Suicidal thoughts and behaviors among youths are important public health concerns in Utah, where the suicide rate among youths consistently exceeds the national rate and has been increasing for nearly a decade (1). In March 2017, CDC was invited to assist the Utah Department of Health (UDOH) with an investigation to characterize the epidemiology of fatal and nonfatal suicidal behaviors and identify risk and protective factors associated with these behaviors, among youths aged 10–17 years. This report presents findings related to nonfatal suicidal behaviors among Utah youths. To examine the prevalence of suicidal ideation and attempts among Utah youths and evaluate risk and protective factors, data from the 2015 Utah Prevention Needs Assessment survey were analyzed. Among 27,329 respondents in grades 8, 10, and 12, 19.6% reported suicidal ideation and 8.2% reported suicide attempts in the preceding 12 months. Significant risk factors for suicidal ideation and attempts included being bullied, illegal substance or tobacco use in the previous month, and psychological distress. A significant protective factor for suicidal ideation and attempts was a supportive family environment. UDOH, local health departments, and other stakeholders are using these findings to develop tailored suicide prevention strategies that address multiple risk and protective factors for suicidal ideation and attempts. Resources such as CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices (2) can help states and communities identify strategies and approaches using the best available evidence to prevent suicide, which include tailored strategies for youths.

The Utah Prevention Needs Assessment is a cross-sectional, school-based health and risk behavior survey conducted biennially in randomly selected public and charter schools in Utah among a representative sample of students in grades 6, 8, 10, and 12 (3). The survey is anonymous, and students are required to have parental consent to participate. The school sample is stratified by district; data were weighted to account for the probability of selection and the distribution of students by sex, grade, and race using iterative proportional fitting. Additional survey details are available elsewhere (3). Among 75,652 youths sampled for the 2015 Utah Prevention Needs Assessment survey, 48,975 (64.7%) participated. For this analysis, 29,089 students aged <18 years in grades 8, 10, and 12 were considered eligible. Approximately 6% of eligible participants were excluded because of missing outcome data, yielding a final analytic sample of 27,329.

Suicidal ideation was defined as an affirmative response to either of the following questions: “During the past 12 months, did you ever seriously consider attempting suicide?” (Yes or No) or “During the past 12 months, did you make a plan about how you would attempt suicide?” (Yes or No). Suicidal attempt was assessed by the response to the question “During the past 12 months, how many times did you actually attempt suicide?” Response options were 0, 1, 2–3, 4–5, or ≥6 times. Because of a skewed distribution, where a small percentage of youths reported multiple suicide attempts (4.2% reported 1; 2.6% reported 2–3; 0.7% reported 4–5; and 0.7% reported ≥6), responses were dichotomized to none (zero times) and ≥1 (≥1 time). Data from additional questions were used to measure risk factors, including bullying on school property in the previous year, electronic bullying in the previous year, any illicit substance use in the previous month, any tobacco use in the previous month, and psychological distress. Protective factors assessed were perceptions of prosocial behaviors and separate measures for a supportive community, school, peer, and family environment (4). Data were analyzed by selected demographic characteristics and weighted to provide estimates of suicidal ideation and attempts with accompanying 95% confidence intervals (CIs). Multivariate logistic regression analyses were conducted to examine risk and protective factors associated with suicidal ideation and attempts in the previous 12 months controlling for all other factors and demographic characteristics informed by prior research (5–10): sex, age, race, religious preference, and highest level of education in the household. Adjusted odds ratios (AORs) and 95% CIs were calculated, with p<0.05 considered statistically significant. Variables in the final models were screened for multicollinearity. Statistical software was used to account for the complex survey design.

In 2015, almost 20% of students in grades 8, 10, and 12 who participated in the Utah Prevention Needs Assessment survey reported suicidal ideation and 8.2% reported having attempted suicide during the past 12 months (Table 1). Prevalence of suicidal ideation and attempts were highest among students who were female, aged 15–17 years, in grade 10, nonwhite, less religious, nonmembers of the Church of Latter Day Saints, and had a household education attainment level of less than high school. After adjusting for the other factors and for demographic characteristics, odds of suicidal ideation were higher among students who were bullied on school property (AOR = 1.95; 95% CI = 1.54–2.48) or electronically (1.82; 1.46–2.26) in the previous year, who reported illicit substance use (1.93; 1.42–2.62) or tobacco use (1.54; 1.14–2.09) in the previous month, and who reported moderate psychological distress (5.67; 4.42–7.28) or serious psychological distress (16.37; 12.12–22.10) (Table 2). Risk for suicide attempt was higher among students who were bullied on school property (2.17; 1.59–2.96), electronically bullied (1.71; 1.19–2.45), used an illicit substance in the previous month (1.90; 1.32–2.74), used tobacco in the previous month (1.70; 1.10–2.63), and reported moderate (3.80; 2.40–6.01) or serious (8.91; 5.75–13.80) psychological distress. A supportive family environment was protective against suicidal ideation (0.86; 0.83–0.90) and suicide attempts (0.87; 0.83–0.93). Nonsignificant protective factors for both suicidal ideation and suicide attempts included prosocial behaviors, and supportive community, school, and peer environments.