PC3027: Adolescent Suicide - Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene and Prevent a Leading Cause of Death

Background: Suicide is the second leading cause of death for adolescents between the ages 10-19 in the U.S., accounting for 2,744 deaths in 2019. The incidence has been steadily rising in the U.S., and 5.1% of male and 9.3% of female high school students in the U.S. report a suicide attempt in the past year. Suicide attempts represent less than 5% of injuries treated at trauma centers in part because of the high lethality of self-inflicted firearm injuries and asphyxiation – the two leading mechanisms of suicide death in this age group, as many die prior to receiving medical care.

Methods: Mortality data were derived from Centers for Disease Control and Prevention, National Center for Health Statistics’ Web-based Injury Statistics Query and Reporting System (WISQARS). Mortality data available through WISQARS are based on death certificates from the National Vital Statistics System (NVSS) operated by CDC’s National Center for Health Statistics. WISQARS provides death counts and death rates for the United States by age, race, Hispanic ethnicity, cause of death, injury intent, and injury mechanism. For the purposes of this study, all youth identified as Hispanic ethnicity were combined into one race/ethnicity category of Hispanic.

Results: The incidence of adolescent suicide has increased from 4.57 per 100,000 in 2001 to 6.5 per 100,000 in 2019, with notable differences and trends among age, race, sex and region. Older adolescents are more likely to die by suicide, as the incidence is 4 times higher among the ages of 15-19 compared to 10-14. Over the past 20 years, the incidence of suicide has increased for all races, with the most drastic increases in American Indian youth. American Indians have the highest incidence followed by non-Hispanic whites, reaching as high as 24 per 100,000 youths. When analyzing rates between sexes, female suicide rates have doubled since 2001, from 1.64 per 100,000 in 2001 to 3.48 per 100,000 in 2019. The leading mechanisms of suicide are suffocation (43%) and firearm injury (43%). Less than 50% of all patients are screened for suicidality, 25% for depression and 7% for PTSD symptoms at level I and II trauma centers across the U.S.

Conclusion: Suicide is the second leading cause of death in U.S. adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. This suggests that trauma providers should not only recognize the risks and signs of suicidality, but should strongly consider using validated instruments to universally screen for depression and suicide, and have plans for referral and treatment in conjunction with mental health partners. Future research efforts should focus on evaluating the outcomes of universal screening among the adolescent trauma population, including the prevalence of suicidality, services referred to and received, and long-term outcomes.