Cited by 303Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGun Ownership and Violence Research

The DOI matches its Crossref record; 20 of the 24 references it cites were found in a registry or an index; none of the 24 sources its claims cite is checked for support yet.

Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016

Open access

Abstract

Importance: Suicide is a leading cause of death among youth aged 10 to 19 years in the United States, with rates traditionally higher in male than in female youth. Recent national mortality data suggest this gap may be narrowing, which warrants investigation. Objective: To investigate trends in suicide rates among US youth aged 10 to 19 years by age group, sex, race/ethnicity, and method of suicide. Design, Setting, and Participants: Cross-sectional study using period trend analysis of US suicide decedents aged 10 to 19 years from January 1, 1975, to December 31, 2016. Data were analyzed for periods defined by statistically significant changes in suicide rate trends. Suicide rates were calculated using population estimates. Main Outcomes and Measures: Period trends in suicide rates by sex and age group were assessed using joinpoint regression. Incidence rate ratios (IRRs) were estimated using negative binomial regression comparing male and female suicide rates within periods. Results: From 1975 to 2016, we identified 85 051 youth suicide deaths in the United States (68 085 male [80.1%] and 16 966 female [19.9%]) with a male to female IRR of 3.82 (95% CI, 3.35-4.35). Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years; 7.9% vs 3.5% for individuals aged 15-19 years). The male to female IRR decreased significantly across the study period for youth aged 10 to 14 years (3.14 [95% CI, 2.74-3.61] to 1.80 [95% CI, 1.53-2.12]) and 15 to 19 years (4.15 [95% CI, 3.79-4.54] to 3.31 [95% CI, 2.96-3.69]). Significant declining trends in the male to female IRR were found in non-Hispanic white youth aged 10 to 14 years (3.27 [95% CI, 2.68-4.00] to 2.04 [95% CI, 1.45-2.89]) and non-Hispanic youth of other races aged 15 to 19 years (4.02 [95% CI, 3.29-4.92] to 2.35 [95% CI, 2.00-2.76]). The male to female IRR for firearms increased significantly for youth aged 15 to 19 years (χ2 = 7.74; P = .02 for sex × period interaction). The male to female IRR of suicide by hanging or suffocation decreased significantly for both age groups (10-14 years: χ2 = 88.83; P < .001 for sex × period interaction and 15-19 years: χ2 = 82.15; P < .001 for sex × period interaction). No significant change was found in the male to female IRR of suicide by poisoning across the study period. Conclusions and Relevance: A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This cross-sectional analysis of 85,051 US youth suicide deaths aged 10 to 19 years from 1975 to 2016 found that the male-to-female suicide rate ratio declined over time, especially among younger youth. Female suicide rates by hanging or suffocation approached male rates, and racial/ethnic differences in the narrowing gap were present.

Key findings

  • Among youth aged 10 to 14 years, the male-to-female incidence rate ratio (IRR) for suicide decreased significantly from 3.14 (95% CI, 2.74-3.61) in 1975-1991 to 1.80 (95% CI, 1.53-2.12) in 2007-2016 (χ2 = 30.41; P < .001 for sex × period interaction).
  • From 2007 to 2016, suicide rates for female youth aged 10 to 14 years increased 12.73% annually (95% CI, 8.81%-16.80%) compared with 7.08% (95% CI, 4.21%-10.03%) for male youth; for ages 15 to 19 years, female rates increased 7.91% annually (95% CI, 5.84%-10.02%) compared with 3.49% (95% CI, 2.28%-4.72%) for male youth.
  • The male-to-female IRR for suicide by hanging or suffocation decreased significantly for both age groups (10-14 years: χ2 = 88.83; P < .001; 15-19 years: χ2 = 82.15; P < .001), while the male-to-female IRR for firearms increased significantly for youth aged 15 to 19 years (χ2 = 7.74; P = .02).
  • Among youth aged 10 to 14 years, the male-to-female IRR declined significantly for non-Hispanic white youth (χ2 = 8.10; P = .02) and non-Hispanic youth of other races (χ2 = 8.79; P = .02); non-Hispanic white youth had an IRR decrease from 3.27 (95% CI, 2.68-4.00) in 1975-1991 to 2.04 (95% CI, 1.45-2.89) in 2007-2016.

