Suicide Among Children, Adolescents, and Young Adults -- United States, 1980-1992

Suicide was the fifth leading cause of years of potential life lost before age 65 years in 1990 (CDC, unpublished data, 1995). During 1980-1992, a total of 67,369 persons aged less than 25 years (i.e., children, adolescents, and young adults) committed suicide and, in 1992, persons in this age group accounted for 16.4% of all suicides. From 1952 through 1992, the incidence of suicide among adolescents and young adults nearly tripled (1). One of the national health objectives for the year 2000 is to reduce the suicide rate for persons aged 15-19 years by greater than 25% to 8.2 per 100,000 persons (objective 7.2a) (2). This report summarizes trends in suicide among persons aged less than 25 years from 1980 through 1992 (the latest year for which complete data are available).

Trends in suicide among young persons were determined using final mortality data from CDC's underlying cause of death files (3). Suicides and methods of fatal injury were determined by using International Classification of Diseases, Ninth Revision, codes. Suicide rates were calculated using population data from the 1980 and 1990 census enumerations and intercensal year estimates compiled by the U.S. Bureau of the Census.

From 1980 to 1992, the number and rate of suicides declined among persons aged less than 25 years from 5381 (5.7 per 100,000 persons) to 5007 (5.4). For persons aged 20-24 years, the suicide rate declined 7.2% (from 16.1 to 14.9). In comparison, the rate increased among persons aged 15-19 years by 28.3% (from 8.5 to 10.9) and among persons aged 10-14 years by 120% (from 0.8 to 1.7). For persons aged 20-24 years, suicide rates declined for all racial and sex groups except black males Table_1. * For persons aged 15- 19 years, the suicide rate increased for all groups except males of other races; in particular, for black males the rate increased 165.3%. For persons aged 10-14 years, suicide rates increased substantially in all racial and sex groups.

In 1992, firearm-related deaths accounted for 64.9% of suicides among persons aged less than 25 years. Among persons aged 15-19 years, firearm-related suicides accounted for 81% of the increase in the overall rate from 1980-1992. During 1980-1992, among persons aged less than 25 years, the proportions of suicides by poisoning, cutting, and other methods declined, while the proportions by firearms and hanging increased; hanging was the second most common method of suicide, followed by poisoning. Reported by: Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: The findings in this report are consistent with previous reports indicating that the risk for suicide is greatest among young white males (4). However, from 1980 through 1992, suicide rates increased most rapidly among young black males. Although suicide among children is a rare event, the dramatic increase in the suicide rate among persons aged 10-14 years underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group.

The causes of suicide are multiple and complex. Potential reasons for the increase in suicides among some groups may reflect increasing interaction of risk factors including substance abuse; mental illness; impulsive, aggressive, and antisocial behavior; family influences, including a history of violence and family disruption; severe stress in school or social life; and rapid sociocultural change (5). The increase in firearm-related suicide probably reflects increased access to firearms by the at-risk population (6).

Most youth suicide-prevention programs are directed toward older adolescents and do not include outreach efforts for minorities (6). The recent increases in suicide rates among young black males and children aged 10-14 years especially indicate the need to develop interventions for these groups. In addition, the increasing use of firearms for suicide underscores the need for intensifying the development and assessment of suicide-prevention measures directed toward firearms. Because a previous report suggested that suicide attempts among younger persons have not increased (7), the increased rate of completed suicides may be attributed to the use of more lethal means during attempts.

Because attempted suicide is a major risk factor for subsequent suicide, in several states public health surveillance projects have been initiated to improve the quality of information about persons who are at risk for suicide (8). In addition, some health departments have initiated comprehensive youth suicide-prevention activities to improve service to the at-risk population (9).

Based on review of programs throughout the United States, CDC has identified strategies for preventing suicide among young persons (6). These strategies include 1) training school and community leaders to identify young persons at highest risk for suicidal thoughts, threats, and attempts; 2) educating young persons about suicide, risk factors, and interventions; 3) implementing screening and referral programs; 4) developing peer-support programs; 5) establishing and operating suicide crisis centers and hotlines; 6) restricting access to highly lethal methods of suicide; and 7) intervening after a suicide to prevent other young persons from attempting or completing suicide. Rigorous evaluation of new and existing prevention programs is essential to identify and establish the most effective interventions for reducing suicide among young persons.

National Suicide Prevention Week is May 7-13, 1995. This year's theme is "Stop the whispers...suicidal persons can be helped." For additional information, contact the American Association of Suicidology, telephone (202) 237-2280.

References

1. Shaffer D, Garland A, Gould M, Fisher P, Trautman P. Preventing teenage suicide: a critical review. J Am Acad Child Adolesc Psychiatry 1988;27:675-87.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

3. NCHS. Vital statistics mortality data, underlying cause of death, 1991 {Machine-readable public-use data tapes}. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993.

4. CDC. Youth suicide -- United States, 1970-1980. MMWR 1987;36:87-9.

5. Goodwin FK, Brown GL. Risk factors for youth suicide. In: Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretary's Task Force on Youth Suicide. Volume 2. Washington, DC: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1989; DHHS publication no. (ADM)89-1622.

6. CDC. Youth suicide prevention programs: a resource guide. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1992.

7. Mocicki EK, O'Carroll P, Locke BZ, Rae DS, Roy AG, Regier DA. Suicidal ideation and attempts: the epidemiologic catchment area study. In: Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretary's Task Force on Youth Suicide. Volume 4: strategies for the prevention of youth suicide. Washington, DC: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1989; DHHS publication no. (ADM)87-1624.

8. Colorado Department of Public Health and Environment. Violence in Colorado: trends and resources. Denver: Colorado Department of Public Health and Environment, 1994.

9. Eggert LL, Thompson EA, Randall BP, McCauley E. Youth suicide prevention plan for Washington state. Olympia, Washington: Washington Department of Health, 1995.

* Because data for racial groups other than black and white were too small for separate analysis, data for these groups were combined. Data on ethnicity were not analyzed because they were not available for the entire study period.

TABLE 1. Rate * of suicide for persons aged 10-24 years, by age group, and percentage change from
1980 to 1992 -- United States
=================================================================================================
                                   Male                                   Female
                   ------------------------------------   ---------------------------------------
Race/Age                                     % Change,                              % Change,
group (yrs)        1980 Rate   1992 Rate   1980 to 1992   1980 Rate   1992 Rate   1980 to 1992
-------------------------------------------------------------------------------------------------
White
  10-14              1.4         2.6          +86%          0.3         1.1          +233%
  15-19             15.1        18.4          +22%          3.3         3.7          + 12%
  20-24             27.7        26.6          - 4%          5.9         4.0          - 32%

Black
  10-14              0.5         2.0         +300%          0.2         0.4          +100%
  15-19              5.6        14.8         +164%          1.6         1.9          + 19%
  20-24             19.9        21.2         +  7%          3.1         2.4          - 23%

Other +
  10-14              0.0         1.1      Undefined &       0.0         0.2       Undefined
  15-19             18.6        17.5          - 6%          3.0         5.0          + 67%
  20-24             24.2        21.1          -13%          6.3         6.2          -  2%

Total               14.5        15.4            6%          3.1         2.8          - 10%
-------------------------------------------------------------------------------------------------

* Per 100,000 persons.
+ Because data for racial groups other than black and white were too small for separate analysis,
  data for these groups were combined.  Data on ethnicity were not analyzed because they were not
  available for the entire study period.
& No suicides were reported among persons in these groups in 1980.
=================================================================================================

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