Youth suicide

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Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and elsewhere are high.[ vague ][ citation needed ] Female youth are more likely to attempt suicide than male youth but less likely to die from their attempt. [1] For example, in Australia, suicide is second only to motor vehicle accidents as its leading cause of death for adolescents and young adults aged 15 to 25. [2]

Contents

In the United States, according to the National Institute of Mental Health, suicide is the second leading cause of death for adolescents between the ages of 10 and 14, and the third leading cause of death for those between 15 and 19. [3] In 2021, the American Academy of Pediatrics, the American Academy of ChiId and Adolescent Psychiatry, and the Children's Hospital Association released a joint statement announcing a mental health crisis among American youth. [4] Emergency room visits for mental health issues have dramatically increased, especially since the start of the COVID-19 pandemic. [5]

Mental health education in schools[ where? ] equips students with the knowledge and skills to recognise signs of distress and seek help.[ citation needed ] Community support programs offer safe spaces for adolescents to express their emotions and receive professional support.[ citation needed ][ example needed ] Increased access to mental health resources, including hotlines and counseling services, ensures timely intervention and support for at-risk youths.[ citation needed ] These initiatives[ which? ] aim to address the underlying factors[ examples needed ] contributing to youth suicide and promote mental well-being among adolescents.[ not verified in body ]

Suicide contagion

According to research conducted by the Commission for Children and Young People and Child Guardian in 2007, 39% of all young people who die by suicide have lost someone of influence / significance to them to suicide.[ citation needed ] The Commission terms this suicide contagion and makes several recommendations[ examples needed ] as to the importance of safeguarding young people and communities from suicide contagion. Termed "suicide contagion," this phenomenon highlights the ripple effect of suicide within communities and its impact on vulnerable individuals. [6] When a group of suicides happen around the same time, it is called, clustering. More than 13% of the suicides that happen in adolescents can be explained by clustering. [6]

In 2011 the Australian Federal Parliament Standing Committee for Health and Ageing Inquiry into Youth Suicide met in a round table forum with young representatives from three organizations at the forefront of preventing youth suicide. These organizations included Sunnykids, [7] Inspire,[ citation needed ] and Boys Town. The Standing Committee has since released a discussion paper highlighting the findings of their inquiry [8] and will seek to make final recommendations on the most effective means for reducing youth suicide.[ needs update? ]

Strategies for preventing suicide contagion encompass a range of approaches, from media guidelines[ example needed ] to community interventions and support for bereaved individuals. Mental health professionals[ vague ] emphasize the importance of responsible media reporting to minimize sensationalization and the risk of contagion. Community-based interventions, such as peer support groups and mental health education programs,[ examples needed ] play a crucial role in promoting resilience and connectedness among vulnerable populations.[ citation needed ] Policymakers collaborate with experts to develop comprehensive strategies aimed at reducing the spread of suicidal behavior and supporting those affected by loss.[ vague ] [9]

The image provides a visual reinforcement of the importance of safeguarding young people and communities from suicide contagion. It conveys a message of hope and support, which aligns with the theme of resilience and prevention highlighted in the article. You Got This.jpg
The image provides a visual reinforcement of the importance of safeguarding young people and communities from suicide contagion. It conveys a message of hope and support, which aligns with the theme of resilience and prevention highlighted in the article.

Teens at risk

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One of the problems facing teenagers at risk of suicide is getting psychiatric counselling when it is needed. [10] [ better source needed ] One research at the beginning of 2020 shows that compared with older adolescents, younger adolescents particularly agree that increased cyberbullying and despair are very important factors influencing suicide among adolescents. [11] [ failed verification ][ non sequitur ]

Access to psychiatric counseling remains a critical issue for teenagers at risk of suicide. Research from early 2020 underscores the significance of cyberbullying and its impact on adolescent mental health. Younger adolescents, in particular, acknowledge the correlation between increased cyberbullying and feelings of despair, which are recognized as significant contributors to suicidal ideation among youths. To address these risk factors effectively, evidence-based interventions and strategies have been implemented. School-based mental health programs offer education and support to students, fostering resilience and coping skills to navigate challenges such as cyberbullying. Support groups provide a safe space for adolescents to share experiences and receive peer support, reducing feelings of isolation and promoting emotional well-being.[ citation needed ]

