What Combination of Factors Makes Teen Suicide More Likely?

In December 2021, the Surgeon General of the United States released an advisory that every parent of teenagers should be aware of. He warned that teenagers in the U.S. are in what can only be described as a mental health crisis.

Here’s a short list of notable excerpts from the advisory:

• Mental health challenges in children, adolescents, and young adults are real, and they are widespread.
• The pandemic era’s unfathomable number of deaths, pervasive sense of fear, economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced.
• The challenges today’s generation of young people face are unprecedented and uniquely hard to navigate – and the effect of these challenges on their mental health is devastating.

Of particular concern to the Surgeon General – and therefore to parents of teens and mental health professionals who work with teens – is the dramatic increase in suicidal ideation, suicidal behavior, and suicide attempts among youth and teens that occurred between 2009 and 2019.

Here are three examples of the teen suicide data cited in the advisory:

• Suicide rates among youth ages 10-24 in the US increased by 57% between 2007 and 2018
• The percentage of high school students seriously considering suicide increase by 36% between 2009 and 2019
• The percentage of high school students with a suicide plan increased by 44% between 2009 and 2019

Those statistics are cause for alarm.

That’s why, in the months before the Surgeon General released the report, we published a series of articles on teen suicide, which included this overview on suicide, suicide risk, suicidal ideation, suicide attempts, and suicide risk factors among adolescents:

A Parent’s Guide to Self-Harm and Suicide Risk in Teens

We encourage parents to read that article to get an idea of the general factors that can increase suicide risk in teens. This present article will elaborate and expand on those risk factors in order to help parents determine whether their teen is in a high-risk group. To that end, we’ll discuss a recent publication that identifies specific categories of teens that may be at significantly higher risk than teens with low or moderate suicide risk.

New Study Identifies Risk Profiles for Teen Suicide

A group of research scientists from the Pediatric Emergency Care Applied Research Network (PECARN) recently published an article called Five Profiles of Adolescents at Elevated Risk for Suicide Attempts. The article, as the title implies, identifies five groups of teens that are at high risk of engaging in suicidal behavior, based on their mental health history, current mental health status, and past and present behavioral characteristics.

Previous studies identified the seven most common risk factors associated with increased risk of teen suicide.

Common Risk Factors: Teen Suicide

1. The presence of a clinically diagnosed mental health disorder. The diagnoses most associated with increased suicide risk are:
   • Depression
   • Anxiety
   • Alcohol use disorder (AUD), a.k.a. alcoholism or alcohol addiction
   • Substance use disorder (SUD), a.k.a. substance abuse or drug addiction
2. Identifying as a member of the LGBTQ + community:
   • Suicide is one of the leading causes of death for LGBTQI individuals age 10-24
   • LGBTQI youth are four times more likely to engage in self-harm than non-LGBTQI youth
   • LGBTQI youth are three times more likely to engage in suicidal ideation or attempt suicide than non-LGBTQI youth
   • 38-65% of the total transgender population engage in suicidal ideation
3. History of trauma
4. History of physical, emotional, or sexual abuse
5. Major loss or grief, such as the death of a loved one, family member or close friend
6. Social isolation
7. Previous suicide attempts

The study we discuss in this article is important because it takes those risk factors and creates risk profiles of teens most likely to engage in suicidal behavior, based on their specific combination of known risk factors. It’s also important because of the sample size, the population in the sample, and the study design.

About the New Research: How Doctors Created Teen Suicide Risk Profiles

In order to formulate reliable, evidence-based risk profiles for adolescents, the researchers – all pediatricians and PhDs – took the following steps:

• They obtained detailed data from 1,609 teens who visited a hospital emergency room for suicidal behavior.
• They screened and assessed the teens for demographic factors, mental health history, and known suicide risk factors. Known suicide risk factors included:
  • Suicidal ideation
  • History of multiple suicide attempts
  • Depression
  • Alcohol use
  • Drug use
  • Impulsiveness-aggression
  • Sexual abuse
  • Physical abuse
• They followed up with families by phone three months and six months after initial analysis and screening to assess current status of each study participant
• They analyzed initial data and follow up data to create five distinct risk profiles for teens at increased risk for suicide.

Their new risk profiles can help parents and clinicians identify teens who need the most support, and prioritize their mental health care based on their individual profile and its associated risks. Before we share the five new high-risk profiles, we want to make sure parents reading this article understand the scope of the teen suicide problem in the U.S.

We shared statistics from the Surgeon General’s report above, which addressed the increase in teen suicide from 2008 to 2009. Now let’s look at the data from 2019, the last year for which we have data that’s been adequately analyzed for accuracy.

Teen Suicide: High School Students Grades 9-12, 2019

• 8.9% of high school students reported at least one suicide attempt in the past 12 months
  • 11.0% of females
  • 6.6% of males
• 18.8% reported seriously considering suicide in the past 12 months (up from 17.2% in 2017)
  • 24.1% of females
  • 13.3% of males

While initial reports from 2020 and 2021 report further increases in suicidal behavior among teens based on emergency room visits and various other sources, we’ll wait for the publication of the 2021 Youth Risk Behavior Survey – which will give us the definitive pandemic suicide data for 2020 and 2021 – to share the final numbers. For now, we’ll put those prevalence statistics in real numbers to help parents understand what they mean:

Attempted Suicide: 8.9% of high school students means about 2.2 million high school students attempted suicide in 2019.

