Groups with Increased Risk
Suicide is the second leading cause of death among the nation’s teenagers.1 In 2019, one out of every five youth reported seriously considering attempting suicide, and one out of every eleven actually made a suicide attempt. 2 For some groups of youth — including youth who are involved in the juvenile justice and child welfare systems; American Indian/Alaska Native (AI/AN); and military service members — the incidence of suicidal behavior is even higher.3 The harsh reality of suicidal ideation and behavior among the nation’s youth must be a call to action for high quality comprehensive support and suicide prevention services, particularly for the populations discussed in this section. High rates of suicidality among youth who belong to one or more of these categories are not fixed phenomena unresponsive to significant public health and policy changes. Rather, they demonstrate that there is much work still to be done to better support the countless youth struggling with suicidality across the U.S. More information regarding recommendations for suicide prevention services are discussed on this page.
Youth involved in the juvenile justice and child welfare systems have a high prevalence of many risk factors for mental, emotional, and behavioral disorders associated with suicide. Juveniles in confinement and foster care have life histories that put them at higher suicide risk.4 Suicide among youth in contact with the juvenile justice system occurs at a rate about four times greater than the rate among youth in the general population.5 In one study, children in foster care were almost four times more likely to have considered suicide and almost four times more likely to have attempted suicide than those who had never been in foster care.6
Because of the heightened vulnerability that youth in the foster care and juvenile justice systems have to engage in suicidal ideation or behavior, specific preventative measures are crucial and can save the lives of youth in need. Parents, caregivers, foster parents, and other trusted adults should remain informed about specific suicidal risk factors that may be present among child welfare and juvenile justice-involved youth and should continually advocate for and involve their youth in trauma-informed approaches to mental health services. While protective factors that stem from adults in youth’s lives cannot necessarily change existing risk factors, the following are protective factors that may minimize youth’s likelihood to engage in suicidal ideation or behavior:7
- Strong and open communication between youth and foster parents/trusted adult
- Safe school and school connectedness
- Frequent physical activity and participation in sports
- Reduced access to alcohol, firearms, medication
- Providing the youth with effective coping skills
- Academic achievement and consistent academic support
Suicide rates among American Indian/Alaska Native (AI/AN) individuals are the highest among any racial or ethnic group in the United States, thus suicide rates among AI/AN youth are significantly higher than that of youth overall. than among youth overall.8 Where the overall U.S. suicide rate in 2019 was 3.2 per every 100,000, the rate for AI/AN individuals was 22.2 per every 100,000. Following a similar trend to the adult population, 34 percent of AI/AN high school youth had seriously considered suicide within the past year compared to the overall U.S. population’s 18 percent, and the percentage of AI/AN youth who made a suicide plan was 9 percent higher than that of non-native U.S. youth.9 Suicide rates for this population peak in adolescence and young adulthood, particularly between the ages of 15-34.10 Although suicide rates vary widely among individual tribes, it is estimated that 14 to 27 percent of AI/AN adolescents have attempted suicide. 11
These statistics underscore how crucial it is that AI/AN youth receive increased access to high-quality, culturally responsive mental health services and suicide prevention interventions. Due to the rural residential settings of many AI/AN adolescents surveyed in current research, there is a strong need for increased implementation of suicide prevention strategies and interventions in rural areas.12 Increased access to mental health services and therapy must also occur in rural areas and those areas with high AI/AN populations in order to identify and diagnose youth struggling with mental disorders that put them at higher risk for suicide early on. Financial incentives such as loan forgiveness for mental health practitioners have been suggested by some as a possible avenue to address provider shortages in these rural areas.13
Between 2013 and 2018, the suicide rate for active Service members increased from 18.5 to 24.8 suicides per 100,000 members.14 In 2018, veterans ages 18 to 34 had the highest suicide rate of all age groups (46 per 100,000), representing a more than 76 percent increase from 2005 to 2018. Within this age group, men had a rate of 52 per 100,000 and women had a rate of 22 per 100,000.15 This steadily increasing rate demonstrates the continued need for outreach, support, and prevention efforts within each branch of the military. As of 2019, suicide rates among active military service members are highest among the youngest enlisted members, primarily those who are male and under the age of 30.16
Resources
988 Suicide & Crisis Lifeline
The 988 Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. When you call 988, you are connected to the nearest crisis center in a national network that provide crisis counseling and mental health referrals day and night. ¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español! Translators speaking approximately 150 languages are available. The network of crisis centers also offers services for people who are deaf and hard of hearing, including veterans.