Methods

  • Deidentified national mortality data were obtained from CDC WONDER for youth aged 10 to 19 years in the United States from 1975 to 2016, with suicide identified by ICD codes E950-E959 (ICD-8/9, 1975-1998) and X60-X84, Y87.0, and U03 (ICD-10, 1999-2016).
  • Crude suicide rates per 100,000 persons were calculated using WONDER population estimates; trends by sex and age group (10-14 and 15-19 years) were assessed with Joinpoint regression software version 4.3.1.0.
  • Incidence rate ratios and 95% CIs were estimated using negative binomial regression comparing male and female suicide rates within select periods; χ2 tests compared male-to-female IRRs across periods, with analyses in Stata/IC version 14.1 and a 2-tailed significance level of P < .05.

Limitations

  • Stated: the data cannot explain underlying reasons for the narrowing gap between sexes in youth suicide.
  • Stated: variations in cause-of-death coding across ICD-8, ICD-9, and ICD-10 may have affected results, and it is unknown whether accuracy of classifying a youth death as suicide changed during the study period.
  • Stated: early suicide trends for Hispanic and non-Hispanic categories should be interpreted with caution because these data were not captured before 1990 and were excluded from select states through 1996; evident from the text, the cross-sectional design using aggregate mortality records cannot establish causality or individual-level mechanisms.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamanetworkopen.2019.3886

Cites

20 of 20 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

Show all 29 claims

  • It may state two separate claims as one. 17
  • The quote only partly states this claim. 3
  • Probably not a substantial claim. 9
26 of 26
  • The paper relies on this without support.

    The WONDER mortality data accurately identify suicide deaths among US youth aged 10 to 19 years over the study period.

    “Deidentified data were obtained from Wide-ranging Online Data for Epidemiologic Research (WONDER) records in which suicide (coded as E950-E959 for the eighth and ninth revisions of the International Classification of Diseases [1975-1998] and X60-X84, Y87.0, and U03 for the International Classification of Diseases, Tenth Revision [1999-2016]) was listed as the underlying cause of death among youth”
  • The paper relies on this without support.

    The accuracy of classification of a death as suicide in youth did not change during the study period.

    “Third, it is unknown whether the accuracy of classification of a death as suicide in youth has changed during the study period.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Citation for earlier disparity studies points to a reporting guideline

    Minor

    The discussion cites reference 9 as an earlier study supporting racial/ethnic disparities, but reference 9 is the STROBE reporting guideline.

  • Table rate denominator conflicts with Methods

    Minor

    The table title labels suicide rates as per 100 100, while the Methods state that rates were calculated per 100 000 persons.

2 of 2

Citations

Cites

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Show all 24 references

4 of the 24 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Klebba, 1980, Estimates of selected comparability ratios based on dual coding of 1976 death certificates by the eighth and ninth revisions of the International Classification of Diseases., Mon Vital Stat Rep, 28
  2. National Action Alliance for Suicide Prevention; Research Prioritization Task Force, 2014, A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives

Cited by

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Metadata

Authors
Ruch, D. A., Sheftall, A. H., Schlagbaum, P., Rausch, J., Campo, J. V., & Bridge, J. A.
Affiliations
  • Nationwide Children's Hospital (US)
  • West Virginia University (US)
Corresponding author
Ruch, Donna A.
Venue
JAMA Network Open
Published
2019-05-17
Volume
2
Issue
5
Pages
e193886
ISSN
2574-3805 (ISSN-L)
OpenAlex
W2945445235
Cited by
303
References
24
Citations by year
2026: 22 · 2025: 38 · 2024: 42 · 2023: 40 · 2022: 39 · 2021: 66 · 2020: 36 · 2019: 19
FWCI
46.68
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • The Research Repository @ WVU (West Virginia University) (submittedVersion, cc-by)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (R21MH116206, R01MH117594, MH117594)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
youth suicide, suicide rates, sex differences in suicide, age differences in suicide, racial and ethnic differences, suicide methods, firearm suicide, hanging, drug overdose, suicide prevention, suicide prevention programs, suicide prevention policy, United States, young adults, Latino youth, Black youth
MeSH terms
Adolescent, Adult, Age Factors, Cause of Death, Child, Cross-Sectional Studies, Female, Forecasting, Humans, Male, Sex Factors, Suicide, United States, Young Adult

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