An international comprehensive meta-analysis found that trends in suicidal thoughts and behaviors (STBs) among youth are not improving worldwide and may be getting worse in the United States. These findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.
Investigators from the Feinstein Institutes of Medical Research in the US searched publication databases for studies evaluating the rate of suicidal ideation (SI) and/or suicide attempt (SA) among youth and young adults aged 22 years and younger.
Data from 369 articles were used to compute 376 effect sizes on the outcome of active SI and 321 on SA. The data were collected from 1981 to 2021 in 149 countries or territories, which were grouped into 10 regions for this analysis.
The weighted average prevalence of SI was 16.3% (95% CI, 14.9%-17.8%), and SA was 6.2% (95% CI, 5.5%-6.9%). These comparisons had significant heterogeneity (both P <.0001). Rates of lifetime active SI were higher than 1-year rates (20.4% vs 15.1%; P <.0001), as were lifetime SA rates than 1-year rates (7.0% vs 5.2%; P =.013), respectively.
Trends in SA and SI differed on the basis of age and gender, in which the rates were lower among younger children and among girls compared with older children and boys, respectively. For ethnicity, SI rates were highest among Asian youth (24.0%) and lowest among Black youth (15.2%), whereas SA rates were highest among Indigenous youth (14.2%) and lowest among White youth (4.9%). The rates also differed by region, in which SI was reported to be highest in Eastern Europe (22.6%) and lowest in the Middle East (14.3%), and SA was reported to be highest in the South Pacific (15.8%) and lowest in Asia (4.6%).
In the meta-regression analysis, significant moderators for SI included study year (β, -0.01; P =.025), lifetime SI rate (β, 0.45; P =.0001), and self-reported SI rate compared with interview-obtained rate (β, 0.59; P =.010). No significant moderators were reported for SA.
As year of study was a significant moderator, the investigators performed an exploratory analysis evaluating how STBs have changed over time. Since 2007, data from previous studies have shown that North America reported a positive relationship between study year and active SI (β, 0.03; P <.0001) and SA (β, 0.02; P =.011) rates.
Stratified by individual country, no significant trend was observed for data collected in Canada. In the US, SI increased from 9.8% in 2007-2008 to 18% in 2011-2012, and SA increased from 5% in 2007-2008 to 9.0% in 2011-2012. The most recent study in 2021 reported an SI rate of 19.9% and SA rate of 9.0%.
There was little evidence of publication bias after removing outliers and influential cases (β, 0.74; P =.362). However, this analysis was limited by the significant heterogeneity.
Study authors concluded, “Suicidal thoughts and behavior among youth are significant public health concerns, but we did not find evidence that STB are increasing universally. Our results show that female youth, those 14 [years]-and-older, youth of color, and those from the South Pacific are at especially elevated risk.”
Van Meter AR, Knowles EA, Mintz EH. Systemic review and meta-analysis: international prevalence of suicidal ideation and attempt in youth. J Am Acad Child Adolesc Psychiatry. 2022;S0890-8567(22)01981-5. doi:10.1016/j.jaac.2022.07.867