It is important for school districts to be aware of student populations that are at elevated risk for suicidal behavior based on various factors. Surveillance/data collection for continuous improvement and pregress monitoring is also necessary for a comprehensive approach to suicide prevention. BSD utilizes data collected through our protocol process to recognize trends to best focus prevention activities where possible. BSD also recognizes state and national trends for suicide and youth in order to best serve those populations at increased risk within the school district.
Youth Living with Mental and/or Substance Use Disorders
People with diagnosed mental health disorders (including substance use disorders) have a higher suicide risk than people without such diagnoses. However, the vast majority of people with mental health disorders will not die by suicide (Bradvik, 2018; Holmstrand et al.;2015; Inskip et al.; 1988; Nordentof et al. , 2011). Suicide rates vary by how common (e.g. mood disorders) and how impairing (e.g. anorexia) the disorder is. Risk also varies based on the age of onset, the age of diagnosis, how many disorders are present and based on demographic characteristics more generally such as. age and sex. With the average onset of depression and dysthymia occurring between ages 11 and 14 years, school staff may play a pivotal role in recognizing and referring the student to treatment that may reduce risk and enhance overall performance and improve long-term outcomes.
In BSD 12.4% of the students are receiving special education services. WE do not always know which students have a formal mental health or substance use disorder diagnosis. However, we do know that 203 interventions out of 639 total for school year 2023-2024 were with students who are receiving special education services and 54 were with students on a 504 Plan. It is important that we pay extra attention to students receiving these services as a potential indicator of increased suicide risk.
Youth Who Engage in Suicide Behavior
Many more people think about and/or attempt suicide than those who die by suicide, and most people who think about or attempt suicide never go on to die by suicide (Wenzel et al. 2011). Understanding these patterns can help ensure timely prevention services are received. A previous suicide attempt is a known powerful risk factor for suicide death. One study found that as many as 88-percent of people who attempt suicide for the first time and are seen in the Emergency Department go on to attempt suicide again within two years. Many adolescents who attempt suicide do not receive necessary follow-up care due to many reasons, including limited access to resources, transportation, insurance, copays and parental consent.
Data on suicide thoughts and attempts in the population come from self-reported survey data and from emergency departments and hospital records. 13% of female high school students and 7% of male high school students reported making a suicide attempt in 2021 (CDC, 2023). Non-Hispanic AI/AN students and non-Hispanic Black students reported the highest percentage of attempts, 16% and 14%, respectively (CDC, 20233). More than 30% of students with same-sex sexual contacts and 22% of LGBQ+ students reported an attempt as compared with 6% of heterosexual students (CDC, 2023).
Trends in suicide attempts over time between 2011-2021 indicate (CDC, 2023) suicide attempts:
- among female students increased from 10% in 2011 to 13% in 2021.
- among non-Hispanic Black students increased from 8% in 2011 to 14% in 2021
- among non-Hispanic White students increased from 6%in 2011 to 9% in 2021
- among Black students needing medical treatment increased from 2% in 2011 to 4% in 2021
For school year 2023-2024 the race/ethnicity of the students in BSD are in the chart below. In the second chart are the race/ethnicity of the 639 screenings in the 2023-2024 school year. Of not is that 5.95% of the screenings were for students who identify as Black/African American and they make up only 3% of our students.
Youth in Out-of-Home Settings
Youth involved in the juvenile justice and child welfare systems have a high prevalence of many risk factors for mental, emotional, and behavioral disorders associated with suicide. Juveniles in confinement and foster care have life histories that put them at higher suicide risk. Suicide among youth in contact with the juvenile justice system occurs at a rate about four times greater than the rate among youth in the general population. In one study, children in foster care were almost four times more likely to have considered suicide and almost four times more likely to have attempted suicide than those who had never been in foster care. Because of the heightened vulnerability that youth in the foster care and juvenile justice systems have to engage in suicidal ideation or behavior, specific preventative measures are crucial and can save the lives of youth in need.
