Alarming rates of teen suicide continue to increase in the U.S.

In the United States suicide has become the second leading cause of premature death among those ages 10 to 24; it is the leading cause of death among teens ages 13 to 14.

Researchers from Florida Atlantic University's Schmidt College of Medicine and collaborators conducted a study exploring trends in rates of suicide among 13 to 14 year olds in the U.S. from 1999 to 2018. They also explored possible modifications by sex, race, level of urbanization, census region, month of the year and day of the week.

Results, published online ahead of print in the journal Annals of Pediatrics and Child Health, showed that among children ages 13 to 14, suicide rates more than doubled from 2008 to 2018, following a rise in social media and despite significant declines in suicide mortality in this age group previously from 1999 to 2007. These trends were similar in urban and rural areas but were more common in boys in rural areas where firearms are more prevalent.

These statistically significant increasing trends were similar by sex, race, urbanization and census regions. In rural areas, firearms were used in 46.7 percent of suicides in boys and 34.7 percent in metropolitan areas. Suicides occurred significantly more often between September and May and were highest on Monday followed by the rest of the weekdays, suggesting school stress as a contributor.

" While further analytic studies are needed, there are certainly important clinical and public health implications based on our study findings," said Sarah K. Wood, M.D., senior author, professor of pediatrics, vice dean for medical education, and interim chair, Department of Women's and Children's Health, in FAU's Schmidt College of Medicine. "Specifically, these descriptive data have temporal correlates with social media, school stress, and firearms, which require further research. In the meanwhile, there are clinical and public health initiatives for those at highest risks."

From 2007 to 2018, in suicides among U.S. youths aged 13 to 14 years in metropolitan areas (large central, large fringe, medium and small), 56.7 percent were due to hanging, strangulation or suffocation, while in 34.7 percent, firearms were used. In medium and small metro, 38.9 percent of suicides were due to hanging, strangling or suffocation, 38.9 percent were due to firearms. In rural (micropolitan and non-core, non-metro) areas, 46.9 percent of suicides were due to hanging, strangulation or suffocation, while 46.7 percent were due to firearms.

"During the years immediately preceding the onset of increases in rates of suicide among 13 and 14 year olds, several prominent social media platforms used by teens, including Reddit, YouTube, Twitter, Facebook, Myspace and Tumblr were launched. In aggregate, all of these sites have grown to billions of users, but large as they are, by 2018, all but YouTube were surpassed in terms of teen use by Instagram and Snapchat," said Charles H. Hennekens, M.D., DrPH, co-author, first Sir Richard Doll Professor of Medicine, senior academic advisor to the dean, and interim chair, Department of Population Health and Social Medicine, in FAU's Schmidt College of Medicine, and an adjunct professor of family and community medicine, at Baylor College of Medicine.

Among the four U.S. Census regions, there were remarkably similar and statistically significant increases in all areas, namely the Northeast, Midwest, South and West.

"Our data show that non-metropolitan areas have higher rates of teen suicide, regardless of method and rural areas have higher rates due to firearms," said Hennekens.

For the study, researchers used publicly available data from the U.S. Centers for Disease Control and Prevention's "Multiple Cause of Death" fields.