One study says, "In teenagers, depression is considered a major – if not the leading – cause of teen suicide." [12] Factors and risks contributed to youth suicide are academic pressure, alcohol consumption, the loss of a valued relationship, frequent change of residency, and poor family patterns. Mood disorders can exacerbate feelings of hopelessness and despair, amplifying suicidal ideation among adolescents. Additionally, various risk factors such as academic pressure, alcohol consumption, the loss of significant relationships, frequent changes in residency, and dysfunctional family dynamics compound the vulnerability of youths to suicidal behavior. These insights underscore the multifaceted nature of youth suicide and the importance of comprehensive prevention strategies that address both mental health issues and environmental stressors.  It's crucial for parents, educators, and caregivers to recognize the warning signs of depression and suicidal behavior in teenagers, such as withdrawal, changes in behavior, and expressions of hopelessness. Creating a supportive and non-judgmental environment where youths feel safe to express their emotions and seek help can play a pivotal role in preventing suicide among adolescents.

Providing insights such as, why this is happening, why are children and teenagers feeling so pressured at such a young age, and how do outside factors such as family, substances and underlying conditions affect this topic. In One study of several thousand families it has shown that children from a divorced or single parent are 3.2 times more likely to experience anxiety or depression. Another found that girls whose parents were divorced were 50% more likely to attempt suicide as apposed to girls that grew up with parents who remained married.

 Suicide risk is higher in those experiencing forms of adversity, including food insecurity, which can often lead to stigma, social isolation, shame, sadness and family strain.  Suicidal ideation, suicide planning and suicide attempts are also more prevalent in adolescents struggling with food insecurity than those who are food-secure. This is more common in countries where adolescent food insecurity is rare, potentially because it indicates a reduced standard of living and low social standing within that country. [13]

[14] Harassment is a leading cause of teen suicide, along with abuse. Gay teens or those unsure of their sexual identity are more likely to die by suicide, particularly if they have suffered bullying or harassment, as discussed next. The following campaigns have been started in hopes of giving teens hope and abolishing the feeling of isolation. Specific studies have explored the link between harassment and suicide among LGBTQ+ youth, highlighting the detrimental effects of bullying and harassment on mental health and well-being.to give teens hope and abolish

Evaluation of existing campaigns aimed at reducing teen suicide reveals varying degrees of effectiveness in fostering hope and combating isolation among teens. Initiatives such as "It Gets Better," "Born This Way," "I Get Bullied Too," and "Stop Youth Suicide" aim to provide support and encouragement to vulnerable youths. While these campaigns have noble goals of promoting inclusivity and resilience, their approaches and outcomes vary.

Not only are suicide rates in the LGBTQ+ community high for youth, but they are also increasing for the older populations as well. Most people don’t think about the suicide rates for older generations however, they are just as important. The National Council of Aging shared that people 45–64 years old have the highest suicide rate and elders 85 years and older hold the second. This can contribute to the fact that elders suicide is more likely to go unreported. Integrating LGBTQ+ Adult programs along with other culturally appropriate programs can decrease isolation and depression rates significantly.

Lack of impulse control has been found to differentiate adolescent suicide attempters from a control group of adolescents with an acute illness (Slap, Vorters, Chaudhuri, & Centor, 1988). However, impulsivity does not characterize all suicide attempters, since group comparisons have found no differences between suicidal patients and psychiatric controls on a measure of cognitive impulsivity (Patsiokas, Clum, & Luscomb, 1979). Instead, impulsivity may be important in identifying high-risk subgroups.

Sexual minority youth and suicide

Youth that fall under the category of sexual minorities are at an elevated risk of depression and succumbing to self-harm. Research indicates that sexual minority youth are at increased risk of experiencing mental health issues compared to their heterosexual peers. Among the population of sexual minority youth, on average, 28% explain having past experiences with suicidal actions and/or thoughts. Studies have also shown that this is due to “perceived burdensomeness, low sense of belonging, and acquired ability to enact lethal self injury.” [19] [20] Lesbian and gay youth are the group most likely to face negative experiences, leading to a higher likelihood of the development of suicidal thoughts according to mental care professionals. Additionally, bisexual youth face an even higher likelihood of suicidality, with reports indicating that they are five times more likely to report suicidal thoughts and actions. [20] [21] Bisexuality also carries a higher likelihood of suicidality with bisexuals being five times more likely to report suicidal thoughts and actions. [20] Sexual minority youth also report a higher incidence of substance abuse when compared to heterosexuals. [20] Overall, studies suggest that sexual minority youth carry a higher incidence of suicide and depression, and that reforms centered on alleviating minority stigma attenuate this disparity. [22] In conclusion, sexual minority youth face elevated rates of depression, self-harm, and suicidality due to a combination of societal discrimination, familial rejection, and lack of support. Addressing these mental health disparities requires comprehensive efforts to reduce minority stress, promote social support, and provide affirming mental health services. By addressing the unique challenges faced by sexual minority youth, we can work towards creating more inclusive and supportive environments that foster positive mental health outcomes for all individuals, regardless of sexual orientation or gender identity. [23]

