Race and Depressive Symptoms are Associated with the Prevalence of Adolescent Suicide Attempts in Hawai'i, Youth Risk Behavior Survey 2015-2017.

Suicide is death caused by injuring oneself with the intent to die. According to the 2017 National Vital Statistics report, suicide was the second leading cause of death for adolescents 10-24 years old, accounting for 19.2% of deaths in that age group. Aggregated 2015-2017 Hawai'i Youth Risk Behavior Survey (YRBS) data from 12 120 respondents were analyzed. Multivariate logistic regression modeling for complex survey procedure was created using predicted marginals to estimate crude and adjusted prevalence ratios for suicide attempts. After adjusting for race, depressive symptoms, bullying, illicit drug use, alcohol use, and self-harm, youth who experienced bullying (adjusted prevalence ratio=1.75; 95% confidence interval: 1.44-2.12), used illicit drugs (1.89; 1.54-2.31), those with one-time self-harm (2.87; 2.04-4.04), or repeated self-harm (5.31; 4.28-6.60) were more likely to have suicide attempts. Race by depressive symptoms interaction was significant (P <.01), demonstrating the heterogeneity of the stratum-specific measures of association. When depressive symptoms were present, youth who are Native Hawaiian (2.64; 1.68-4.15), Japanese (2.39; 1.44-3.95), other Pacific Islander (2.04; 1.29-3.21), Filipino (1.77; 1.21-2.59), and those who do not describe as only one race/ethnicity (1.74; 1.16-2.62) were more likely to have suicide attempts compared to White. When depressive symptoms were not present, other Pacific Islanders (4.05; 1.69-9.67), Hispanics/Latinos (3.37; 1.10-10.30), Native Hawaiians (3.03; 1.23-7.45), and other race groups (2.03; 1.03-4.00) were more likely to have suicide attempts compared to White. These results demonstrated the importance of screening for depressive symptoms and other risk factors to prevent suicide attempts in adolescents.