was the third leading cause of death among youths and young adults aged 10--24 years in the United States, accounting for 4,599 deaths (1,2). During 1990--2003, the combined suicide rate for persons aged 10--24 years declined 28.5%, from 9.48 to 6.78 per 100,000 persons (2). However, from 2003 to 2004, the rate increased by 8.0%, from 6.78 to 7.32 (2), the largest single-year increase during 1990--2004. To characterize U.S. trends in suicide among persons aged 10--24 years, CDC analyzed data recorded during 1990--2004, the most recent data available. Results of that analysis indicated that, from 2003 to 2004, suicide rates for three sex-age groups (i.e., females aged 10--14 years and 15--19 years and males aged 15--19 years) departed upward significantly from otherwise declining trends. Results further indicated that suicides both by hanging/suffocation and poisoning among females aged 10--14 years and 15--19 years increased from 2003 to 2004 and were significantly in excess of trends in both groups. The results suggest that increases in suicide and changes in suicidal behavior might have occurred among youths in certain sex-age groups, especially females aged 10--19 years. Closer examination of these trends is warranted at federal and state levels. Where indicated, health authorities and program directors should consider focusing suicide-prevention activities on these groups to help prevent suicide rates from increasing further.

Annual data on suicides in the United States during 1990--2004 (1) were obtained from the National Vital Statistics System via WISQARS (2) by sex, three age groups (i.e., 10--14, 15--19, and 20--24 years), and the three most common suicide methods (firearm, hanging/suffocation,* and poisoning). Although coding of mortality data changed from the International Classification of Diseases, Ninth Revision (ICD-9) to the Tenth Revision (ICD-10) beginning in 1999, near total agreement exists between the two revisions regarding classification of suicides (3). Suicide trends during the 15-year period were examined for each sex-age group overall and by method, using a negative binomial rate regression model. Differences between observed rates and model-estimated rates for each year were evaluated using standardized Pearson residuals, which account for the general level of variability in the year-to-year rates. Standardized Pearson residuals >2 or <-2 were used to identify unusual departures from the modeled rate trends. A comprehensive explanation of these methods has been published previously (4).

Significant upward departures from modeled trends in 2004 were identified in total suicide rates for three of the six sex-age groups: females aged 10--14 years and 15--19 years and males aged 15--19 years (Table). The largest percentage increase in rates from 2003 to 2004 was among females aged 10--14 years (75.9%), followed by females aged 15--19 years (32.3%) and males aged 15--19 years (9.0%). In absolute numbers, from 2003 to 2004, suicides increased from 56 to 94 among females aged 10--14 years, from 265 to 355 among females aged 15--19 years, and from 1,222 to 1,345 among males aged 15--19 years.

In 1990, firearms were the most common suicide method among females in all three age groups examined, accounting for 55.2% of suicides in the group aged 10--14 years, 56.0% in the group aged 15--19 years, and 53.4% in the group aged 20--24 years. However, from 1990 to 2004, among females in each of the three age groups, significant downward trends were observed in the rates both for firearm suicides (p<0.01) and poisoning suicides (p<0.05), and a significant increase was observed in the rate for suicides by hanging/suffocation (p<0.01). In 2004, hanging/suffocation was the most common method among females in all three age groups, accounting for 71.4% of suicides in the group aged 10--14 years, 49% in the group aged 15--19 years, and 34.2% in the group aged 20--24 years. In addition, from 2003 to 2004, hanging/suffocation suicide rates among females aged 10--14 and 15--19 years increased by 119.4% (from 0.31 to 0.68 per 100,000 persons) and 43.5% (from 1.24 to 1.78), respectively (Figures 1 and 2). In absolute numbers, from 2003 to 2004, suicides by hanging/suffocation increased from 32 to 70 among females aged 10--14 years and from 124 to 174 among females aged 15--19 years. Aside from 2004, the only other significant departure from trend among females in these two age groups during 1990--2004 was in suicides by hanging/suffocation among females aged 15--19 years in 1996 (Figure 2).

Reported by: KM Lubell, PhD, SR Kegler, PhD, AE Crosby, MD, D Karch, PhD, Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note:

The findings in this report indicate that 2004 suicide rates for males aged 15--19 years and females aged 10--14 years and 15--19 years diverged upward significantly from modeled trends during 1990--2004. For females in the two age groups, significant departures were observed for 2004 in suicides by hanging/suffocation and poisoning. The rate for suicide by hanging/suffocation among females aged 10--14 years more than doubled from 2003 to 2004, from 0.31 to 0.68 per 100,000 population. During 1990--2003, the highest yearly rate for such deaths among females in this age group was 0.35 per 100,000 population in 1998.

