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Health Objectives for the Nation Attempted Suicide Among High School Students -- United States, 1990

Suicide rates for adolescents 15-19 years of age have quadrupled from 2.7 per 100,000 in 1950 to 11.3 in 1988 (1,2). Data from earlier decades are not available to assess similar trends in rates of attempted suicide in this population. Attempted suicide is a potentially lethal health event, a risk factor for future completed suicide, and a potential indicator of other health problems such as substance abuse, depression, or adjustment and stress reactions (3). This report examines self-reported data to estimate the annual prevalence of suicidal thoughts and behaviors among U.S. high school students.

The national school-based Youth Risk Behavior Survey (YRBS) is one component of CDC's Youth Risk Behavior Surveillance System, which periodically measures the prevalence of priority health-risk behaviors among youth through comparable national, state, and local surveys (4). The school-based YRBS used a three-stage sample design to obtain a representative sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. Students were asked whether they had seriously thought about attempting suicide during the 12 months preceding the survey, whether they had made a specific plan about how they would attempt suicide, how many times they had actually made a suicide attempt, and whether their suicide attempt(s) resulted in an injury or poisoning that had to be treated by a doctor or nurse.

For the 12 months preceding the survey, 27.3% of all students in grades 9-12 reported that they had thought seriously about attempting suicide (Table 1). Fewer students (16.3%) reported that they had made a specific plan to attempt suicide. About half the students who made a specific plan (8.3% of all respondents) reported that they actually attempted suicide. Two percent of the students reported that they made a suicide attempt that resulted in an injury or poisoning requiring medical attention. This systematic decline was noted for both male and female students and for white, black, and Hispanic students.

Female students were significantly more likely than male students to report that they had thought seriously about attempting suicide, had made a suicide plan, or had attempted suicide one or more times during the 12 months preceding the survey (Table 1). Similarly, 2.5% of female students and 1.6% of male students indicated they had made a suicide attempt that required medical attention, but this difference was not statistically significant.

Hispanic and white students reported higher levels of suicidal thoughts and behaviors than black students (Table 1), although these differences were not always statistically significant. Hispanic female students (14.9%) were significantly more likely to have attempted suicide during the 12 months preceding the survey than white female (10.1%) or black female students (8.2%). Reported by: Div of Injury Control, National Center for Environmental Health and Injury Control; Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:In past surveys assessing the lifetime prevalence of attempted suicide, 9% (5,6) to 14% (7) of adolescents reported that they had attempted suicide at some time in their lives. Few studies have tried either to quantify the health impact of an adolescent's self-reported attempted suicide or to determine whether high school students' perception of a suicide attempt includes overt injury or other sequelae. The findings reported here add to increasing evidence that most self-reported suicide attempts among adolescents and young adults do not result in injury or hospitalization (6). In addition, a recent investigation among college students found that only half of those who sought medical care for injuries sustained during a suicide attempt were admitted to a hospital for one or more nights (8). These findings suggest that future studies of attempted suicide among adolescents should also assess the medical consequences of self-reported suicidal behavior.

YRBS data indicate an estimated 276,000 high school students in the United States made at least one suicide attempt requiring medical attention during the 12 months preceding the survey (9). The national health objective for the year 2000 (objectives 6.2 and 7.8) is to ``reduce by 15 percent the incidence of injurious suicide attempts among adolescents aged 14 through 17'' (10). The YRBS data do not permit a precise calculation of this incidence rate because some students may have made more than one suicide attempt requiring medical attention during the 12 months preceding the survey. However, using the annual prevalence of U.S. high school students who made at least one suicide attempt requiring medical attention as a proxy, the annual prevalence will need to be reduced from 2.1% of high school students in 1990 to 1.8% by the year 2000 to meet the objective.

A variety of youth suicide prevention strategies have been suggested to reduce known risk factors for suicide (e.g., social isolation, depression, alcohol and other drug use, and access to lethal means for suicide) and to increase referrals of high-risk adolescents to appropriate mental health services (3). These strategies include educating youth about the warning signs of suicide and about suicide prevention services and training those who work with youth to identify high-risk youth and refer them to prevention services (e.g., crisis centers, hotlines, and other crisis services). These strategies have not been widely implemented, however, and little is known about their relative effectiveness. Evaluation research is needed to help identify the most effective means for preventing attempted and completed suicide among youth.

References

  1. CDC. Youth suicide in the United States, 1970-1980. Atlanta: US Department of Health and Human Services, Public Health Service, 1986.

  2. NCHS. Vital statistics mortality data, multiple cause-of-death detail (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1988.

  3. Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretary's Task Force on Youth Suicide. Washington, DC: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (ADM)89-1621-4.

  4. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-7.

  5. Harkavy Friedman JM, Asnis GM, Boeck M, DiFiore J. Prevalence of specific suicidal behaviors in a high school sample. Am J Psychiatry 1987;144:1203-6.

  6. Smith K, Crawford C. Suicidal behavior among ``normal'' high school students. Suicide Life Threat Behav 1986;16:313-25.

  7. American School Health Association/Association for the Advancement of Health Education/Society for Public Health Education, Inc. The National Adolescent School Health Survey: a report on the health of America's youth. Oakland, California: Third Party Publishing Co., 1989:31.

  8. Meehan PJ, Lamb JA, Saltzman LE, O'Carroll PW. Suicide attempts among young adults. Am J Psychiatry (in press).

  9. Bureau of the Census. School enrollment--social and economic characteristics of students: October 1988 and 1987. Washington, DC: US Department of Commerce, Bureau of the Census, 1990:443. (Current population reports; series P-20).

  10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.



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