Socioenvironmental drivers of adolescent suicide in the United States: A scoping review

Runkle, Harden, Hart, Moreno, Michael & Sugg (2022) published “Socioenvironmental Drivers of Adolescent Suicide in the United States: A scoping review” in Journal of Rural Mental Health. 

A UC Davis study reports that adolescent suicide rate increased 60% between 2007 and 2018, making it the second leading cause of death for young people. Runkle et al. focus on rural teens. Here’s the abstract:

Suicide is an ongoing public health crisis among young people in the United States. Suicide rates in rural areas are often more than double rates in urban locales. Few reviews have examined the contextual place-based social, environmental, or economic factors that contribute to differences in mental health risks for young people. This scoping review aims to map the state of the evidence on socioenvironmental factors driving suicide risks in adolescents with a particular focus on rural America. A literature database search using PRISM guidelines identified 143 research studies meeting inclusion and review criteria. Descriptive and thematic analyses were conducted and presented in a narrative form for the following topics: (a) Adolescent suicide and vulnerable populations, (b) Mental health conditions in the pathway of suicide, (c) Rural versus urban, (d) Social determinants of mental health and access, and (e) Impact of physical environment on adolescent mental health. Findings highlight that hopelessness, particularly in minority populations, inadequate family and peer support, unaddressed traumatic experiences, and underdiagnosis and treatment for mood disorders or substance abuse, are essential contributory factors to rural adolescent suicide. Nearly all of the evidence focused on individual rather than community-level factors like school bullying and low screening. Improvements in school-based detection of mental disorders, particularly around critical transition periods, and more longitudinal research investigating causal links, rural populations, and the contextual socioenvironmental determinants of adolescent suicide are needed, emphasizing distinct challenges for rural areas in response to the pandemic. 

The CDC also reports that, “In May 2020, during the COVID-19 pandemic, ED visits for suspected suicide attempts began to increase among adolescents aged 12–17 years, especially girls. During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%.” 

These data suggest that it is critical to attend to young adolescents who are distressed and to ask good questions about family and peer support, traumatic experiences, possible mood disorders, and substance abuse. As Runkle et al. note, the transitions from elementary to middle or middle to high school may be especially important.