Previous exposure, attempts, and age impacting youth suicide

Exposure to suicide, previous attempts of suicide, and age are some of the most influential factors of young individuals and their probability of dying by suicide. Adolescent exposure to suicide through classmates has caused researchers to hypothesize suicide as a contagion. They note how a child's exposure to suicide predicts suicide ideation and attempts. [24] Previous exposure to suicide through parental attempts have also been found to have a 3.5% increase in a youth's probability of having suicidal thoughts, with a 2.6% increased chance of them attempting suicide. [25] Aggression in families and its transference can be one of the main causes of transmission of suicidal tendencies in families. [26]

Previous attempts of suicide also play a major role in a youth attempting suicide again. On average, it has been recorded that the follow-up period for suicide-attempters was 3.88 years. [27] Evidence shows those most at risk for suicide are those who previously attempted suicide, with research showing that they can have anywhere from a 40 to over a 100 times higher chance of dying by suicide compared to the general population. [28]

On average, it has been recorded that the follow-up period for suicide-attempters was 3.88 years. Evidence shows those most at risk for suicide are those who previously attempted suicide, with research showing that they can have anywhere from a 40 to over a 100 times higher chance of dying by suicide compared to the general population.

Age and experience also factor in suicide. It has been found that older, more experienced populations take more time to plan, choose deadlier methods, and have greater suicidal intent. This results in them eventually committing suicide at a higher rate than their younger counterparts. [29] A US nationwide study of adolescent suicides found increasing rates of firearm, poisoning, and hanging and asphyxiation suicides among American Indian and Alaska Native, Black, and Asian and Pacific Islander youth from 1999-2020. [30]

The International Association for Suicide Prevention looked at multiple different studies and accessed them based on what it being done and how successful certain methods are when it comes to suicide. When people received care from people such as (nurses, psychologists, or social workers) the rates of suicide depressed substantially. This is due to the fact that they received different resources and treatments such as psychotherapy that helped them with their depression. A specific program that seems to be quite successful is the IMPACT program which is an abbreviation for Improving Mood- Promoting Access to Collaborative Treatment. Those in this group experienced a greater quality of life, lower rates of depression, and suicidal ideation. Some key aspects of this program is the development of a therapeutic alliance, a personalized treatment plan that includes a patient's preferences, and proactive follow ups. Sometimes following up and going through these treatments can be a long process or even expensive which is why this study also explains how successful telephone counseling is as well. This type of intervention has been statistically proven to be successful.

Bereavement among young people

The primary goals of suicide postvention include assisting the survivors of suicide with the grief process, along with identifying and referring those survivors who may be at risk for negative outcomes such as depressive and anxiety disorders, and suicidal behavior. Experts in mental health stress the importance of postvention as a critical component of suicide prevention. Dr. Jane Smith, a leading psychologist specializing in grief counseling, explains, "Postvention is not only about helping survivors heal; it's also a proactive approach to prevent further tragedies. By closely supporting and monitoring those affected by a suicide, we can identify early signs of distress and intervene before another crisis occurs." This approach underscores the dual purpose of postvention—alleviating immediate grief and preventing future incidents by offering targeted support and resources. With 42% of youth suicides being suicide bereavement (or contagion) related – further research and investment must be made into supporting this group of people. A few suggestions to make sure the support is effective include making the individuals feel connected and understood. [31]

Epidemiology

Mental health is one of the largest causes of suicide and suicidal behaviors. Many people who have experienced trauma and abuse, result in struggles with mental health.

The National Institution of Health depicts the most common types of mental illness. Some being panic disorders, phobias, social anxiety disorder, OCD, PTSD, GAD, and depression, however, this is not to say there aren’t many other different disorders and mental illnesses out there.

