Racial Disparities Seen for Black Children Age 5-12 in Youth Suicide

The second study in less than a week regarding youth and suicide was released Monday, with the latest one showing an age-related trend in racial disparities in suicide rates in elementary and middle school—aged children. The study, published in JAMA Pediatrics, showed that suicide rates for black children aged 5-12 were roughly 2 times higher than those of similarly-aged white children.¹

Researchers obtained data for cases in which suicide was listed as the underlying cause of death among persons aged 5-17 years from 2001 to 2015 from the CDC’s Injury Statistics Query and Reporting System.

Suicide rates in the United States have traditionally been higher among whites than blacks across all age groups. Suicide is the third leading cause of death among adolescents, after accidents and homicides, according to the CDC, and both studies were released as the second season of the Netflix show “13 Reasons Why,” a drama about the aftermath of a teenage girl’s suicide, resumed this weekend, prompting a fresh round of warnings and toolkits from medical and psychological groups about how to talk with youth who are watching the show.

From 2001 to 2015, for American youth aged 5-17 years, 1661 suicide deaths in black youths (74% boys, 26% girls) and 13,341 suicide deaths in white youths (74% boys, 26% girls) occurred. The overall suicide rate was about 42% lower in black youth (1.26 per 100,000) than in white youth (2.16 per 100,000).

However, among children aged 5 to 12 years, black children had a significantly higher incidence of suicide than white children (incidence rate ratio [IRR], 1.82; 95% CI, 1.59-2.07).

"Our findings provide further evidence of a significant age-related racial disparity in childhood suicide rates and rebut the long-held perception that suicide rates are uniformly higher in whites than blacks in the United States," said Jeff Bridge, PhD, director of the Center for Suicide Prevention and Research at Nationwide Children's Hospital and lead author, in a statement. "The large age-related racial difference in suicide rates did not change during the study period, suggesting that this disparity is not explained by recent events such as the economic recession."

For older children, the trend reverts back to the national average. For youth aged 13-17 years, suicide was roughly 50% lower in black children than in white children (IRR, 0.51; 95% CI, 0.48-0.53).

"The existing literature does not adequately describe the extent of age-related racial disparities in youth suicide, and understanding these differences is essential to creating targeted prevention efforts," said Bridge, also a professor of Pediatrics, Psychiatry and Behavioral Health at The Ohio State University College of Medicine.

"We lacked information on key factors that may underlie racial differences in suicide, including access to culturally acceptable behavioral health care or the potential role of death due to homicide among older black youth as a competing risk for suicide in this subgroup," Bridge said. Understanding those differences could help create targeted interventions, he said.

Bridge’s previous work on this topic was referenced in the study released last week and published in Pediatrics, which did not explicitly study race by age or gender.² That study performed a retrospective analysis of administrative and billing data from 49 children’s hospitals across the country using the Pediatric Health Information System database between 2008 to 2015.

The annual percentage of all visits for suicide ideation (SI) and suicide attempts (SAs) almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% CI, 0.15-0.17]).

During the study period, researchers identified 115,856 encounters for suicide ideation and attempts in emergency departments at 31 children's hospitals. Nearly two-thirds of those encounters were girls. While increases were seen across all age groups, they were highest among teens ages 15-17, followed by ages 12-14.

Just over half of the encounters were children ages 15-17; another 37% were children ages 12-14; and 12.8% were children ages 5-11. Seasonal variation was also seen consistently across the period, with October accounting for nearly twice as many encounters as reported in July, suggesting that youth may face increased stress and mental health challenges when school is in session.

Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 per centage points [95% CI, 0.23-0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI, 0.21-0.27]).

Increases were noted for both girls (average annual increase 0.14 percentage points [95% CI, 0.13-0.15]) and boys (average annual increase 0.10 percentage points [95% CI, 0.09-0.11]), but were higher for girls (P <.001).

The authors of the Pediatrics study questioned whether the overall increased and seasonal difference represented true differences or reflect improved recognition and screening. However, even though both outpatient and inpatient specialty mental health care services increased during the time period, they noted that less than half of young people with a mental disorder seek treatment, and only a small minority of individuals affected with depression receive care. In addition, a minority of pediatricians are uncomfortable treating these issues and may be referring patients to higher levels of care, including teaching hospitals.

Addressing his study released Monday, Bridge said future research should “try to find out whether risk and protective factors identified in studies of primarily white adolescent suicides are associated with suicide in black youth and how these factors change throughout childhood and adolescence."

References

1. Bridge JA, Horowitz LM, Fontanella CA. Age-related racial disparity in suicide rates among US youths from 2001 through 2015 [published online May 21, 2018]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2018.0399.

2. Plemmons G, Hall M, Doupnik S, et al. Hospitalization for suicide ideation or attempt: 2008—2015. Pediatrics. 2018;141(6):2017-2426. doi: 10.1542/ peds.