A recent article, published in the JAMA Pediatrics, assessed the association between pediatric suicide rates and the concentration of poverty at the county level in the United States. The retrospective cross-sectional study investigated whether socioeconomic deprivation in a community increases the risk of pediatric suicide among youth aged 5 to 19 years old in the US.
“Poverty has been associated with worse youth health outcomes including higher rates of intentional and unintentional injuries,” the lead author Jennifer A. Hoffmann from the Children’s Hospital of Chicago notes. “Knowledge of the risk factors for pediatric suicide may guide targeted interventions because effective programs exist to reduce suicidal ideation and attempt.”
Suicide prevention interventions have received increased scrutiny, as suicide is now one of the leading causes of death among youth in the United States. In 2017, the Centers for Disease Control and Prevention (CDC) reported 3013 youths died by suicide, and the pediatric suicide rate had increased 88%. In addition, recent studies have found that poverty is associated with suicide rates and poor mental health outcomes with higher rates of depression and anxiety. However, the risk factors for pediatric suicide have not been well studied.
“Limited prior studies have examined suicide by socioeconomic status in the pediatric population,” the authors note. “Socioeconomic factors previously associated with pediatric suicide include household receipt of public assistance, parental unemployment, and poor parental educational attainment.”
The study hypothesized that there would be higher suicide rates among young people living in counties with higher poverty concentrations. It examined whether the association of county poverty concentration with pediatric suicide varied by suicide methods.
“To analyze the association between pediatric suicide rates and county poverty concertation, we used a population average generalized estimating equation,” the authors explain. “Annual county poverty concentration, the percentage of the population living below the deferral poverty level, was divided into 5 groups (0%-4.9%, 5.0%-9,9%, 10.0%-14.9%, 15.0%-19.9%, and >= 20%).”
The data showed 20,982 suicides among youths aged 5 to 19 years from 2007 to 2016. The suicide rate increased 57% from 2007 to 2016 among youth aged 5 to 19 years. The suicide rate for male youth was more than 3 times greater than female youth. The three most common methods of suicide from 2007 to 2016 were suffocation (45.9%), firearms (41.1%), and poisoning (6.1%).
“In the multivariable model, there was a higher suicide rate in the highest poverty concentration countries (>/20%) compared with the lowest poverty concentration counties (0%-4.9%), and suicide rates increased in a stepwise manner as poverty concertation increased,” the authors point out.
The results showed that suicides by young people in counties with higher concentrations of poverty were more likely to involve firearms, which could inform suicide prevention strategies in these areas.
In terms of demographic trends, the authors found:
“Particular groups of youths are differentially affected by suicide, including youths aged 15 to 19 years (relative to younger youth), male youth, and white youth.”
In the discussion section, the author provided examples and further explanations on how poverty potentially affects health and mental health through various pathways such as childhood adversities and long-term exposure to toxic stress levels. Children living in poor neighborhoods are also more likely to be exposed to family dysfunction, violence, and social isolation, which put them at higher risks for externalizing mental health conditions and a greater sense of hopelessness.
This study called for more suicide prevention efforts that address poverty across different settings, including school, community, and health care. In addition, on a societal level, strategies that tackle poverty, such as increasing the minimum wage, should be considered for reducing the suicide rate among youths.
“In the United States, increased suicide rates among children were associated with increasing levels of county poverty concentration. This association was most prominent for firearms suicide,” the authors conclude.
“As pediatric suicide rates in the United States continue to increase, understanding the upstream contributions to pediatric suicide, including poverty-related factors, appears to be needed so that suicide prevention efforts can focus on the youths at highest risk.”
Hoffmann, J. A., Farrell, C. A., Monuteaux, M. C., Fleegler, E. W., & Lee, L. K. (2020). Association of pediatric suicide with county-level poverty in the United States, 2007-2016. JAMA pediatrics, 174(3), 287-294. (Link)