Long-Term Trends, Disparities, and Changes in Suicide Mortality During the COVID-19 Pandemic Among US Adolescents: A Population-Based Study.

Abstract

Purpose: Suicide is a leading cause of adolescent death in the United States, yet its mortality trends and disparities remain incompletely characterized, particularly during the COVID-19 pandemic.

Methods: This study analyzed mortality data from 1999 to 2023 among individuals aged 10-19 years from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Population characteristics of decedents and trends in crude suicide mortality rates per 100,000 (CSMRs) were examined. Mortality changes were compared across the prepandemic (2018-2019), early pandemic (2020-2021), and later pandemic (2022-2023) periods.

Results: From 1999-2019, 44,426 adolescents died by suicide, mostly among males (77.6%), older adolescents (84.5%), and White adolescents (82.5%). After an initial decline from 1999-2007, overall CSMRs increased markedly from 2007-2019. CSMRs were highest among males, older adolescents, and White adolescents, whereas the fastest increases occurred among females, younger adolescents, and non-Black/non-White adolescents. Regionally, Midwestern and rural areas showed the highest CSMRs and rates of increase. During the early pandemic period, overall mortality declined slightly (-1.23%) but increased among females (+4.22%), younger adolescents (+2.88%), Black adolescents (+21.88%), the South (+4.58%), noncore rural counties (+1.08%), and large central metropolitan counties (+4.81%). The later pandemic period was marked by an overall decline in CSMRs (-8.53%), with decreases across most subgroups, although rates did not decline among Black adolescents (+0.85%).

Discussion: Adolescent suicide is an escalating public health crisis with disparities that require equity-focused strategies to reverse trends and reduce gaps.