Suicidal Thoughts and Behaviors Among U.S. High School Students, 2019

Suicide is the second leading cause of death among Americans aged 14 to 18, after unintentional injuries. In 2018, 2,039 young people in that age group died by suicide — about one in three injury deaths — and the suicide rate for this age group rose 61.7% from 2009 to 2018, from 6.0 to 9.7 per 100,000. Many more struggle with suicidal thoughts or survive attempts: about 95,000 youths aged 14–18 went to emergency departments for self-harm injuries in 2018.

A CDC team led by Asha Z. Ivey-Stephenson used the 2019 Youth Risk Behavior Survey, a nationally representative survey of students in grades 9–12, to show who is most affected, so that schools and youth programs can direct help where it is needed.

Image from CDC's MMWR report on suicidal ideation and behaviors among high school students.

What students reported, 2019

In the 12 months before the survey:

Differences between groups

Race and ethnicity. White students most often reported having seriously considered suicide (19.1%, against 16.9% of Black and 17.2% of Hispanic students), and Black male students the least. But Black students had the highest rate of attempts: 11.8%, against 7.9% of white and 8.9% of Hispanic students — and 15.2% among Black female students.

Grade. Attempts did not differ by grade, but among male students, making a plan rose with each grade, from 9.5% in 9th grade to 13.6% in 12th — a pattern that suggests tailoring school prevention by sex and grade.

Sexual identity — the largest gaps.

Students who had sexual contact with the same sex or both sexes had similarly high rates: 54.2% had seriously considered suicide and 30.3% had attempted it.

Adolescence is a time of rapid change and identity development, and developing a sexual identity can be complex and stressful. The gap between identity and behavior, and the social rejection sexual minority youth often face, may help explain their higher risk. Research is needed on reducing the stress of discrimination and victimization they experience.

Attempts are rising

Suicide attempts are the strongest predictor of death by suicide. Among all students, reported attempts rose from 6.3% in 2009 to 8.9% in 2019, with increases among female, white, Black and 12th-grade students. Emergency visits by children and adolescents for suicide attempts rose sharply over a similar period, from 540,000 in 2007 to 960,000 in 2015. Other research found attempts among Black students rising, accelerating among Black girls. American Indian and Alaska Native youth have also been reported to be at increased risk and need closer study.

What prevention looks like

A comprehensive approach, using the best available evidence and working at the individual, family, community and societal levels, can reduce suicidal thoughts and behaviors. CDC's Preventing Suicide technical package describes strategies that states, communities and schools can use:

• Prevent adverse childhood experiences, such as abuse, by fostering safe, stable, nurturing relationships and environments.
• Support families, strengthening economic supports and teaching coping and problem-solving skills to young people and parents.
• Build connectedness between young people and their schools, teachers, peers and families.
• Create protective environments at school and home, including limiting at-risk students' access to lethal means such as medications and firearms.
• Encourage seeking help and reduce stigma.
• Train teachers and other adults to recognize warning signs and refer young people to effective treatment, such as cognitive-behavioral therapy.
• Prevent reattempts, for example through emergency department follow-up, and support people grieving a friend or family member lost to suicide.
• Report responsibly. Schools and media should respond to suicides in supportive ways and avoid sensationalizing them, which can lead to further suicides.

Limitation

Analyses included all students, without separating those who had experienced suicidal thoughts from those who had not; patterns might differ between them.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Ivey-Stephenson AZ, Demissie Z, Crosby AE, et al., "Suicidal Ideation and Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019," MMWR Supplements, Centers for Disease Control and Prevention; a work of the United States government in the public domain.