In BSD in 2023-2024, 3.1% of our students were eligible for McKinney-Vento Act services. The McKinney-Vento Act defines homeless children and youth as individuals who lack a fixed, regular, and adequate nighttime residence. This definition also includes children and youth who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason. We also have students involved with Juvenile Justice and DHS Child Welfare. Unfortunately, that data is not available to cross reference this with suicide ideation or behavior.
American Indian/Alaska Native (AI/AN) Youth
Suicide rates among American Indian/Alaska Native (AI/AN) individuals are the highest among any racial or ethnic group in the United States, thus suicide rates among AI/AN youth are significantly higher than that of youth overall. Where the overall U.S. suicide rate in 2019 was 13.2 per every 100,000, the rate for AI/AN individuals was 22.2 per every 100,000. Following a similar trend to the adult population, 34 percent of AI/AN high school youth had seriously considered suicide within the past year compared to the overall U.S. population’s 18 percent, and the percentage of AI/AN youth who made a suicide plan was 9 percent higher than that of non-native U.S. youth. Suicide rates for this population peak in adolescence and young adulthood, particularly between the ages of 15-34. Although suicide rates vary widely among individual tribes, it is estimated that 14 to 27 percent of AI/AN adolescents have attempted suicide.
These statistics underscore how crucial it is that AI/AN youth receive increased access to high-quality, culturally responsive mental health services and suicide prevention interventions. Due to the rural residential settings of many AI/AN adolescents surveyed in current research, there is a strong need for increased implementation of suicide prevention strategies and interventions in rural areas. Increased access to mental health services and therapy must also occur in rural areas and those areas with high AI/AN populations in order to identify and diagnose youth struggling with mental disorders that put them at higher risk for suicide early on. Financial incentives such as loan forgiveness for mental health practitioners have been suggested by some as a possible avenue to address provider shortages in these rural areas.
In BSD the American Indian/Alaska Native population is relatively small. BSD has a position dedicated to supporting American Indian/Alaska Native students in the district and during the 2023-2024 school year there were efforts to coordinate and share resources specific to this population with this staff person and their programming.
LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer or Questioning) Youth
Youth who are not heterosexual and/or express their gender in diverse ways are nearly one and a half to three times more likely to have reported suicidal ideation and nearly one and a half to seven times more likely to have reported attempting suicide than heterosexual and cisgender youth. Rates of “suicidal ideation, suicide plans, attempts, and attempts requiring medical treatment were highest among sexual minority youth, those who identified as LGB, and youth who reported having had sexual contact with the same or with both sexes during 2019.” Some groups of LGB youth are at particular risk: those who experience homelessness or have run away from home, are living in foster care, and/or are involved in the juvenile justice system. Surveys show high rates of suicidal behavior in the transgender population, with transgender boys, transgender girls, and nonbinary adolescents assigned female at birth showing significantly higher suicidality outcomes than cisgender adolescents, including higher suicidal ideation and suicide attempts.
In BSD, the data available is not very specific in terms of identity either at the district level or in terms of suicide interventions. At the district level the data points are only male or female, 51.3% Male and 48.7% Female. For suicide interventions, females were 53.21%, males 44.29% and non-binary 2.5%. There has been promotion of professional development on this topic for those that provide suicide first aid for students in the district, particularly the concerns regarding high rates of suicidal behavior for students in the transgender population.
Youth Bereaved by Suicide
Studies show that those who have experienced suicide loss, through the death of a friend or loved one, are nearly four times as likely to attempt suicide themselves. Suicide and suicide attempts affect the health and well-being of friends, loved ones, co-workers, and the community. When people die by suicide, their surviving family and friends may experience prolonged grief, shock, anger, guilt, symptoms of depression or anxiety, and even thoughts of suicide themselves. We pay close attention to those bereaved by suicide if we are aware of the suicide. Often we are not aware until the point of the suicide first aid that the student is struggling with this issue. We do not collect data regarding this in BSD.
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