'Unprecedented' Rise in Suicide Rates Among Young Girls

George W. Citroner

May 17, 2019

Suicide rates have increased among all youth, but there has been a particularly sharp rise among young females, new research shows.

A new study conducted by the Centers for Disease Control and Prevention reveals that the suicide rate among girls aged 10 to 14 years tripled from 1999 through 2014. Although males traditionally take their own lives at much higher rates, researchers at Nationwide Children's Hospital, Columbus, Ohio, found that this gender gap is narrowing.

"Based on recent mortality data showing an increase in female youth suicide rates, we investigated trends among US youth aged between 10 and 19 to better understand if the traditional gap between male and female youth suicide rates is decreasing," lead study author Donna Ruch, PhD, postdoctoral scientist at the Center for Suicide Prevention and Research, the Research Institute at Nationwide Children's Hospital, told Medscape Medical News.

The study was published online May 17 JAMA Network Open.

Gender Gap Narrowing

Finding a considerable rise in suicide among females aged 10 to 19 years, Ruch and team explored whether this also indicates a narrowing of the typically wide gap in rates between male and female youth.

"Consistent with earlier studies, our findings provide evidence of racial/ethnic disparities in youth suicide rates among males and females. The ratio of male-to-female suicide rates decreased for all racial and ethnic categories since 2007, with a significant declining trend across the study period in younger non-Hispanic white youth and older non-Hispanic youth of other races," said Ruch.

"These results expand upon previous reports of a disproportionate increase in the suicide rate among female relative to male youth and highlight a significant reduction in the historically large gap in suicide rates between sexes," she added.

The cross-sectional study employed period trend analysis of US suicide decedents aged 10 to 19 years from 1975 to 2016.

In the study, 85,051 US youth suicide deaths were identified, including deaths of 68,085 males and 16,966 females, from 1975 through 2016. The male-to-female incidence rate ratio (IRR) was 3.82 (95% confidence interval [CI], 3.35 – 4.35).

Deidentified data were obtained from the publicly available Wide-ranging Online Data for Epidemiologic Research (WONDER) records in which suicide was the cause of death in this age group.

WONDER population estimates were used to calculate crude suicide rates per 100,000. Joinpoint regression software was used to assess these trends by sex and age.

Negative binomial regression was employed to estimate IRRs; corresponding 95% CIs were used to compare suicide rates within select periods for males and females.

Stata/IC software and a 2-tailed significance level of P < .05 were utilized to conduct the statistical analysis. A chi-squared test was performed to compare male-to-female IRR for each period and to identify statistically significant trends within demographic subgroups.

More Lethal Means

The findings show that hanging or suffocation had significantly increased as cause of death among young women.

"A particularly important finding relates to changes in method of suicide, with hanging and suffocation showing a greater increase as the cause of death among females relative to males," said Ruch.

"Consistent with previous reports of increasing rates of suicide by hanging or suffocation in female youth, the ratio of male-to-female suicide rates by hanging or suffocation declined significantly for both age groups," she continued.

"It’s troubling that a growing proportion of females are choosing this more violent and lethal method, since it's well documented that females have higher rates of attempted suicide," said Ruch.

Suicide among female youth showed the greatest percentage increase following a downward trend through 2007 compared with males, with 12.7% vs 7.1% for individuals aged 10 to 14 years and 7.9% vs 3.5% for those aged 15 to 19 years.

The sex gap significantly decreased in male-to-female IRR for children aged 10 to 14 years (IRR, 3.14; [95% CI, 2.74 – 3.61] to IRR, 1.80 [95% CI, 1.53 – 2.12]) and for those aged 15 to 19 years (IRR, 4.15 [95% CI, 3.79 – 4.54] to IRR, 3.31 [95% CI, 2.96 – 3.69]).

By race, significant declining trends were also found in the male-to-female IRR in non-Hispanic white youth aged 10 to 14 years (IRR, 3.27 [95% CI, 2.68 – 4.00] to IRR, 2.04 [95% CI, 1.45 – 2.89]) and non-Hispanic youth of other races aged 15 to 19 years (IRR, 4.02 [95% CI, 3.29 – 4.92] to IRR, 2.35 [95% CI, 2.00 – 2.76]).

Ruch believes this significant reduction in the traditionally wide difference between male and female suicide rates highlights a need for more targeted interventions in which suicide risk by sex is considered.

"The narrowing gap in suicide rates between male and female youth underscores the urgency to identify suicide prevention strategies that address the unique developmental needs of female youth. Future research examining sex-specific risk and protective factors associated with youth suicide and how these determinants can inform interventions is warranted," she said.

Social Media a Factor?

In an accompanying commentary, Joan Luby, MD, and Sarah Kertz, PhD, note that the study shows "an unprecedented escalation" in suicide rates in young girls.

They add that although the study does not shed any light on the reason for the leveling of suicide rates between boys and girls, social media is a "key target of interest.

"While this is an area in need of further well-controlled investigation, a marked increase in the use of social media for peer interaction, with more than 95% of youth now connected to the internet, represents a clear and powerful social change occurring over the same period," they write.

Luby and Kertz also note that "social media use is more strongly associated with depression in girls compared with boys and cyberbullying is more closely associated with emotional problems in girls compared with boys."

Commenting on the findings for Medscape Medical News, Mary T. Rourke, PhD, director of school psychology concentration at Widener University, Chester, Pennsylvania, and co-director of the Widener Child Therapy Clinic, who was not involved in the study, noted that girls attempt suicide by less lethal means compared to boys.

This, she said, "may color the way we respond to suicidal statements in girls. I think we're going to have to think about that a lot differently in light of these findings, especially regarding our younger girls."

As for the potential influence of social media on the increasing rates of suicide in girls, Rourke said she believes the "jury is out."

"Certainly social media is important, but it's only one aspect of a culture that can be overwhelming. In fact, social media can even be helpful when dealing with a suicide crisis. Clinically, I've had a number of clients who have expressed something on social media and a friend has seen it and shown an adult or a parent has reviewed the child's messages.

"However, younger kids are impulsive, less likely to talk, less likely to show depression and anxiety in a way adults can understand. This may be a way social media plays a role. Because of social media, the means and models of suicide are much more accessible to younger kids. Pair that with higher levels of impulsivity and difficulty communicating their feelings and it may explain the increasing risk at younger ages. Maybe the sex differences which we've seen in prior generations aren't as relevant considering these newer factors," she added.

Coauthor Jeffrey A. Bridge, PhD, was supported a grant from the National Institute of Mental Health, National Institutes of Health, and is an unpaid member of the scientific advisory board of Clarigent Health. Rourke has disclosed no relevant financial relationships.

JAMA Netw Open. Published online May 17, 2019. Full text, Commentary

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