New Research Efforts and Approaches Are Needed to Change the Current Youth Suicide Risk Trends Among Health Disparity Groups

In February 2023, the Centers for Disease Control and Prevention (CDC) released two reports on suicidal thoughts and behavior (STB) trends.^1,2 After a two-year decrease, overall suicide rates increased in 2021. Of particular concern are increasing racial and ethnic disparities in STBs, which have been exacerbated by COVID-19.

For example, among racial/ethnic groups, Black decedents 10 to 24 years of age had the largest rate increase (36.6%). Similarly, 10-year trends (2011–2021) among high school students in grades 9 through 12 from the Youth Risk Behavior Survey indicated high past-year rates of STBs and depressive symptoms among racial and ethnic minoritized youths and sexual minoritized youths. Students reporting multiple races had the highest rates (49%) of persistent feelings of sadness or hopelessness. Twenty-two percent of lesbian, gay, bisexual, questioning, or other nonheterosexual identity students (transgender youths were not categorized in the 2021 Youth Risk Behavior Survey) and 33% of students with same-sex partners reported at least one suicide attempt in the past year, as compared with 6% of youths with only opposite-sex partners. These federally fielded surveillance efforts are critical to understanding the growing unmet mental health needs of youths, many of whom have inequitable access to mental health care and face individual-, provider-, institutional-, and systemic-level barriers.³

Research that examines ways to optimize and implement effective interventions in settings that serve youths at risk for suicide is urgently needed. For the purposes of this commentary, “minoritized youths” refers to youths who experience mental health disparities and are at increased risk for suicide. We acknowledge that terms used here cover a vast range of diversity and may change with further research advances and social trends. The National Institute of Mental Health (NIMH) funds research on interventions to reduce STBs among Black youths, including scalable versions of evidence-based strategies in emergency departments, middle schools, and faith-based organizations (Box 1). Studies targeting systems-level suicide risk detection among youths experiencing disparate suicide-related outcomes are also of interest.⁴ (See Box 1 for a reissued funding announcement on this topic.)

BOX 1—

Examples of Current National Institute of Mental Health Initiatives Addressing Mental Health Disparities and Youth Suicide Risk and Protective Factors

Setting/Topic	Initiatives
Acute care (e.g., emergency department, psychiatric inpatient)	•Notice of Special Interest: Priority Research Opportunities in Crisis Response Servicesa
Ongoing treatment of psychiatric problems and suicide risk, attempts, and relapse	•Pilot Practice-Based Research for Primary Care Suicide Prevention (R34) •Systems-Level Risk Detection and Intervention to Reduce Suicide, Ideation, and Behaviors in Black Children and Adolescents (R34)a •Systems-Level Risk Detection and Interventions to Reduce Suicide, Ideation, and Behaviors in Black Children and Adolescents (R01)a •Systems-Level Risk Detection and Intervention to Reduce Suicide, Ideation, and Behaviors in Youth From Underserved Populations (R34)a •Systems-Level Risk Detection and Interventions to Reduce Suicide, Ideation, and Behaviors in Youth From Underserved Populations (R01)a
Universal intervention/environmental safety	•Addressing Mental Health Disparities Research Gaps: Aggregating and Mining Existing Data Sets for Secondary Analyses (R01) •Career Enhancement Award to Advance Research on Firearm Injury and Mortality Prevention (K18)a •Notice of Special Interest: Firearm Injury and Mortality Prevention Researcha •Using Secondary Data Analysis to Determine Whether Preventive Interventions Implemented Earlier in Life Reduce Suicide Risk (U01)
Risk and protective factors and trajectories	•Understanding Suicide Risk and Protective Factors among Black Youth (R01)a •Understanding Suicide Risk and Protective Factors among Black Youth (R21)a •Approaches to Identifying Preteen Suicide Risk and Protective Factors (R01) •Data Coordinating Center for Approaches to Identifying Preteen Suicide Risk and Protective Factors (U24)

Note. Except for preteen initiatives funded in fiscal year 2024, these initiatives are supporting active grants as of fiscal year 2023. Designations in parentheses are grant mechanisms.

^a Issued with additional institutes, centers, or National Institutes of Health offices.

