More than 20% of teens have seriously considered suicide. Psychologists and communities can help tackle the problem

A troubling pattern is on the rise in adolescents across the country: increasing rates of suicide, with youth of color and LGBTQ+ youth most affected—all against a backdrop of teens reporting high levels of hopelessness, sadness, loneliness, and suicidal ideation.

A report from the Centers for Disease Control and Prevention (CDC) looking at mental health and suicidal behaviors from 2011 to 2021 indicates that 13% of high school girls had attempted suicide (30% had seriously considered it). That jumped to more than 20% for LGBTQ+ teens (45% had seriously considered it) (Youth Risk Behavior Survey Data Summary and Trends Report: 2011–2021opens in new window).

These stats paint a dismaying picture of youth mental health. Stymying efforts to turn the tide, the field of youth suicide research is still young, and suicidal behavior is underresearched in youth of color. Researchers and clinicians are now working to understand the nuances around youth suicide and to view risk in a more holistic way.

“We focus so much on symptom reduction at the individual level, but without really contextualizing these forces that are more systemic,” said Jocelyn Meza, PhD, a clinical psychologist and professor in psychiatry at the University of California, Los Angeles, who studies culturally responsive interventions for underrepresented youth. “We’re really ignoring social structures in our treatment development.”

Shortages of clinical staff and the sheer number of youth struggling mean that suicide prevention needs to occur on a systemic level, psychologists say. Fortunately, there are an expanding number of school-, telehealth-, and community-based programs that aim to streamline the process of seeking help and to help youth recognize signs of distress in one another and support their peers.

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Between 2000 and 2018, the suicide rate among youth ages 10 to 24 rose from 6.8 per 100,000 to 10.7 per 100,000, according to death certificate data (Curtin, S. C., National Vital Statistics Reportopens in new window, Vol. 69, No. 11, 2020 [PDF, 477KB]opens in new window). This rise pushed suicide into the second leading cause of death for people ages 10 to 14 in 2021, according to the CDC (Facts About Suicide, May 2023opens in new window).

The overall suicide rate declined in 2019 and 2020 before rising nearly back to the 2018 peak again in 2021 (Stone, D. M., et al. Morbidity and Mortality Weekly Report, Vol. 72, No. 6, 2023opens in new window). The most alarming trend in this period was a sharp rise in suicide among Black youth ages 10 to 24. In this group, the suicide rate increased from 8.2 per 100,000 in 2018 to 11.2 per 100,000 in 2021, a rise of 36.6%. “Adolescent Black girls, compared with other demographics, have the highest increase in suicide attempts,” said Meza.

American Indian and Alaska Native youth have even higher rates of suicide, with a rate of 36.3 per 100,000 in 2021. For White youth, the rate in 2021 was 12.4 per 100,000, compared with 7.9 for Hispanic or Latino youth and 9.4 for Asian youth.

The CDC report paints a picture of U.S. high school students in distress. An increasing number of students reported persistent feelings of sadness or hopelessness in 2021, including 57% of girls (up from 36% in 2011), 29% of boys, and 69% of LGBTQ+ students.

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With such widespread distress, prevention needs to be broad-based, said Christine Moutier, MD, a psychiatrist and the chief medical officer of the American Foundation for Suicide Prevention (AFSP). One of the prime environments for interventions is schools, the origin of both stressors and protective factors for many teens. Signs of Suicide (SOS), one of the most widespread programs, has been shown in two randomized controlled trials led by University of Connecticut medical sociologist Robert Aseltine, PhD, to increase knowledge about suicide risk, increase adaptive attitudes about depression and suicide, and reduce suicide attempts by 40% in high schoolers (American Journal of Public Health, Vol. 94, No. 3, 2004opens in new window; BMC Public Health, Vol. 7, No. 161, 2007opens in new window). A more recent study replicated these results, with ninth graders who had taken the SOS training 64% less likely than those who had not taken the training to report a suicide attempt (Prevention Science, Vol. 17, No. 2, 2016opens in new window).

The brief curriculum uses video clips to educate students about signs of suicidal behavior and teaches them how to demonstrate care and get help from a trusted adult. “They’re going to talk to each other before they reach out to an adult,” said Lisa Desai, PsyD, a clinical psychologist and the chief behavioral health officer at MindWise Innovations, which runs the SOS program. “Let’s equip middle schoolers and high schoolers to have that conversation with each other.”

