Undetected Mental Health Diagnoses in US Youth Suicides: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On August 1, 2024, we reported on findings from a study published in JAMA Network Open that examined the association of documented mental health (MH) diagnosis with sociodemographic characteristics, suicide mechanism, clinical characteristics, and precipitating circumstances among youth suicide decedents.

The study

Using data from the CDC National Violent Death Reporting System (NVDRS) collected between 2010 and 2021, investigators identified 40 618 youth suicide decedents to include in the analysis. Most participants (58.1%) were aged between 20 and 24 years, male (79.2%), and non-Hispanic White (76.1%). Also, 13.2% of the cohort was Hispanic, 12.7% was Black, 4.2% Asian, Native Hawaiian, or other Pacific Islander, and 2.9% AI/AN.

The findings

Overall, 40.4% of the cohort had a documented MH diagnosis and 46.8% died by firearms. Across individual groups, researchers observed that White youths had the highest rate of MH diagnosis (42.8%) and AI/AN youths had the lowest rate (28.0%); slightly more than half of girls (52.4%) had an MH diagnosis compared to 37.3% of boys.

Racial and ethnic disparities. Compared with White youths, the adjusted odds of having a MH diagnosis were lower among AI/AN (aOR 0.45, 95% CI 0.39-0.51); Asian, Native Hawaiian, or other Pacific Islander (aOR 0.58, 95% CI 0.52-0.64); and Black (aOR 0.62, 95% CI 0.58-0.66) youths. Adjusted odds were also lower among Hispanic youths (aOR 0.76, 95% CI 0.72-0.82) compared with non-Hispanic youths.

Age and sex disparities. The adjusted odds of having a MH diagnosis were lower among youths aged 10 to 14 years (aOR 0.70, 95% CI 0.65-0.76) compared with those aged 20 to 24 years. The odds were higher among young women (aOR 1.64, 95% CI 1.56-1.73) compared with young men.

Suicide mechanism. An MH diagnosis was documented for 33.2% of youths who died by firearms, 61.6% of those who died by poisonings, 44.2% of those who died by hanging, strangulation, or suffocation, and 44.8% of those who died by other mechanisms.

Authors' comment

"Given the low rates of MH diagnoses among youth suicide decedents, prevention efforts must also address family and life stressors in tandem with MH risk factors. Both increased identification of unmet MH needs and universal, community-based approaches are needed to prevent youth suicide."

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