To help youths earlier in the risk trajectory, more formative research is needed to understand current risk and protective factors among understudied minoritized youths who experience mental health disparities. In one study, NIMH-funded researchers used latent analyses in the CDC National Violent Death Reporting System (NVDRS) narratives to examine discrimination and harassment as precipitating factors among sexual and gender minority decedents 12 years or older.⁵ In addition, with NIMH support, Sheftall et al. analyzed NVDRS data and found differences in suicide methods among Black youth decedents⁶; youths 15 to 17 years old frequently used firearms as a suicide method, whereas hanging methods were more common among children 5 to 14 years old. Precipitating events also varied by age: romantic peer relationship problems and criminal or legal problems were more frequent among older youths, and family and school problems were more common in the younger age groups.

To further understand the neurobiological, behavioral, social, and structural or systemic mechanisms underlying risk and protective factors for STBs among Black youths, the NIMH has issued funding opportunities aiming to identify novel targets for future development of prevention and intervention efforts (Box 1).

To address long-standing high suicide rates among American Indian/Alaska Native youths,⁷ the NIMH has invested in research⁸ to expand the reach of and research base on effective culturally relevant preventive interventions aimed at increasing resilience and reducing STBs in rural and urban indigenous communities. As the field identifies effective programs, consideration of how successful programs for minoritized youths who experience mental health disparities can be adapted and sustained⁹ is an ongoing NIMH priority. Research on the effects of federal, state, and local policies can help define community social determinants of mental health and identify and address drivers of inequality regarding help seeking, availability and quality of mental health service delivery, and outcomes among youths. We next describe examples of resources for research on minoritized youths who experience mental health disparities and youth suicide risk and protective factors.

RESEARCH APPROACHES TO SUICIDE PREVENTION

NIMH research on suicide is guided by the NIMH Strategic Plan for Research¹⁰ and informed by the Prioritized Research Agenda for Suicide Prevention (2014),¹¹ which considers surveillance trends and suicide risk within social and service systems and includes preventive efforts at multiple levels of risk. Prevention approaches include identification and assessment of risk, intervention with those at acute risk, ongoing mental health management for those with identified psychiatric problems, and relapse prevention among youths who have attempted suicide. Because most suicide deaths occur upon a first attempt, universal approaches are also needed. These approaches include enhancing the safety of the environment to reduce lethality when attempts occur (e.g., reducing access to firearms and medications) and establishing early intervention programs aimed at building problem-solving and communication skills and supportive family and school environments to prevent STBs in the first place.

EFFORTS TO ADDRESS YOUTH SUICIDE TRENDS

Through collaborations between NIMH’s Suicide Research and Mental Health Disparities teams, NIMH supports a considerable portfolio of research on suicide among minoritized youths who experience mental health disparities. The NIMH continues to release new initiatives (Box 1) that align with the Strategic Framework for Addressing Youth Mental Health Disparities,¹² which outlines the institute’s commitment to reducing youth mental health disparities by 2031 not only by launching new research programs focused specifically on supporting minoritized youths experiencing disadvantage but also by supporting workforce development and community outreach and collaboration. Current funding opportunities are posted on the NIMH Suicide Research Team Web site, and the institute offers information on the grant writing process.

Although there are efforts to improve national surveillance suicide reports on youths who are multiracial, more work is needed to address the needs of youths who are defined by demographic characteristics (race, ethnicity, gender or sexual identity, poverty) and experience discrimination. Federal efforts to modernize standards for data collection on race and ethnicity are under way. The NIMH has funded work to better identify sexual and gender minority status among suicide decedents.¹³ Improving practices in child death investigations and death determinations for health disparity groups through youth suicide research also holds promise for more reliable outcomes and improved understanding of risk factors.

Addressing the ways in which social determinants of health increase the risk of poor mental health outcomes is critical. The National Institute on Minority Health and Health Disparities has developed a toolkit¹⁴ that offers standard data protocols researchers can use to help measure individual and structural factors that affect health outcomes; furthermore, standardized protocols may assist with comparing, sharing, and combining data from different studies. Consistent use of social determinants of health measures can lead to a greater understanding of social factors that affect mental health by informing research on youth risk trajectories as well as the design and evaluation of interventions.

Practice to science and science to practice are needed in suicide prevention. Agencies that provide surveillance information and support evidence-based services, such as the CDC, the Centers for Medicare & Medicaid Services, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and the Indian Health Service, will continue to be our partners in this effort. Suicide prevention requires multiple approaches and collaboration across government and private groups (e.g., the National Action Alliance for Suicide Prevention).¹¹ We are grateful for the opportunity to speak to the audience of this important special issue of AJPH on mental health. The NIMH is invested in reducing suicide risk and encourages new approaches to change the current troubling trends.