Sofia Chaudhary, MD, is an assistant professor of pediatrics and emergency medicine at Emory University School of Medicine and physician at Children’s Healthcare of Atlanta.
In 2023, the U.S. Surgeon General described youth mental health as the “defining public health crisis of our time” amidst a surge in hospital visits for mental health care among children and nearly a 50% increase in suicide rates among youths aged 10 to 24 from 2010-21. As youth suicide rates have increased, disparities have widened and have been exacerbated further by the onset of the COVID-19 pandemic.
While more attention is being paid to the need for mental health services, challenges persist in identifying mental health needs among at-risk youth. A new study published in JAMA Open Network show the majority of youth suicide decedents did not have a documented mental health diagnosis.
We asked Sofia Chaudhary, MD — the study’s lead author, an assistant professor in Emory’s School of Medicine, a pediatric emergency medicine physician at Children’s Healthcare of Atlanta and a co-chair of the violence prevention task force for Emory's injury prevention research center — to answer five questions about why this study is significant and what we can learn to address the mental health needs of youth.
We used most recently available data from the CDC’s National Violent Death Reporting System (NVDRS) to better understand the characteristics of youth who died by suicide and the association with mental diagnosis.
What was most striking from this analysis is that approximately 3 out of 5 youth who died by suicide did not have a documented mental health diagnosis. Looking deeper, we found that youth decedents across all minoritized racial and ethnic groups (American Indian and Alaska Native, Asian Native Hawaiian or other Pacific Islander, Black and Hispanic Youth) and those that used firearms were also less likely to have a mental health diagnosis.
This shows the crucial need for improved detection and connection to mental health services and the importance of universal lethal means counseling, where families are instructed on how to store their firearms safely, in both health care and community settings.
Nearly 72,000 youth suicide deaths were reported between 2010-21 and we know that access to mental health services has been challenging in the face of this continued youth mental health crisis. Our findings show that the younger cohort, in particular younger boys, also seem to be amongst the most vulnerable. Suicide has become the second leading cause of death in youths aged 10-14 years, but this age group has significantly lower odds of having a mental health diagnosis.
Prior studies suggest that impulsivity among younger youth plays a greater role in suicide vulnerability. Prevention strategies in primary care and community settings that are tailored specifically to younger age groups should promote peer and family connectedness, foster resilience and empower children with coping strategies for times of crisis.
Reducing access to lethal means through simple, proven interventions such as safe firearm storage is so important. Currently, 4.5 million children in the U.S. live in a home where a firearm is stored unlocked and loaded. Firearms were the most commonly utilized method for youth suicide in our data and a majority of these youth did not have a previous mental health diagnosis. Firearm safety legislation such as child access protection laws have been shown to reduce firearm deaths including firearm suicide.
We also need a comprehensive approach that includes looking further upstream for adequate prevention strategies. Youth suicide can be impulsive and may be prompted by life stressors or acute crises. Early intervention programs that strengthen family and community connections can enhance problem-solving skills and resilience. We also need more community programming to reach youth in schools, community rec-centers and faith-based settings as they may frequent these locations more often than clinical settings.
Distrust in the health care system is more common among ethnic and racial minorities. Increasing culturally sensitive services and diversity in the mental health workforce can help ensure equitable access to mental health screening and diagnosis.
As a society we have a shared responsibility to ensure every child and teen has the ability to live a full life. By working together across disciplines and across medical and non-medical settings, we can collectively help reduce youth suicide through both clinical interventions and upstream societal/community efforts.
Many hospitals are now incorporating universal lethal means screening and counseling. Additionally, schools are incorporating not only anti-bullying programs but also increasing mental health supports and peer-to peer programming. We have a long way to go, but I’m hopeful we can build on these strategies and begin to see positive change.
