The emergence of youth suicide: an epidemiologic analysis and public health perspective.

In this epidemiologic analysis, we examine death certificate data to identify significant patterns and trends in suicide in the United States. Although the overall suicide rate did not change from 1950 to 1980, fundamental and important changes did occur: suicide rates among older persons decreased and rates among younger persons increased markedly. Suicide rates have increased most dramatically among young white men aged 15 to 24. From 1950 to 1980, rates among white males aged 15 to 19 increased by 305%; among white males aged 20 to 24, by 196%. The percentage of suicides in which firearms were used has also increased markedly, most dramatically in young men and women. These fundamental changes in the pattern of suicide in the United States have critical implications for how the mental health and public health communities approach the problem. Suicide has traditionally been considered a mental health problem, and our approach to prevention was based on a portrait of the typical suicidal individual as an older, depressed, white male. The basic prevention strategy involved detection and treatment of depression. If, as some recent research suggests, most young persons at high risk for suicide are not depressed, the whole approach to prevention must be reexamined. There is an urgent need to reexamine and advance our understanding of what causes suicide. Who are the persons at greatest risk, and what can be done to prevent these deaths? Although increased use of drugs and alcohol has been proposed as a possible cause of the increase in suicides, it is only one hypothesis among others that must be examined. The significance of mental illness, suicide clusters and contagion, and the availability of firearms need further study as possible risk factors for youth suicide. Suicide represents the second leading cause of death among young persons aged 15 to 24. A problem of this magnitude should be given high priority by the public health community in planning and implementing research and interventions.