What Puts Teens at Higher Risk of Suicide?

[seriesbox]A Parent’s Guide to Self-Harm and Suicide Risk in Teens
The Association Between Teen Suicidal Ideation and Childhood Depression and Irritability
Insomnia and Sleep Disturbances in Teens Linked to Higher Risk of Suicide
Are Brooding, Impulsive Teens at Higher Risk for Suicidality?
Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents
Teen Suicide Contagion: Is Suicide Contagious?[/seriesbox]The suicide rate among teens is a topic of legitimate concern among mental health professionals who work with adolescents every day. A confluence of factors contributes to this growing problem, with new evidence published every month indicating that rates of suicidal ideation, suicide attempts, and death by suicide among teenagers continue to increase year after year. Many mental health professionals see it as more than a problem: they see it as both a crisis and an emergency.

Here’s an overview of the data that creates concern. We’ll start with the one statistic that should have everyone asking why this is happening and what can be done to reverse this trend:

In 2014, suicide became the second leading cause of death for adolescents and young adults in the U.S.

That was seven years ago – and the trend has not stopped. It has continued in the wrong direction.

In 2019, the National Youth Risk Behavior Survey (2019 YRBS), which includes data on more than 13,000 middle and high school students from 44 states, 28 large cities, three U.S. territories, and two tribal governments, published the latest data on teen suicide:

• 8.9% of high school students reported at least one suicide attempt in the past 12 months
• 18.8% reported seriously considering suicide in the past 12 months
• An average of 3,703 adolescents in grades 9-12 attempt suicide every day

All these figures represent increases since the Centers for Disease Control (CDC) first reported suicide became the second leading cause of death of adolescents and young adults in 2014. When a middle or high school student experiences bullying, data shows they’re at increased risk of:

• Depression
• Anxiety
• Insomnia
• Academic problems
• Dropping out of school

New data shows another alarming fact: not only does experiencing bullying increase the risk of mental health disorders and other negative outcomes, but it also increases the risk of suicide.

Prevalence of Bullying in U.S. Middle and High Schools

Before we discuss the statistics connecting bullying – both in-person and online – to suicide, it’s important to understand the facts about bullying among middle and high school students in the U.S. Here’s the latest data from the 2019 YRBS:

• 20% of high school students reported being bullied on school property in the previous 12 months
• Bullying at school takes place:
  • Between classes In the hallway or stairwell 43.4% of the time.
  • In the classroom 42.1% of the time.
  • In the cafeteria 26.8% of the time.
  • Outside of school 21.9% of the time
  • In the gym or PE class 19.5% of the time.
  • In the bathroom 12.2% of the time.
• 15% of high school students report being cyber-bullied (online or via text) while at school
• 7% report being cyber-bullied outside of school hours

The suicide numbers we mention above increased between 2014 and 2019: that’s one reason adults who work with teens express concern. The bullying numbers above also represent an increase since the last YRBS report on bullying, published in 2017.

That begs the question:

What is the connection?

Before we answer that, let’s also get clear on exactly what we mean by bullying.

What Exactly is Bullying?

The CDC defines bullying as:

“Unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social, or educational harm.”

There are two distinct forms of bullying:

• Direct bullying occurs in person. It includes things like pushing, hitting, or shoving, and/or verbal or written communication designed to inflict harm or cause distress.
• Indirect bullying does not occur in person. It includes threats, aggressive/derogatory language, and spreading false and/or harmful rumors through text, instant messages, or social media posts.

These two forms of bullying come in four types:

1. Physical Bullying

Physical bullying is the use of physical force to harm or intimidate an individual. It includes, but is not limited to:

• Hitting
• Kicking
• Punching
• Tripping
• Pushing
• Spitting

2. Verbal Bullying

Verbal bullying is the use of verbal or written behavior designed to harm or intimidate an individual. This type of bullying includes:

• Taunting
• Name calling
• Threatening
• Inappropriate sexual comments/gestures

3. Relational Bullying

Relational bullying is intended to damage the reputation and/or the relationships of the person being bullied. This type of bullying can be:

• Direct: isolating or excluding an individual from peers
• Indirect: Spreading rumors, images, or derogatory comments in a public space, whether online or in-person

4. Property Damage

This type of bullying refers to theft, vandalism, or damage of the personal property of the bullied individual. This includes:

• Taking/stealing personal possessions
• Damaging/destroying possessions in front of the bullied individual
• Deleting/changing online or digital information with the purpose of causing harm or intimidating the bullied individual

We include this information so parents and teens understand what qualifies as bullying. This is important because sometimes parents, teens, teachers, and school administrators alike downplay bullying and write it off as typical teen behavior. In some cases, adults expect youth to learn to handle bullying and accept it as part of teen life.

