Gender- and Ethnic-Specific Trends in Suicidality Among Adolescents in the US Between 1991-2019

shot of word suicide
It is known that disparities exist among US adolescent suicide death rates by sex, race, and ethnicity. Study researchers look at suicidal ideation and attempts amidst these same parameters from 1991 and 2019.

Suicidal ideation and attempt rates among adolescents differed on the basis of gender and ethnicity, indicating a need for population-specific suicide prevention programs. These findings, from a cross-sectional study, were published in JAMA Network Open.

Data from the national Youth Risk Behavior Survey (YRBS) were analyzed for this study. High school students were surveyed biennially from 1991 to 2019 about suicidal ideation and attempts.

Over the 2 decades, participants in the survey totaled 183,563 adolescents aged mean 16.07 (standard deviation [SD], 1.23) years. The number of girls was 49.4%. The ethnic makeup of participants was: 64.0% White, 15.5% Hispanic, 12.5% Black, 4.0% Asian or Pacific Islander, 3.3% mixed ethnicity, and 0.7% American or Alaskan Native.

Suicidal ideation without an attempt decreased by 18.2% over time from 19.4% in 1991 to 15.8% in 2019. Conversely, nonfatal suicide attempts increased by 22.5% from 7.3% in 1991 to 8.9% in 2009.

The trend over time for suicidal ideation had a joinpoint curve, in which ideation decreased at an annual percent change (APC) of -3.1% (95% CI, -3.7% to -2.6%) from 1991 to 2009. Between 2009 and 2019, the rate increased by 3.4% (95% CI, 1.9%-4.8%).

Stratified by gender, suicidal ideation decreased between 1991 and 2019 by 18.5% for girls and 21.8% for boys. The joinpoint regression analysis found an APC between 1991 to 2009 of -3.2% (95% CI, -3.8% to -2.7%) and 2009 to 2019 of 4.0% (95% CI, 2.5%-5.6%) among girls. For boys, between 1991 and 2007, the APC was -3.3% (95% CI, -4.9% to -1.6%) and from 2007 to 2019 it was 1.4% (95% CI, -1.2% to 4.0%).

Stratified by ethnicity, suicidal ideation was increasing among American and Alaskan Natives (98.1%) and Blacks (9.5%) and decreased among Whites (-23.8%), Asians and Pacific Islanders (-23.1%), and Hispanics (-1.2%). The joinpoint turn from decreasing trends to increasing trends in suicidal ideation was in 2005 for Black youths, in 2007 for Hispanic youths, and in 2009 for White youths.

The APC of suicide attempts among girls was -0.6% (95% CI, -1.3% to 0.1%) compared with 0.6% (95% CI, -0.2% to 1.5%) among boys. The increasing trend of nonfatal suicide attempts was 20 times greater among boys (68.4%; 95% CI, 0.2%-1.2%) compared with girls (3.4%; 95% CI, -0.1% to 0.2%).

The increase in nonfatal suicide attempts was greatest among Black adolescents (79.7%) compared with American or Alaskan Native (70.0%), White (17.8%), Hispanic (13.4%), or Asian and Pacific Islander (-37.6%) youths.

Stratified by gender and ethnicity, suicidal ideation increased among American and Alaskan Native girls (32.6%) and Black girls (13.4%) and nonfatal suicide attempts increased among American and Alaskan Native boys (204.0%) and Black boys (20.8%).

This study was of a cross-sectional design and the investigators were unable to assess causality in trends.

These data indicated that patterns of suicidal ideation and nonfatal attempts varied on the basis of gender and ethnicity. Suicide prevention programs may be more effective if they are tailored for specific populations, addressing unique difficulties and concerns.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Xiao Y, Cerel J, Mann JJ. Temporal trends in suicidal ideation and attempts among US adolescents by sex and race/ethnicity, 1991-2019. JAMA Netw Open. 2021;4(6):e2113513. doi:10.1001/jamanetworkopen.2021.13513