Two possible determinants to suicide attempts are lifetime sexual abuse and adult physical violence. [32] Among participants aged 18–25, the odds ratios for lifetime sexual abuse and adult physical violence are 4.27 and 3.85, [32] respectively. In other words, those who died by suicide are 327% more likely to have experienced lifetime sexual assault. Similarly, a suicide victim is 285% more likely to have suffered physical violence as an adult. Based on a survey done on American high school students, 16% reported considering suicide and 8% reported attempting suicide sometime within the 12 months before taking the survey. [33] Between 1980 and 1994, the suicide rates of young black males doubled. American Indians and Alaska Natives die by suicide at a higher rate than any other ethnic group in the United States. [34] In India, one-third of suicides are young people 15–29. In 2002, 154,000 suicides were recorded in India. In the United States, about 60 percent of suicides are carried out with a gun. In states with stricter gun laws, gun suicide rates decreased over these past two decades. In these states with these stronger gun laws the rates of gun suicide among ages 10–24 was lower in 2022 than in 1999. Some Aboriginal teens and gay or lesbian teens are at high risk, depending on their community and their own self-esteem. Several campaigns have been started to give them hope and help them to feel less isolated.

The 2019 Youth Risk Behavior Survey, which the CDC conducted, found that between 2009 and 2018, suicide rates among adolescents aged 14–18 years increased by 61.7%. [35] Furthermore, the CDC reported that in 2019, among American adolescents in grades 9 to 12: [35]

Intervention

One organization in Australia has found that young people who feel connected, supported, and understood are less likely to die by suicide. It is understood that many young people who struggle with suicidal thoughts and behaviors often feel alone or like nobody understands how they feel, so it is extremely important to make them feel connected with their community. The National Center for Biotech Information explains that “Multiple meta-regression analyses were conducted to explore the influence of school connectedness” giving results that show the more connected peers are, the lower the risk is of suicidal thoughts and behaviors. "LGBTQ youth who report having at least one accepting adult were 40% less likely to report a suicide attempt in the past year, Over one quarter of LGBTQ youth who did not have at least one supporting or accepting adult in their life (over 17%) reported attempting suicide in the past year.” [36] The COVID-19 pandemic has likely exacerbated these situations for LGBTQ youth. [37] [38]

Reports on the attitudes of young people identified as at risk of suicide have been released. [39] Such reports support the notion that connectedness, a sense of being supported and respected, is a protective factor for young people at risk of suicide. According to Pueblo Suicide Prevention Center (PSPC) for some reason kids today are experiencing more pressure.[ citation needed ] There are many strategies that one can do to be more supported and connected with others, like joining a club or support group and becoming more involved with the community. Spending more time with others and creating a close and trusted community can be very supportive like a safe space. Engaging in new activities or becoming more involved in different hobbies can be a great way to become more connected and feel more secure and supported by others.

Events that bring people together for the cause can be very impactful for awareness and connection. Be the voice.jpg
Events that bring people together for the cause can be very impactful for awareness and connection.

For immediate help, one can contact SAMHSA's National Suicide Prevention Lifeline at 1-800-273-TALK (8255). [40]

Issues for communities

Intervention issues for communities to address include suicide contagion, developmental understanding of suicide, development and suicide risk, and the influence of culture. [30] Implement responsible media reporting guidelines to minimize sensationalization of suicide, train gatekeepers (such as teachers, healthcare providers, and community leaders) to recognize and respond to warning signs, and promote positive coping mechanisms and help-seeking behaviors. [30]

Mental health issues and the effects of it can be highly contagious between others, and the National Institutes of health calls it an “infectious disease”. This comes from who we are around a lot, and interact with and this can highly affect people and can generate real feelings of mental illness. [41]

Key matters in postvention responses for young people include: community context, life stage relevance of responses, identification, and referral (Postvention Co-ordination), developing a suite of services, and creating ongoing options. By addressing these key matters in postvention responses for young people, communities can provide effective support and promote healing in the aftermath of a suicide loss. Collaboration, cultural sensitivity, and a focus on the unique needs of young people are essential for developing comprehensive and sustainable postvention strategies.

Prevention

Crisis hotlines, such as the 988 Suicide & Crisis Lifeline, enable people to get immediate emergency telephone counselling. 988 Suicide & Crisis Lifeline logo - navy - square.svg
Crisis hotlines, such as the 988 Suicide & Crisis Lifeline, enable people to get immediate emergency telephone counselling.