Seriously Considered Attempting Suicide: 18.8% of high school students means about 4.7 million high school students seriously considered attempting suicide in 2019.

That’s the size and scope of our teen suicide problem in the U.S. It’s significant, which is why these new risk profiles can provide a valuable tool: they can help adults identify at-risk teens to mitigate – or prevent entirely – any additional increases in suicide attempts among teens.

In other words, these new profiles will help us protect our kids at a time when they need our protection the most.

The Results: Five Teen Suicide Risk Profiles

Let’s recap: the study examined over a thousand teens who visited a hospital emergency room for suicidal behavior. Among those teens, some were in a low to moderate risk category, which is common. Many teens with minor mental health issues, teens with a history of trauma, or recent stress, loss, or grief are considered are in this low to moderate risk category. In the study, researchers used this group as their default baseline. Researchers place other teens, based on their history and documented risk factors, in the high-risk group. Then, they created risk profiles for these teens based on their status at a three- and six-month follow-up interview, conducted via telephone.

When compared to teens with low suicide risk, all the profiles below were associated with elevated suicide risk at the six-month follow up.

Increased Suicide Risk Among High-Risk Adolescents: Five Risk Profiles

1. Severe Suicidal Thoughts and Behavior plus Aggression: (9% of the sample group)
   • Attempted suicide within 6 months of initial screening: 28%
   • Adolescents who attempted suicide were 45 times more likely to have this risk profile compared to the low-risk group
2. Severe Suicidal Thoughts and Behavior: (21% of the sample group)
   • Attempted suicide within 6 months of initial screening: 26.1%
   • Adolescents who attempted suicide were 42 times more likely to have this risk profile compared to the low-risk group
3. Suicidal Thoughts and Behaviors: (15% of the sample group)
   • Attempted suicide within 6 months of initial screening: 13.8%
   • Adolescents who attempted suicide were 19 times more likely to have this risk profile compared to the low-risk group
4. History of Suicidal Thoughts and Behavior plus Aggression: (10% of the sample group)
   • Attempted suicide within 6 months of initial screening: 12.4%
   • Adolescents who attempted suicide were 17 times more likely to have this risk profile compared to the low-risk group
5. History of Suicidal Thoughts and Suicidal Behavior (45% of the sample group)
   • Attempted suicide within 6 months of initial screening: 6.6%
   • Adolescents who attempted suicide were 8 times more likely have this risk profile compared to the low-risk group

Please note: 0.8% of adolescents in this study with low/moderate risk of suicide reported a suicide attempt within six months of initial screening. This number presents no statistically significant elevation of odds risk compared to the general population.

Now we’ll interpret and simplify those profiles for the benefit of parents – or anyone – reading this article.

Highest Risk (Extremely High Risk): Profiles 1-2

Profile 1: Teens with current severe suicidal thoughts, current severe suicidal behavior, and current aggressive behavior. This means teens who have active suicidal thoughts, active suicidal behavior, and display active aggression.

Profile 2: Teens with current severe suicidal thoughts and current severe suicidal behavior. This means teens who have active suicidal thoughts and active suicidal behavior.

Higher Risk (Very High Risk): Profiles 3-4

Profile 3: Teens with current suicidal thoughts and current suicidal behavior. This means teens who have suicidal thoughts and behavior, but they have not acted on them and the thoughts are not considered severe.

Profile 4: Teens with a history of suicidal thoughts, a history of suicidal behavior, and current aggressive behavior. This means teens who have considered suicide before, attempted or made a plan to commit suicide in the past, and currently display aggressive behavior.

High Risk (Significantly High Risk Compared to Baseline and National Average): Profile 5

Profile 5: Teens with a history of suicidal thoughts and a history of suicidal behavior. This means teens who have considered suicide before and attempted or made a plan to commit suicide in the past.

Let’s be clear. Teens in all five of these risk groups are at high risk of attempting suicide. Although the range is extreme – 45 times more likely and 8 times more likely, as compared to baseline – parents of teens that meet any of these profile criteria need to pay close attention to their teen, and seek professional support if they have not yet done so.

In addition to the overview piece we mention at the beginning of this article, we encourage parents to read our six additional article on the subject of teen suicide:

1. The Association Between Teen Suicidal Ideation and Childhood Depression and Irritability
2. Insomnia and Sleep Disturbances in Teens Linked to Higher Risk of Suicide
3. Bullying and Cyberbullying Associated with Higher Risk of Suicide in Teens
4. Are Brooding, Impulsive Teens at Higher Risk for Suicidality?
5. Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents
6. Teen Suicide Contagion: Is Suicide Contagious?

Each of those articles contain valuable information that can help parents support their teens as they manage suicidal thoughts and behaviors, as well as the mental health disorders and risky behaviors associated with teen suicide.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.