Suicidal Thoughts and Behaviors Among U.S. High School Students, 2019–2021

Suicide is the third leading cause of death among U.S. high school-age youths aged 14–18. In 2021, 1,952 young people in that age group died by suicide — a rate of 9.0 per 100,000, and about one-fifth (18.6%) of all their deaths. Deaths are only part of the picture: suicidal thoughts and attempts are far more common, and in 2020 about 105,000 youths aged 14–18 visited emergency departments for self-harm injuries. Among people of all ages, 48,183 died by suicide in 2021.

A CDC report in the MMWR compared answers to four suicide-related questions on the national Youth Risk Behavior Survey (YRBS) — given to 13,677 students in grades 9–12 in 2019 and 17,232 in 2021 — covering the past 12 months: whether students had seriously considered suicide, made a plan, attempted suicide, or made an attempt that needed treatment by a doctor or nurse.

Female students: sharp increases

Among female students, the first three measures rose significantly; among male students overall, all four stayed stable. By 2021, roughly one in three female students had seriously considered suicide, one in four had made a plan, and 13.3% had attempted it.

Who was most affected

Race and ethnicity.

• Seriously considering suicide rose among Black, Hispanic and White female students.
• In 2021, Black female students were more likely than White female students to have attempted suicide, and Hispanic female students more likely to have made an attempt needing medical care. Asian female students were less likely than White female students to have seriously considered suicide.
• Among male students, American Indian or Alaska Native and Black students were more likely than White students to report an attempt; Black and Hispanic male students were more likely to report an attempt needing medical care. Native Hawaiian or other Pacific Islander male students were more likely to have made a plan.

Grade. Female students in 9th and 10th grade were more likely than 12th graders to have seriously considered suicide, made a plan or attempted it, and 9th-grade girls were more likely to have made an attempt needing medical care. Among boys, by contrast, 9th and 10th graders were less likely than 12th graders to have seriously considered suicide.

Sexual identity. Students who identified as lesbian, gay, bisexual, questioning or another non-heterosexual identity (LGBQ+) were much more likely than heterosexual students to report suicidal thoughts and behaviors. Among male students, LGBQ+ students were more likely on all four measures; among female students, on the first three. Students who had had sexual contact — especially with same-sex partners — were also more likely than those with no sexual contact to report every outcome.

What might explain it

The rise among girls continues a trend that began before the pandemic. The authors suggest that COVID-19 mitigation measures may have increased social isolation and anxiety, triggering or worsening mental health problems. Another study found that in February and March 2021, emergency department visits for suspected suicide attempts rose 50.6% among girls aged 12–17, compared with 3.7% among boys. Many students — especially racial and ethnic minority youths from under-resourced families — rely on mental health care at school, which school closures may have cut off. Substance misuse, family and relationship problems, community violence and discrimination may also play a part.

What can help

The authors call for a comprehensive approach to suicide prevention with a focus on health equity: preventing risk, supporting those at higher risk, preventing repeat attempts and supporting people who have lost someone to suicide. Schools and communities can:

• create safe, supportive environments and promote connectedness to school;
• teach coping and problem-solving skills;
• train gatekeepers to recognize and help students at risk;
• provide mental health services and programs in schools;
• support LGBQ+ students with measures such as gay–straight alliances, teacher training on inclusivity and inclusive curricula, which have been linked to lower odds of suicidal thoughts and behaviors;
• reach younger students early, given the higher risk among 9th and 10th graders.

The authors also call for more research on how gender, race and ethnicity and sexual orientation together shape risk, and for more culturally and linguistically relevant mental health services.

A note on the data: the 2021 survey expanded its sexual identity answer choices, so those results can't be compared with earlier years.

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

• Gaylor EM, Krause KH, Welder LE, et al. "Suicidal Thoughts and Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2021," MMWR Supplements Vol. 72, No. 1, CDC; a work of the United States government in the public domain.