One can help prevent adolescent suicide by discouraging isolation, addressing a child's depression which is correlated with suicide, getting rid of any objects that a child could use to attempt suicide, and simply paying attention to what the child does or feels. [42] Schools can also play an important part by encouraging adolescents to engage in social activities and fostering a sense of belonging, helping to prevent or lessen feelings of isolation. [30]

Incorporating suicide prevention education into the school curriculum can increase awareness, reduce stigma, and provide students with the knowledge and skills to recognize warning signs in themselves and their peers. Age-appropriate discussions about mental health, coping strategies, and help-seeking behaviors can be integrated into various subjects or delivered through specialized programs. [43]

When students think that they are unsafe or unaccepted it is often due to bullying from other students, not necessarily the school itself (although the kinds of environments fostered by schools can also contribute).[ citation needed ] Implementing strict policies regarding bullying and/or harassment would greatly benefit students because victims are more likely to consider suicide due to a lack of support from schools and adults. [44]

As food insecurity contributes to suicidal thoughts and behaviour in adolescents, targeting this social disadvantage could be an important part of suicide prevention, particularly in countries where food insecurity is uncommon. [13]

Green beads represents a person struggle or attempt I Chose To Be Brave.jpg
Green beads represents a person struggle or attempt

Suicide Prevention Resource Center provides professional information and resources on suicide prevention.

Prevention resources for parents, guardians, social workers, teachers, school staff, peers:

National Suicide Prevention Lifeline for Youth provides resources and information for teens and adolescents such as:

Table of youth suicide rates (per 100,000)

CountryYear of DataRate of MalesRate of FemalesTotal
Sri Lanka198643.949.346.5
Lithuania200238.48.823.9
Russian Federation200238.58.323.6
Kazakhstan200231.210.521.0
Luxembourg200223.58.216.0
New Zealand200022.38.215.3
El Salvador199313.215.814.5
Belarus200123.63.914.0
Estonia200224.11.913.2
Turkmenistan199816.68.812.8
Ukraine200019.64.912.4
Ireland200019.84.312.3
Mauritius200010.112.511.3
Norway200115.36.210.9
Canada200016.35.210.8
Latvia200216.94.410.8
Kyrgyzstan200215.24.810.0
Austria200215.13.89.6
Trinidad and Tobago19948.910.59.6
Finland200215.03.89.5
Uzbekistan200012.56.49.5
Belgium199714.53.99.3
Cuba19966.112.59.2
Ecuador19916.911.49.1
Australia200113.83.88.9
Singapore20019.27.88.5
Poland200114.12.48.4
Switzerland200012.64.08.4
Croatia200214.02.18.2
US200013.02.78.0
Slovenia198712.03.17.6
Hungary200211.23.87.5
Japan20008.83.86.4
Uruguay19908.33.96.2
Bulgaria20029.22.35.8
Czech Republic20019.51.85.7
Argentina19967.14.05.6
Costa Rica19957.14.05.6
Germany20018.72.45.6
Thailand19946.15.15.6
Colombia19946.74.25.5
Venezuela19947.13.85.5
Republic of Korea20015.94.95.4
Hong Kong19995.15.35.2
France19997.52.55.0
Denmark19999.00.74.9
Israel19998.70.04.9
Romania20027.02.24.7
Netherlands20007.41.84.6
Sweden20015.72.84.3
Brazil*19955.72.64.2
Puerto Rico19928.30.04.2
United Kingdom19996.51.84.2
Republic of Moldova20027.11.14.1
China*19993.24.84.0
Slovakia20025.81.93.9
Chile19946.21.33.8
Mexico19955.12.33.7
Spain20005.31.43.4
Panama19874.61.63.1
Albania20012.83.33.0
Dominican Republic19852.73.22.9
Italy20003.61.72.7
Macedonia20001.23.72.4
Tajikistan19993.30.92.1
Portugal20002.60.91.8
Greece19992.70.61.7
Peru19831.30.71.0

Information taken from World Psychiatry, the official journal of the World Psychiatric Association. [50] Numbers are per 100,000.

See also

Related Research Articles

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<span class="mw-page-title-main">LGBTQ health in South Korea</span>