Teens and young adults turn to each other in times of crisis, said Kurt Michael, PhD, a clinical psychologist and senior clinical director at The Jed Foundation (JED)opens in new window, a nonprofit dedicated to preventing youth suicide. A 2015 survey of first-year college students by Harris Poll on behalf of JED (PDF, 2.08MB)opens in new window found that 76% of these students said they’d turn to friends for emotional support, compared with 64% who would reach out to family. And peer support can reduce risk, with research showing that perceived social support reduced the link between severe anxiety and suicidal thoughts in teens (Gallagher, M., et al., Journal of Abnormal Child Psychology, Vol. 42, 2014opens in new window). Given these findings, the JED High School Programopens in new window aims to foster enhanced social connectedness, youth engagement, and positive school climate that affirms the benefits of help-seeking among the students.

Promoting peer-to-peer support is also a key goal for Seize the Awkwardopens in new window, a national initiative created by AFSP and JED, in collaboration with the Ad Council. This public awareness campaign aims to educate teens and young adults about mental health and empower them to reach out and have a conversation when a friend is struggling. Though there have long been concerns about putting pressure on young people to support each other, young people already feel that pressure and want the tools to help, Moutier said. “They take their responsibility as a friend very, very seriously,” she said.

Part of the challenge is to overcome teens’ fear that if they tell a trustworthy adult about a friend’s struggles, the friend will be angry, said Vanessa Prosper, PhD, a counseling psychologist and associate professor of the practice of counseling, developmental, and educational psychology at Boston College and a clinical coordinator at Boston Latin School. To overcome this, teens need to hear messages about how people experiencing suicidal ideation may not always make the best decisions for themselves. “We say that we understand that you don’t want your friend to be upset, but when you’re in great distress and crisis, your mind is foggy,” Prosper said. “We tell teens, once your friend gets treatment, they’ll probably thank you. Would you rather have your friend alive but mad at you, or your friend really in harm’s way?”

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Other efforts focus on strengthening the safety net for students who are struggling. The TRAILS Suicide Prevention and Risk Management program helps schools build suicide prevention policies and staff trainings aligned with best practices, putting a particular emphasis on building connections between schools and outside mental health professionals. Often, a student who reports suicidal thoughts or behavior is sent to an emergency room, which may be unnecessary for youth not in immediate crisis. There are also few established lines of communication between school staff and outside mental health providers, said Natalie Rodriguez-Quintana, PhD, MPH, a clinical psychologist and the vice president of clinical science at TRAILS. The program equips school staff with proper risk assessments and protocols to coordinate care.

The TRAILS suicide prevention program launched in 2020 and is seeing snowballing adoption, with nine schools partnering with the program in the 2021–2022 academic year and 70 joining in 2022–2023. (TRAILS also provides programming and training in social and emotional learning and cognitive behavioral skills to more than 800 schools.)

Two waves of state funding are helping expand the effort. “We have gotten such amazing feedback with regard to Tier 3 [the suicide prevention program] and partners wanting to implement, so I’m expecting it to grow,” Rodriguez-Quintana said.

Pushing for more mental health staff in school is crucial for reducing suicide risk, said Prosper. “When we try to connect kids to outside providers, there are long waiting lists,” Prosper said. “That’s why it’s so important we get staff inside of schools, because out there it can take months.”

[Related: Talking to teens: Suicide prevention]

Some of the most underserved and vulnerable youth are concentrated within the justice system. Justice-involved youth are four times more likely to attempt suicide than the general youth population, said Kathleen Kemp, PhD, a clinical psychologist at Brown University. Many have multiple risk factors for suicide, including substance use disorders, psychiatric disorders, exposure to trauma, and access to lethal means, said Katherine Elkington, PhD, a clinical psychologist at Columbia University.

Kemp is currently working on a 5-year National Institute of Mental Health-funded project to improve treatment for suicidal ideation and behaviors in justice-involved youth. The project, Kemp says, grew out of an initial push to get nonmental health staff within the justice system to conduct evidence-based suicide screening. But it soon became clear that not even mental health professionals in the system were doing this screening adequately, because of both inadequate staffing and inadequate training in suicide prevention. The researchers are implementing a training in best practices for screening and in a 4-session intervention for youth who show signs of suicidal ideation or self-injury.

A major goal is to ensure the program can be implemented effectively, Kemp said. “We’re going to be asking administrators these questions and then looking at outcomes to see if they sustain the training practice after we withdraw from providing the training directly,” she said.

Building sustainable systems is a goal of Elkington’s research, as well. She is leading a project called e-Connect, which focuses on youth under community supervision, or probation. The goal of the program is to better identify youth at risk of self-harm and suicide and to make sure they get treatment once they are identified.

