Abstract
Background: Death by suicide is the second leading cause of death among adolescents globally. Healthy People 2020 set a goal to reduce by 10% the rate of suicide attempts that required treatment and designated the Youth Risk Behavior Survey (YRBS) to measure this objective.
Objectives: This study used cross-sectional YRBS data (2009-2017) to (a) investigate whether gender moderates the linear time trend for the rate of depressive symptoms, suicidal ideation, and suicide attempts among high school students within the United States; (b) estimate these same measures stratified by gender; and (c) investigate whether the Healthy People 2020 goal for reduction in suicide attempts was met in 2017 for males and females.
Methods: Secondary analysis of nationally representative high school students using YRBS data 2009-2017 were analyzed using R and the R survey package. Based on Strengthening the Reporting of Observational Studies in Epidemiology guidelines (STROBE), additive interactions using rate difference were compared to multiplicative interactions using odds ratios.
Results: Additive interactions were identified between female gender and linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Females, but not males, had positive linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Suicide attempts requiring treatment among females was 36% higher in 2017 than in 2009 but decreased 13% in males during the same period.
Discussion: The Healthy People 2020 goal to reduce suicide attempts requiring treatment by 10% has not been met among females. The divergent trends by gender highlight the importance of surveillance measures by gender. Future research is needed to identify better suicide prevention strategies that address underlying factors and are gender specific.