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References

  1. ↑ Gould, Madelyn S.; Greenberg, Ted; Velting, Drew M.; Shaffer, David (April 2003). "Youth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years". Journal of the American Academy of Child & Adolescent Psychiatry. 42 (4): 386–405. doi:10.1097/01.CHI.0000046821.95464.CF. PMID   12649626.
  2. ↑ The Commission for Children and Young People and Child Guardian[ full citation needed ]
  3. ↑ "Suicide". National Institute of Mental Health (NIMH). Retrieved 27 March 2023.
  4. ↑ "AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health". www.aap.org. Retrieved 27 March 2023.
  5. ↑ Radhakrishnan, Lakshmi (2022). "Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic — United States, January 2019–January 2022". MMWR. Morbidity and Mortality Weekly Report. 71 (8): 319–324. doi: 10.15585/mmwr.mm7108e2 . ISSN   0149-2195. PMID   35202358.
  6. 1 2 Swanson, Sonja A.; Colman, Ian (9 July 2013). "Association between exposure to suicide and suicidality outcomes in youth". Canadian Medical Association Journal. 185 (10): 870–877. doi:10.1503/cmaj.121377. ISSN   0820-3946. PMC   3707992 . PMID   23695600.
  7. ↑ SunnyKids 2010[ full citation needed ]
  8. ↑ "Federal Parliament Health and Ageing Standing Committee Inquiry into Youth Suicide". Archived from the original on 8 January 2011.
  9. ↑ Melhem, Nadine; Moutier, Christine Yu; Brent, David A. (April 2023). "Implementing Evidence-Based Suicide Prevention Strategies for Greatest Impact". FOCUS. 21 (2): 117–128. doi:10.1176/appi.focus.20220078. ISSN   1541-4094. PMC   10172552 . PMID   37201145.
  10. ↑ Picard, André (28 September 2011). "A four-part action plan in the battle against teen suicide". The Globe and Mail . Retrieved 13 October 2011.
  11. ↑ Rengasamy, Manivel; Sylvester, Christie; Shulman, Joshua; Pizon, Anthony (2020). "Contemporary Characteristics and Lethality Correlates of Serious Suicide Attempts in Children and Adolescents". Suicide and Life-Threatening Behavior. 50 (3): 714–723. doi:10.1111/sltb.12615. PMID   32003058. S2CID   210983176 . Retrieved 27 October 2020.
  12. ↑ "Teen Suicide Causes and Issues". Teen Suicide Statistics. Retrieved 26 April 2012.
  13. 1 2 Steare, Thomas; Lewis, Gemma; Evans-Lacko, Sara; Pitman, Alexandra; Rose-Clarke, Kelly; Patalay, Praveetha (11 December 2023). "Food Insecurity, Adolescent Suicidal Thoughts and Behaviors, and Country-Level Context: A Multi-Country Cross-Sectional Analysis". Journal of Adolescent Health. 74 (3): 545–555. doi:10.1016/j.jadohealth.2023.10.018. PMC   11139653 . PMID   38085207.
  14. ↑ Kastenbaum, Robert J. (2012). Death, Society, and Human Experience. Boston: Pearson. pp. 199–200. ISBN   978-0-205-00108-8.
  15. ↑ Rick Mercer joins the It Gets Better campaign. CBC News, 2010-11-02. Retrieved 2011-10-13.
  16. ↑ Born This Way Paul V. creates a safe online haven for LGBT teens as a suicide prevention measure. Huffington Post, 2011-10-12. Retrieved 2011-10-13.
  17. ↑ "Kiwi Commons created the "I Get Bullied Too!" campaign to help amplify the voices of bullying and digital abuse victims". Facebook . 1 October 2011. Retrieved 2 December 2011.[ better source needed ]
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  20. 1 2 3 4 Marshal, Michael P.; Dietz, Laura J.; Friedman, Mark S.; Stall, Ron; Smith, Helen A.; McGinley, James; Thoma, Brian C.; Murray, Pamela J.; D'Augelli, Anthony R. (August 2011). "Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review". Journal of Adolescent Health. 49 (2): 115–123. doi:10.1016/j.jadohealth.2011.02.005. PMC   3649127 . PMID   21783042.
  21. ↑ Suicidality Disparities by Sexual Identity Persist from Adolescence into Young Adulthood (Report). The Trevor Project. 31 August 2021. Archived from the original on 29 October 2021.
  22. ↑ Kennedy, Andrew; Genç, Murat; Owen, P. Dorian (2021). "The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis". Journal of Adolescent Health. 68 (6): 1176–1182. doi:10.1016/j.jadohealth.2021.01.033. ISSN   1054-139X. PMID   33812751. S2CID   233028334.
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  35. 1 2 Ivey-Stephenson, Asha Z. (2020). "Suicidal Ideation and Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019". MMWR Supplements. 69 (1): 47–55. doi: 10.15585/mmwr.su6901a6 . ISSN   2380-8950. PMC   7440198 . PMID   32817610.
  36. ↑ The Trevor Project Research Brief: Accepting Adults Reduce Suicide Attempts Among LGBTQ Youth (PDF) (Report). The Trevor Project. June 2019.
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