“Typically, what happens is once they move over from the justice system to the treatment system, they fall through the cracks and they don’t get there,” Elkington says. “e-Connect was developed not only to do a better job of identification but critically to do a better job of ensuring that the youth then make it to care.”

The program consists of a digital evidence-based screening that classifies youth into different risk levels and generates local referral pathways to care, all of which were designed with input from local stakeholders. The screening is scored in real time and probation officers are trained to effectively debrief families on the results. “A non-clinician faced with a youth who is suicidal may feel a little panicky,” Elkington said. “But with e-Connect, how to effectively manage the situation is detailed right there on the tool.”

A trial of e-Connect was carried out in New York and found a substantially higher treatment initiation using e-Connect compared with baseline (Journal of Consulting and Clinical Psychology, in pressopens in new window). The program also seemed to shrink racial disparities in who gets referred to treatment. Elkington and her team are now scaling up the program in nine counties in Indiana.

Reducing access to lethal means is another crucial pathway to preventing adolescent suicide, JED’s Michael said. The odds of dying by suicide are twice as high in rural America compared to urban areas, and rural teens report easier access to firearms than urban teens, according to research led by epidemiologist Talia Spark, PhD, of the Department of Veterans Affairs (JAMA Network Open, Vol. 4, No. 10, 2021opens in new window). “When a fence barrier was installed on the Duke Ellington Memorial Bridge, suicide deaths from the bridge were reduced by 90%—and it did not increase the rate of attempts at other bridges around Washington, DC,” Michael said. “We can reduce death by firearms using the same model. Rather than attempting to predict individual behavior, prevention should focus on reducing access to lethal means.”

While the most concerning rates of suicide are in underrepresented youth, most of the research on youth suicidality has focused on White adolescents. Psychologists are now trying to address the knowledge gap to better understand how to assess youth of color and LGBTQ+ youth. They’re also working to better understand how a national atmosphere of trauma and discrimination affects these young people’s suicide risk. “We need to focus on the context that is impacting their sense of belonging,” UCLA’s Meza said.

It’s clear that suicide risk can be tied into the overall social climate. After the mass shooting in Uvalde, Texas, in 2021, messages to the nonprofit Crisis Text Line that mentioned firearms and grief spiked, according to research led by a team including Adam Bryant Miller, PhD, a clinical psychologist at the Research Triangle Institute in North Carolina (JMIR Public Health and Surveillance, Vol. 9, 2023opens in new window). “Our current landscape with mass shootings drives psychological distress,” Miller said. “The ripple effects are just enormous, and I think it’s even larger than what we’re capturing.”

Likewise, Black youth can be traumatized by repeated videos of the deaths of Black men at the hands of police officers, said Sherry Molock, PhD, a clinical psychologist at The George Washington University. But this sort of trauma isn’t recognized in traditional assessments of suicide risk. “We need to ask kids, What are you exposed to that really bothers you?” Molock says.

Political and social context also impacts LBGTQ+ youth. The Trevor Project, a nonprofit that focuses on suicide prevention in LGBTQ+ youth, has found higher rates of suicide attempts in youth who report that their homes, schools, or communities are not accepting (2022 National Survey on LGBTQ Youth Mental Healthopens in new window). A report by the research institution Child Trends found that in states that proposed anti-LGBTQ+ legislation, texts to the Crisis Text Line rose a small but statistically significant amount in the subsequent 4 weeks (Parris, D., et al., “Anti-LGBTQ Policy Proposals Can Harm Youth Mental Health,” Child Trends, July 6, 2021opens in new window).

“You have youth existing in an environment that is pervasively invalidating,” Miller said.

Meza, Molock, and Miller are members of the Youth Suicide Research Consortium (YSRC), a group that formed 4 years ago to address the issue of youth suicide, particularly in communities of color. Current assessments often fail to capture risk for Black youth, Molock said, with Black youth being less likely to report suicidal ideation or diagnoses of depression before a suicide attempt. This suggests that assessments fail to inquire about risk factors in a way that resonates with Black teens. Assessments also often fail to ask about protective factors, such as faith communities or family ties, which may be particularly important to young Black people, Molock said.

The goal of the YSRC is to delve into the complex and nuanced factors that drive risk and protection in these vulnerable populations. They’re also extending this nuance into new treatments. Molock is leading research on increasing social cohesiveness via Black churches in New York. Meza and her colleagues are testing an intervention with Black and Latino college students that targets their sense of belonging by encouraging them to participate in civic engagement.

“Part of the reason why we haven’t made a dent in suicide deaths,” Molock said, “is that we only focus on individualized solutions. People don’t live in an individualized world.”