Whether it’s due to social media, political turmoil, or lack of sleep, American teenagers are facing a mental health crisis. In August 2018, the CDC reported that suicidal ideation had risen among teens in the past decade, and a paper published Friday in JAMA Network Open shows that the rise in completed suicides have accelerated in one group in particular.

Beginning in 2007, the authors report, the rate of suicides among adolescent girls began to outpace the rate of suicides among boys. This finding contradicts the previous pattern in suicide behavior in young adults, sometimes called the “gender paradox.” Historically, boys have taken their own lives at far higher rates than girls have.

Between 1975 and 2016, there were 85,051 teen suicide deaths, and 80.1 percent of them were in teenage boys, according to the new analysis. But now, that the gap is closing, report postdoctoral researcher Donna Ruch, Ph.D., and epidemiologist Jeffrey Bridge, Ph.D., both at Nationwide Children’s Hospital.

If you or someone you know is in crisis, read the Warning Signs of Suicide and call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

A Worrying Trend Among Adolescent Girls

In 2007, female suicide rates in 15- to 19-year-olds started to climb by 7.9 percent per year. The male suicide rate for the same age group climbed just 3.5 percent over the same time period. Ruch called these increases “disproportionate.”

“Overall, we found a disproportionate increase in female youth suicide rates compared to males, resulting in a narrowing of the gap between male and female suicide rates,” she said.

Suicide rates in boys remain higher than those in girls, but the gap is closing as female suicide rates rise at a disproportionately fast rate. JAMA

The data show that the trends are as nuanced as they are tragic. While they didn’t narrow down the exact cause of the increase, they did note an important detail that could explain why the gap is closing.

The CDC’s Youth Risk Behavior Survey 2018 results showed that girls tend to have higher rates of suicidal thoughts than boys do. Between 2007 and 2017, the percentage of girls who seriously considered suicide rose from 18.7 percent to 22.1 percent. In boys, that rate rose from 10.3 percent to 11.9 percent over the same time period.

Boys, however, still have higher suicide completion rates — in part because of the lethality of the method they choose, says Bridge.

“One of the potential contributors to this gender paradox is that males tend to use more violent means,” he said.

The new paper shows that girls now are choosing more violent means of suicide than they did historically. If this trend toward “highly lethal methods” is sustained, the authors write, it “could have grave public health impacts and drive elevations in the rates of female suicide.”

Bridge and Ruch paint an increasingly sad picture about the nature of self-harm in teenagers. But with their data, they hope to to help stop suicidal ideation before it becomes actionable in the first place.

The Role of Social Media

In an accompanying commentary, Dr. Joan Luby at the University of Washington in St. Louis and Sarah Kertz, Ph.D., at Southern Illinois University, point an accusatory finger at social media, which they argue has a foundational role in driving suicides among teens.

Among girls, they write, social media has stronger associations with depression. Furthermore, girls are also more likely to experience cyberbullying and feel greater emotional impacts because of it (cyberbullying is also distressing for men too).

The notOK app alerts a trusted circle of individuals when the user is in need, and when the problem has been addressed. notOK App

“Increasing rates of suicidality may be the ‘canary in the coal mine’ signaling important health concerns arising from the increased and pervasive use of social media affecting child and adolescent development,” they write.

The hope is that scientists can illuminate this problem in such granular detail that we may one day be able to overcome it. Fortunately, increased awareness about mental health issues is creating new opportunities for teens to seek help, like the Not OK “panic button” app that helps them access help when they’re feeling vulnerable, to bills advocating for mental health first aid training in schools.

Importantly, the people in a teen’s life should remember that they can be critical lifelines. On a day to day basis, individuals can keep an eye out for the people in their lives who seem detached from friends or groups or seem “unhappy for an extended period,” and show support by reaching out — regardless of their gender.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741

Abstract:

Importance: Suicide is a leading cause of death among youth aged 10 to 19 years in the United States, with rates traditionally higher in male than in female youth. Recent national mortality data suggest this gap may be narrowing, which warrants investigation.

Objective: To investigate trends in suicide rates among US youth aged 10 to 19 years by age group, sex, race/ethnicity, and method of suicide.

Design, Setting, and Participants: Cross-sectional study using period trend analysis of US suicide decedents aged 10 to 19 years from January 1, 1975, to December 31, 2016. Data were analyzed for periods defined by statistically significant changes in suicide rate trends. Suicide rates were calculated using population estimates.

Main Outcomes and Measures: Period trends in suicide rates by sex and age group were assessed using joinpoint regression. Incidence rate ratios (IRRs) were estimated using negative binomial regression comparing male and female suicide rates within periods.

Results: From 1975 to 2016, we identified 85051 youth suicide deaths in the United States (68085 male [80.1%] and 16 966 female [19.9%]) with a male to female IRR of 3.82 (95% CI, 3.35-4.35). Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years; 7.9% vs 3.5% for individuals aged 15-19 years). The male to female IRR decreased significantly across the study period for youth aged 10 to 14 years (3.14 [95% CI, 2.74-3.61] to 1.80 [95% CI, 1.53-2.12]) and 15 to 19 years (4.15 [95% CI, 3.79-4.54] to 3.31 [95% CI, 2.96-3.69]). Significant declining trends in the male to female IRR were found in non-Hispanic white youth aged 10 to 14 years (3.27 [95% CI, 2.68- 4.00] to 2.04 [95% CI, 1.45-2.89]) and non-Hispanic youth of other races aged 15 to 19 years (4.02 [95% CI, 3.29-4.92] to 2.35 [95% CI, 2.00-2.76]). The male to female IRR for firearms increased significantly for youth aged 15 to 19 years (χ2 = 7.74; P = .02 for sex × period interaction). The male to female IRR of suicide by hanging or suffocation decreased significantly for both age groups (10-14 years: χ2 = 88.83; P < .001 for sex × period interaction and 15-19 years: χ2 = 82.15; P < .001 for sex × period interaction). No significant change was found in the male to female IRR of suicide by poisoning across the study period.

Conclusions and Relevance: A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.