[Title card] Pediatrics: Official Journal of the American Academy of Pediatrics Video Abstracts pediatrics.org/videoabstract Facebook: @aappeds Instagram: @aap_pediatrics pediatrics.org [Title card] Racial Differences in Suicide Trends Among Adolescents --- Michael A. Lindsey, PhD, MSW, MPH; Arielle H. Sheftall, PhD; Yunyu Xiao, M. Phil; Sean Joe, PhD, MSW Reference locator: 10.1542/peds.2019-1187 [Michael Lindsey addressing the camera] ML: Hello, I'm Dr. Michael Lindsey, Executive Director of the NYU McSilver Institute for Poverty Policy and Research, and the Constance and Martin Silver Professor of Poverty Studies at the NYU Silver School of Social Work. ML: Our research team from the McSilver Institute, Nationwide Children’s Hospital and the Brown School at Washington University in St. Louis has been concerned about the problem of suicidal behaviors among American adolescents, and we set out to study whether certain racial and ethnic subgroups are at higher risk to engage in suicide behaviors. ML: What we know is suicide is the second leading cause of death among adolescents 12-18 years old in the United States. [Graphic: CDC top 10 causes of death for ages 12 to 19, showing suicide in second place after unintentional injury] ML: Recent empirical data has discovered racial disparities in completed suicides, especially among young Black children ages 5 to 12 years old. Let that sink in for a moment. This group of young children are ending their lives before they have barely had a chance to live it. ML: Meanwhile, gender disparity in youth suicidal behavior has also been observed, with female adolescents showing greater non-fatal suicidal behaviors than their male counterparts. ML:However, racial/ethnic and sexual differences in suicidal ideation, plan, and suicide attempts among older adolescents, particularly those who are high-school aged, have not been examined in the last two decades. [Graphic: Titles over video of people walking, shot from ground-level. Who is most at risk? How do we reach them?] ML: This information is important to know because if rates of suicide behaviors are increasing, we need to know how best to target strategies for those who are most at-risk for engagement in suicide behaviors. [Graphic: stock photos of young people from a variety of backgrounds] ML: Given this context, our research team set to examine whether there are certain racial and ethnic subgroups of adolescents at high-risk for engagement in suicidal behaviors, including: suicide ideation, suicide plans, suicide attempts, and injuries by attempt. [Graphic: Youth Risk Behavior Survey (YRBS) figures over stock video of desks in a classroom] ML: To answer this question, we used the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, covering approximately 200,000 high school students. [Graphic: Summary of YRBS Trends 1991-2017 showing no statistically significant identifiable trend or linear and/or quadratic decreasing trends across all race/ethnic and gender groups for each suicide behavior, except suicide attempts for Black male (linear trend) and female (linear and quadratic) youth, and injury by attempt for Black male yourh.] [Graphic: Lineplot graphs of the raw YRBS data] ML: We conducted logistic regression analyses to examine the linear and quadratic trends by different racial/ethnic groups, with suicidal ideation, plan, attempts, and injury by attempts serving as dichotomous outcomes. ML: Our findings uncovered racial/ethnic and sexual differences in trends of suicidal behaviors. Black male and female adolescents had increasing trends for suicide attempts, despite the fact that there were significant linear decreases in self-reported suicidal ideation and suicide plans across all sex and racial and ethnic groups during the time period. Black adolescents were the only racial and ethnic group for which this was the case. ML: For Black females, the rates of suicide attempts have increased at an even faster, accelerating rate. Finally, there was also a significant linear increase in injury by attempts for Black males. [Michael Lindsey addressing the camera] ML: Our findings are both surprising and alarming for the increasing rates of suicide attempts and injury by attempts uniquely among Black adolescents. [Graphic: Stock photos depicting: a person reclined in therapy, hands filling a loan application, a distressed child, and a payday loan storefront] ML: Possible reasons that explain these phenomena are: skepticism towards mental health treatment and social etiological factors, such as racial discrimination, adverse childhood experiences, and poverty, which have been disproportionately experienced by Black adolescents. ML: So where do we go from here? Future research is needed to understand the unique risk factors associated with increasing suicide attempts among Black adolescents. [Graphic: "needed research," "tailor programs," "stigma," "help-seeking" listed as main points for future study] ML: In terms of clinical practice, it is critical to develop and test suicide intervention and prevention programs tailored for the Black community, reducing the stigma related to mental illness and increasing help-seeking behaviors in clinical and non-clinical settings. [Graphic: Author Permission Statement] Photos (1:31, 2:10, 3:58) licensed freely from Pixabay (https://pixabay.com/service/terms/), accessed June 2019. Additional photos (1:31, 2:08, 2:10, 3:30, 3:58) licensed commercially from iStockPhoto (https://www.istockphoto.com/legal/license-agreement), accessed June 2019. Background video (1:54-2:05,2:23-2:25) licensed freely from Pexels (https://www.pexels.com/photo-license/), accessed June 2019. Background music: “Once Again” by Benjamin Tissot from Bensound.com via Creative Commons license (https://www.bensound.com/licensing), accessed June 2019. Note: Additional documentation available by request from the NYU McSilver Institute, contact mcsilver.comms@nyu.edu