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

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.

Preventing adolescent suicide: Recommendations for policymakers, practitioners, program developers, and researchers

“…Adolescents in rural areas have higher suicide fatality rates, as compared with adolescents who live in urban areas, and this rural/urban pattern is repeated for most racial/ethnic groups and for both boys and girls (although especially so for Indigenous adolescents and boys); see Figure A7 (Fontanella et al, 2015). This difference in suicide rates among adolescents within rural areas is associated with increased access to lethal means, primarily firearms (as we discuss above), and unmet need for mental health services (Runkle et al, 2022). However, while the rate of suicide death is higher for youth who live in rural areas, 8 in every 10 deaths due to suicide among adolescents occur among adolescents who live in urban areas, because more adolescents live in urban areas (CDC, 2023a).…”

Examining area‐ and individual‐level differences in suicide ideation severity and suicide attempt among youth

“…Across studies, rates of completed suicides tend to vary across rural/urban classifications and area‐level socioeconomic factors. In particular, systematic reviews suggest that both rural areas and lower SES areas tend to show higher rates of completed suicides (Casant & Helbich, 2022; Runkle et al., 2022). Among youth, population‐based studies examining aggregated area‐level differences in suicide rates in the United States represent an important area of continuing research (Runkle et al., 2022).…”

“…The US Preventive Services Task Force recommends universal dual screening for both depression and suicide ideation among youth age 12 and older in primary care settings (Mangione et al., 2022). While research has identified other important risk factors for youth suicide including substance abuse, serious mental health issues, and consistent school or family problems, the four risk factors of hopelessness, suicide ideation, suicide planning, and suicide attempt are generally considered the most proximal indicators of suicide risk (Davidson & Linnoila, 2013; Klonsky et al., 2018; Runkle et al., 2022). Considering these risk factors collectively is essential for identifying youth in most acute need of suicide prevention services (Klonsky et al., 2018; Mangione et al., 2022).…”

“…In particular, systematic reviews suggest that both rural areas and lower SES areas tend to show higher rates of completed suicides (Casant & Helbich, 2022;Runkle et al, 2022). Among youth, population-based studies examining aggregated area-level differences in suicide rates in the United States represent an important area of continuing research (Runkle et al, 2022). Fontanella et al (2015) examined suicide rates of youth and young adults aged 10-24 from 1996 to 2010 at the county-level by urban/rural classifications.…”

“…These studies have largely concluded that youth living in lower SES environments are at increased risk for experiencing depressive symptoms (Mair et al, 2008;McBride Murry et al, 2011). Fewer observational or population-based studies have examined geographic variation in suicide ideation or attempt among youth in the United States (Runkle et al, 2022). Hill et al (2021) recently gathered electronic health record data on youth suicide ideation and attempts from one large metropolitan area to examine geographic variation by zip code.…”