The marked increases in suicide rates among females in the two younger age groups suggest possible changes in risk factors for suicide and the methods used, with greater use of methods (e.g., hanging by rope) that are readily accessible (5). Scientific knowledge regarding risk factors for suicide in young females is limited. Research that focuses on suicide mortality has emphasized males, who constitute approximately three fourths of suicide decedents aged 10--19 years (2). In contrast, research on suicidal behavior among females primarily has examined factors related to suicidal thoughts and nonfatal self-inflicted injuries. One comparative study, conducted in Singapore, suggested that perceptions of interpersonal relationship problems are more common among young female suicide decedents than among their male counterparts (6). Family discord, legal/disciplinary problems, school concerns, and mental health conditions such as depression increase the risk for suicide among youths of both sexes (6,7). Drug/alcohol use can exacerbate these problems (7).

Recent reports have detailed unintentional asphyxia fatalities resulting from adolescents playing "the choking game" (i.e., intentionally restricting the supply of oxygen to the brain, often with a ligature, to induce a brief euphoria). Some of these fatalities likely are misclassified as suicides. However, such deaths are unlikely to account for a substantial portion of the recent increases in hanging/suffocation suicides among young girls. The available evidence suggests that choking-game fatalities occur predominantly among boys (8). In addition, analysis of hanging/suffocation deaths classified as unintentional or undetermined in this population did not reveal increases that paralleled those in hanging/suffocation suicides (CDC, unpublished data, 2007).

The findings in this report are subject to at least three limitations. First, because U.S. mortality data currently are available only through 2004, whether the increases observed in 2004 represent changes in trends or single-year anomalies is not clear and suggests a need for further study as more current data become available. Second, official mortality data for suicides might include classification errors. Previous research has highlighted the extent to which suicides are undercounted (9). Finally, because U.S. mortality data include limited variables, these data do not allow examination of potential differences or changes in the underlying risk factors for fatal suicidal behavior among young females. Other data sources (e.g., the National Violent Death Reporting System) that collect a broader array of information about the circumstances surrounding suicides (10) might provide additional insights.

These findings demonstrate the potential mutability of youth suicidal behavior. Public health researchers and suicide-prevention practitioners need to learn more about both the risk factors for suicide among young females and effective strategies for suicide prevention. The trends in suicide rates and methods described in this report, if confirmed, suggest that prevention measures focused solely on restricting access to the most lethal means are likely to have limited success. Prevention measures should address the underlying reasons for suicide in populations that are vulnerable.

References

  1. National Center for Health Statistics. Multiple cause-of-death public-use data files, 1990 through 2004. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2007.
  2. CDC. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/ncipc/wisqars/default.htm.
  3. Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA. Deaths: injuries, 2001. Natl Vital Stat Rep 2004;52:1--5.
  4. Agresti A. An introduction to categorical data analysis. 2nd ed. Hoboken, NJ: Wiley; 2007.
  5. CDC. Methods of suicide among persons aged 10--19 years---United States, 1992--2001. MMWR 2004;53:471--4.
  6. Ang RP, Chia BH, Fung DSS. Gender differences in life stressors associated with child and adolescent suicides in Singapore from 1995 to 2003. Int J Soc Psychiatry 2006;52:561--70.
  7. Kloos AL, Collins R, Weller RA, Weller EB. Suicide in preadolescents: who is at risk? Curr Psychiatry Rep 2007;9:89--93.
  8. Le D, Macnab AJ. Self strangulation by hanging from cloth towel dispensers in Canadian schools. Inj Prev 2001;7:231--3.
  9. O'Carroll PW. A consideration of the validity and reliability of suicide mortality data. Suicide Life Threat Behav 1989;19:1--16.
  10. Steenkamp M, Frazier L, Lipskiy N, et al. The National Violent Death Reporting System: an exciting new tool for public health surveillance. Inj Prev 2006;12(Suppl 2):ii3--5.

* Includes self-inflicted asphyxiation and ligature strangulation.

Includes intentional drug overdose and carbon monoxide exposure.

Table

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Figure 1

Figure 1
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Figure 1

Figure 2

Posted: September 2007


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