Let’s be clear:

No one, anywhere, at any time – teens included – have to accept bullying as part of their life. Bullying is wrong and causes real harm. Accepting bullying personally can lead to mental health problems, and seeing bullying without doing anything makes an individual indirectly complicit in bullying.

The Connection Between Bullying and Suicide

In order to examine the relationship between in-person bullying and cyberbullying and suicide, a group of researchers performed a retrospective analysis on the 2017 YRBS. In the past, research indicated that in-person bullying happened at almost double the rate of cyberbullying. By in the past, we mean less than ten years ago – around 2014.

Read our article Long-Term Effects of Cyber and Traditional Bullying to learn where our understanding of bullying stood then, and read our article October is Bullying Prevention Month to get an idea of where the scholarship on the subject stood two years ago.

The 2017 YRBS included data on 14,603 adolescents (14-18). Study authors stated the goal of their retrospective analysis clearly:

“The objective of the study was to investigate the association between bullying victimization and suicidal ideation among adolescents.”

Here’s what they found:

• Teens who experienced both in-person bullying and cyberbullying showed were 3.26 times more likely to report suicidal ideation than teens who were not bullied.
• Teens who experienced in-person bullying were 2.15 times more likely to report suicidal ideation than teens who were not bullied
• The teens who experienced cyberbullying were twice as likely to report suicidal ideation than teens who were not bullied

In addition, they identified other factors associated with increased risk of suicidal ideation:

• Depressive symptoms
• Cigarette smoking
• Alcohol use
• Cannabis use
• Illicit drug use

We mention those additional factors because of the stressful year and half our teens lived through from the beginning of the coronavirus pandemic until now. Scores of studies show an increase in all of the above during and after the pandemic, as compared to before the pandemic. To learn more about the general effect of the pandemic on teen mental health, please read this article we published in January:

Teens and Mental Health in the News: The NBC Report

A Second Report: A Twist in the Data

Now, back to the suicide statistics. Another study published in 2020 analyzed data from over two thousand Canadian teens over a period of four years. Researchers examined the relationship of in-person and cyberbullying and suicidal ideation/suicide attempts over a period of four years, administering surveys to teens at age 13, 15, and 17. This study is important because it took place over four years, as opposed to the YRBS, which is a snapshot-in-time study. The nature of the study yielded interesting results.

Here’s what the researchers found:

• Teens bullied online or via text showed a higher risk of suicidal ideation/attempts. They were:
  • 2.3 times more likely to engage in suicidal ideation or attempt suicide at age 13
  • 4.2 times more likely at age 15
  • 3.5 times more likely at age 17
• Teens bullied both in-person and online had higher risk of suicidal ideation or suicide attempt, compared to teens bullied face-to-face and not also bullied online
• Teens bullied online did not have an increased risk of suicidal ideation or suicide attempt after two years, compared to teens bullied in person
• The teens bullied face-to-face had an increased risk of suicidal ideation or suicide attempt after two years, compared to teens bullied online

Those last two bullet points are what we call interesting. Online bullying – in the context of this study – did not have a lasting effect on suicidal ideation or suicide attempts, as compared to in-person bullying alone and a combination of in-person and cyberbullying.

What does this mean?

From our point of view, this may mean two things.

First, it may mean that in-person interactions of any type inherently have more power than interactions mediated by digital media such as text or posts on social networking sites.

However, we do not downplay the negative effects of cyberbullying: it causes real harm to our teens every day, and we need to maintain strict vigilance to prevent normalizing online bullying and protect our teens from online bullying.

Second, it may mean that our teens have, or a slowly becoming, inured to the negativity common online and on social networking sites.

This is not necessarily a good thing: we advocate for a decrease in negative online behavior, rather than an increase in the efficacy of our teen’s coping skills to mitigate the negative effects of online bullying.

At the same time, when teens show they’re resilient and capable of processing difficult emotions and situations with positive adaptive behavior, rather than maladaptive behavior such as suicidal ideation and suicide attempts, we see hope for the future, and find hope for our teens.

What Parents, Teachers, and Teens Can Do When They See Bullying

A valuable resource from the CDC shows that in 60% of cases when a third party intervenes when they witness bullying, the bullying stops quickly. The same resource identifies the five most effective steps parents can take to stop bullying:

1. Promote a safe, inclusive atmosphere in the home, school, and community
2. Provide early education that includes all family members
3. Teach younger children appropriate social and emotional skills, i.e. teach them at an early age bullying is not acceptable
4. Create environments, programs, and norms at school and at home that promote positive interaction and give teens the chance to interact with positive adult role models who offer alternatives to bullying
5. Intervene immediately when bullying happens

The unifying message in these five steps is that bullying is preventable. Preventing bullying starts in the home, extends to school, and reaches into the community at large. When we understand the significant mental, emotional, and psychological damage in-person and online bullying can cause – up to and including suicidal ideation and suicide attempts – we also understand the vital importance of stopping bullying before it can begin.