2012 National Strategy for Suicide Prevention: Goals and Objectives for Action (PDF, 184 pages)
This resource is a call to action to guide suicide prevention in the United States. The National Strategy includes 13 goals and 60 objectives that reflect advances in suicide prevention knowledge, research, and practice, as well as broader changes in society and health care delivery. It also includes an appendix with information on groups with increased risk.
Juvenile Suicide in Confinement: A National Survey (PDF, 68 pages)
This report presents findings from the first national survey of juvenile suicides in confinement and offers recommendations for preventing suicide in juvenile facilities.
Foster Care Providers: Helping Youth at Risk for Suicide (PDF, 7 pages)
This information sheet addresses suicide prevention among youth in foster care. It is written for professionals and volunteers who interact with foster children or work with their caregivers.
Indian Health Service American Indian/Alaska Native Suicide Prevention Website
This website provides AI/AN communities with culturally appropriate information about best and promising practices, training opportunities, tools for adapting mainstream programs to tribal needs, ongoing activities, potential partnerships, and other information on suicide prevention and intervention.
American Indian/Alaska Native National Suicide Prevention Strategic Plan (2011–2015) (PDF, 18 pages)
This strategic plan provides a comprehensive and integrated approach to reducing the loss and suffering that result from suicidal behaviors among the AI/AN population.
Adolescent Suicide Prevention Program Manual: A Public Health Model for Native American Communities (PDF, 57 pages)
This manual outlines methods for community involvement, culturally framed public health approaches, outreach efforts, behavioral health programs, program evaluation, and sustainability.
To Live To See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults (PDF, 184 pages)
This guide supports AI/AN communities in developing effective, culturally appropriate, and comprehensive suicide prevention planning and postvention responses for youth and young adults.
Suicide Prevention Website
This website provides information on recognizing symptoms of those at risk for suicide, links to suicide prevention in each branch of the military, and a list of organizations that can provide information and assistance.
Suicide Prevention
The official website of the Military Health System’s suicide prevention topic area offers access to current resources, articles, and initiatives across military services. Particularly relevant is the “Suicide Prevention Tools for Warriors Fact Sheet.”
Family Guide: Supporting Military Families in Crisis (PDF, 30 Pages)
This guide for military service members and their loved ones provides thorough descriptions of the causes and warning signs of suicide, advice, and explanations about what to do if you suspect yourself or your loved one may be at risk for suicidal behavior, and it offers tools and resources for developing effective coping skills and maintaining mental health support long-term.
Veterans Crisis Line
This website describes the services of the Veterans Crisis Line, a toll-free, confidential resource that connects Veterans and their families and friends with specially trained responders. It also includes information on warning signs and awareness and campaign materials.
Interagency Task Force On Military And Veterans Mental Health 2013 Interim Report (PDF, 74 pages)
In 2012, the President signed an Executive Order directing the U.S. Departments of Veterans Affairs, Defense, and Health and Human Services—in coordination with other federal agencies—to take steps to ensure that Veterans, Service Members, and their families receive the mental health services and supports they need. This report summarizes action steps undertaken, including suicide prevention.
References
1 CDC, 2020
2 CDC, 2020
3 HHS, 2012
4 HHS, 2012
5 HHS, 2012
6 Pilowsky & Wu, 2006
7 National Center for the Prevention of Youth Suicide, 2016
8 Leavitt et al., 2018
9 SPRC, 2019
10 SPRC, 2019
11 HHS, 2012
12 Leavitt et al., 2018
13 Leavitt et al., 2018
14 DOD, 2018
15 DOD, 2011
16 DOD, 2018