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In two cross-sectional studies, researchers found a significant increase in suicide rates among preteens in the U.S., while more than half of adolescents who died by suicide did not have a prior documented mental health diagnosis.

Among U.S. preteens ages 8 to 12 years, suicide rates significantly increased by 8.2% annually from 2008 to 2022, after a downward trend until 2007, according to Donna A. Ruch, PhD, of Nationwide Children's Hospital in Columbus, Ohio, and co-authors.

The overall suicide rate during that time period (5.71 per 1 million) also represented a significant increase over the rate from 2001 to 2007 (3.34 per 1 million), for an incidence rate ratio (IRR) of 1.71, they reported in .

"These findings suggest there is a need for widespread and universal suicide risk screening starting at earlier ages as a preventative measure," Ruch told 口袋女优 in an email, adding that the overall increasing trend was concerning, and several minority groups were disproportionately affected.

For example, female preteens saw a disproportionate increase in suicide rates compared with male preteens (IRR 3.32 vs 1.35). Black preteens had the highest overall suicide rates for both time periods: 4.94 per 1 million in 2001-2007 and 8.50 per 1 million in 2008-2022.

Meanwhile, another study of suicide among youths ages 10 to 24 years found that just 40.4% had a documented mental health diagnosis, and 46.8% died by firearms, said Sofia Chaudhary, MD, of Emory University School of Medicine in Atlanta, and co-authors.

This study, which was also published in , showed that minority youth were less likely to have a mental health diagnosis than white youth, especially those who identified as American Indian or Alaska Native (adjusted OR 0.45, 95% CI 0.39-0.51); Asian, Native Hawaiian, or other Pacific Islander (aOR 0.58, 95% CI 0.52-0.64); and Black (aOR 0.62, 95% CI 0.58-0.66).

Notably, girls were more likely to have a mental health diagnosis than boys (aOR 1.64, 95% CI 1.56-1.73).

Chaudhary told 口袋女优 that her team's results highlighted the challenges facing at-risk adolescents, especially minority groups.

"This speaks to the critical need for improved detection and connection to mental health services and the importance of universal lethal means counseling in both healthcare and community settings," she said.

Chaudhary added that social inequities could be a contributing factor to racial and ethnic disparities, so communities could help ensure equitable access to mental health services by increasing culturally sensitive services and diversity in the mental health workforce.

"We need a comprehensive approach that includes looking further upstream for adequate prevention strategies," she said. "We also need more community programming to reach youth in schools, community rec centers, and faith-based settings, as [youths] may frequent these locations more often than clinical settings."

for Chaudhary's study, Lisa M. Horowitz, PhD, MPH, of the National Institute of Mental Health, who was also a co-author on Ruch's study, and co-authors noted that the findings show that identifying mental disorders and suicide risk early are a rare exception to the rule in the U.S.

"Intervention in childhood has potential to reduce mental health concerns and reduce suicide risk across the lifespan," they wrote. "The importance of improving recognition in healthcare settings is also supported by previous research demonstrating that most people who die by suicide have visited a healthcare clinician in the months and even weeks beforehand."

They also explained that universal suicide risk screening, which has been supported by the , should be considered to address these trends. Community-level interventions will play a critical part in identifying, diagnosing, and treating all at-risk youth, they added.

For their study, Ruch and colleagues collected data on 2,241 preteens who died by suicide from January 2001 through December 2022, using the Web-based Injury Statistics Query and Reporting System (WISQARS). The majority were male (68.1%) and white (68.3%); 24.5% were Black, 18.8% were Hispanic, and 7.2% were American Indian or Alaska Native, Asian, or Pacific Islander.

Analyses showed significant increases among all subgroups, with the greatest increases in girls (IRR 3.32); American Indian or Alaska Native, Asian, or Pacific Islander preteens (IRR 1.99); Hispanic preteens (IRR 2.06); and firearm suicides (IRR 2.29).

For the second study, Chaudhary and team collected data on 40,618 youths who died by suicide from January 2010 through December 2021, using the National Violent Death Reporting System (NVDRS) Restricted Access Database. The data were collected from three main sources: death certificates, coroner and medical examiner records, and law enforcement reports. Suicide deaths were determined using the ICD-10 cause-of-death codes and source documents.

Overall, 58.1% were ages 20 to 24 years, 79.2% were male, 76.1% were white, 12.7% were Black, 2.9% were American Indian or Alaska Native, and 4.2% were Asian, Native Hawaiian, or other Pacific Islander.

The authors also noted that mental health diagnoses were less likely among Hispanic youths compared with non-Hispanic youths (aOR 0.76, 95% CI 0.72-0.82), and youths ages 10 to 14 years compared with youths ages 20 to 24 years (aOR 0.70, 95% CI 0.65-0.76).

Both studies had key limitations. For the study by Ruch's group, some suicides may have been misclassified as other causes of death. Similarly, the lack of more specific racial and ethnic categorization may have limited accuracy of suicide statistics.

For the study by Chaudhary's group, the NVDRS database was not a nationally representative sample, and the use of source records and family member accounts to determine mental health diagnoses may mean some prior diagnoses were unknown or underreported.