Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016

IMPORTANCE Suicide is a leading cause of death among youth aged 10 to 19 years in the United States, with rates traditionally higher in male than in female youth. Recent national mortality data suggest this gap may be narrowing, which warrants investigation. OBJECTIVE To investigate trends in suicide rates among US youth aged 10 to 19 years by age group, sex, race/ethnicity, and method of suicide. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using period trend analysis of US suicide decedents aged 10 to 19 years from January 1, 1975, to December 31, 2016. Data were analyzed for periods defined by statistically significant changes in suicide rate trends. Suicide rates were calculated using population estimates. MAIN OUTCOMES AND MEASURES Period trends in suicide rates by sex and age group were assessed using joinpoint regression. Incidence rate ratios (IRRs) were estimated using negative binomial regression comparing male and female suicide rates within periods. RESULTS From 1975 to 2016, we identified 85 051 youth suicide deaths in the United States (68 085 male [80.1%] and 16 966 female [19.9%]) with a male to female IRR of 3.82 (95% CI, 3.35-4.35). Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years; 7.9% vs 3.5% for individuals aged 15-19 years). The male to female IRR decreased significantly across the study period for youth aged 10 to 14 years (3.14 [95% CI, 2.74-3.61] to 1.80 [95% CI, 1.53-2.12]) and 15 to 19 years (4.15 [95% CI, 3.79-4.54] to 3.31 [95% CI, 2.96-3.69]). Significant declining trends in the male to female IRR were found in non-Hispanic white youth aged 10 to 14 years (3.27 [95% CI, 2.68- 4.00] to 2.04 [95% CI, 1.45-2.89]) and non-Hispanic youth of other races aged 15 to 19 years (4.02 [95% CI, 3.29-4.92] to 2.35 [95% CI, 2.00-2.76]). The male to female IRR for firearms increased significantly for youth aged 15 to 19 years (χ2 = 7.74; P = .02 for sex × period interaction). The male to female IRR of suicide by hanging or suffocation decreased significantly for both age groups (10-14 years: χ2 = 88.83; P \u3c .001 for sex × period interaction and 15-19 years: χ2 = 82.15; P \u3c .001 for sex × period interaction). No significant change was found in the male to female IRR of suicide by poisoning across the study period. CONCLUSIONS AND RELEVANCE A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted

‘Kamikaze’ heritage tourism in Japan: A pathway to peace and understanding?

Reflecting the wider belief that international tourism offers the opportunity to encourage peace and understanding amongst peoples and nations, one objective of Japan’s recent tourism development policy is the enhancement of mutual understanding and the promotion of international peace. The purpose of this paper is to consider the extent to which this objective is achievable, particularly in the context of continuing controversy surrounding the country’s confrontation of its twentieth century military heritage in general and its role in the Pacific War in particular. Based on research at two ‘difficult’ heritage sites, Chiran Peace Museum in Kagoshima Prefecture and Yūshūkan War Museum in Tokyo, it explores specifically how the kamikaze phenomenon is commemorated and interpreted for international visitors, in so doing revealing a significant degree of dissonance at both sites. Not only is a selective narrative of heroic sacrifice presented within a wider revisionist history of the Pacific War but also no attempt is made to acknowledge the prevailing cultural context that might underpin a more nuanced understanding of the kamikaze. Hence, the paper concludes that a meaningful opportunity to enhance international understanding has been missed

Introduction: Toward an Engaged Feminist Heritage Praxis

We advocate a feminist approach to archaeological heritage work in order to transform heritage practice and the production of archaeological knowledge. We use an engaged feminist standpoint and situate intersubjectivity and intersectionality as critical components of this practice. An engaged feminist approach to heritage work allows the discipline to consider women’s, men’s, and gender non-conforming persons’ positions in the field, to reveal their contributions, to develop critical pedagogical approaches, and to rethink forms of representation. Throughout, we emphasize the intellectual labor of women of color, queer and gender non-conforming persons, and early white feminists in archaeology

Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017

OBJECTIVES: To determine if racial and ethnic subgroups of adolescents are at high risk for engagement in suicidal behaviors. METHODS: Using the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, we conducted logistic regression analyses to examine trends by different racial and ethnic groups, with each suicide indicator serving as a dichotomous outcome. Participants included 198 540 high school students. RESULTS: Across all sex and race and ethnic groups, there were significant linear decreases in self-reported suicidal ideation and suicide plans from 1991 to 2017. Female adolescents (odds ratio [OR], 0.98; P &amp;lt; .001) had significant decreases in attempts over time. Black adolescents had positive linear trends for suicide attempts among both boys (OR, 1.04; P &amp;lt; .001) and girls (OR, 1.02; P = .003). Black adolescent boys (OR, 1.04; P = .048) had a significant linear increase in injury by attempt. CONCLUSIONS: The results suggest that, over time, black youth have experienced an increase in suicide attempts, which is troubling because attempts are the most prominent risk factor associated with suicide death. For black boys, a significant increase in injury by attempt occurred, which suggests that black boys may be engaging in increasingly lethal means when attempting suicide. Examining trends of suicidal thoughts and behaviors over time by sex and race and ethnicity allow us to determine where to focus prevention and intervention efforts. Future research should examine the underlying reasons for these changes observed in US high school students. </jats:sec

Insecure Attachment and Suicidal Behavior in Adolescents

Background: Suicide among adolescents is an important public health problem. One risk factor for youth suicidal behavior that has been underexplored is insecure attachment. Aims: To investigate the association between attachment avoidance/anxiety and suicidal behavior in an adolescent sample. Method: This study examined attachment insecurity in 40 adolescents who had attempted suicide and 40 never-suicidal demographically matched youths. Adolescents completed self-report measures of attachment style, family alliance, and depressive symptoms. Results: Suicide attempters reported significantly higher attachment avoidance and anxiety. Attachment avoidance, but not anxiety, predicted suicide attempt status in a conditional logistic regression analysis that controlled for depressive symptoms and family alliance. Conclusion: Future research should determine the relative utility of attachment insecurity in prospectively predicting suicide attempts and investigate potential mediators and moderators of this association. Implications for clinicians working with suicidal youth with insecure attachment styles are discussed. </jats:p

Depressed Mood Prior to Death

Abstract. Background: Suicide is a leading cause of death among youth in the United States. Multiple factors have been shown to increase risk for suicidal behavior, including depressed mood. Aims: The purpose of this study was to examine individual characteristics and precipitating circumstances of suicide in youth decedents with and without depressed mood at the time of death. Method: Data from the National Violent Death Reporting System (NVDRS) were analyzed for 17 US states from 2003 to 2012. Participants included suicide decedents aged 10–19 years ( N = 4,053). Analyses compared youth suicide decedents with depressed mood at time of death with those without depressed mood using logistic regression. Sex-specific differences in youth with depressed mood were also explored. Results: Youth suicide decedents with depressed mood were more likely than those without depressed mood to exhibit clinical characteristics and precipitating circumstances associated with suicide. Comparison of males and females with depressed mood found unique sex-specific differences. Limitations: Data were limited to 17 states, analyses did not include a control group, and data were collected through postmortem reporting. Conclusion: Findings support a significant association between depressed mood and factors associated with suicidal behavior in youth and offer potential areas to focus prevention strategies. </jats:p

The Importance of Screening Preteens for Suicide Risk in the Emergency Department

OBJECTIVES: To describe the prevalence of screening positive for suicide risk in a sample of 10- to 12-year-olds presenting to the emergency department (ED). METHODS: Patients presenting to the ED were administered a battery of measures, including the Ask Suicide-Screening Questions and the criterion-standard Suicidal Ideation Questionnaire. Answering affirmatively to any of the 4 Ask Suicide-Screening Questions and/or scoring above the Suicidal Ideation Questionnaire cutoff score was considered a positive screen result for suicide risk. RESULTS: The sample included 79 preteen patients. The overall positive screen result rate was 29.1% (23 of 79). More than half (54.1%) of patients presenting with psychiatric chief complaints screened positive for suicide risk, and 7.1% of preteens presenting with chief medical complaints screened positive. Of preteens, 17.7% (14 of 79) reported previous suicidal behavior. CONCLUSIONS: Preteens think about suicide and engage in suicidal behavior at rates that warrant further study. Notably, 7% of preteens presenting with chief medical complaints screened positive, highlighting the importance of screening all preteen patients as young as 10 years old for suicide risk in the ED. </jats:sec