The Rise and Child Suicide Stigma

The Rise and Child Suicide Stigma

Note: this is part of the Youth Suicide Rise project.

Decreasing stigma of suicide could lead to increasing likelihood of fatal injuries being classified as suicides, especially when the deceased are children (due to the greater role of families in providing information and influencing coroners).

CDC Fatal Injury data classify Intent as Homicide/Suicide/Unintentional/Undetermined.  It is not specified which injuries classified as Unintentional/Undetermined were self-inflicted.

We will presume that nearly all child suffocation deaths -- unlike firearm deaths -- are self-inflicted. This presumption is supported by data: the ratio of suicide to homicide is more than 10:1 for child suffocation (but less than 1:1 for child firearm deaths).

Let us examine suffocation deaths of age groups 10-14, 15-19, and 30-59; we will sum Unintentional and Undetermined Intent suffocation as Accidents and sum Suicides and Accidents as Self-Inflicted deaths.

Share of Suffocation Deaths

Let us now look at the share of Accidents versus Suicides in all Self-Inflicted suffocation deaths:

As we can see, the share of accidents has decreased from 38% in 2007 to 13% in 2015 for tween kids (10-14), a very rapid decline (the 3-year average decreased from 35% in 2005-07 to 15% in 2016-18).

Age group 15-19 had a decrease from 9% to 4%, with the 3-year average decrease from 10% to 5%.

Middle-aged adults had a decrease from 20% to 13%, with the 3-year average decrease from 21% to 14%.

Question: why is the accidents share of non-homicide suffocation so much smaller for youth (age 15-19) than it is for middle-aged adults (age 30-59)?


Potential Impact

Let us for a moment presume that these declines are mainly caused by a decreasing stigma attached to suicide, and that they apply similarly to other suicide methods.

Let us also presume that declines in stigma lead to more accurate suicide classifications; from this we would conclude that in 2005-07 there were actually 31% more suicides in age group 10-14 and only 6% more actual suicides in age group 15-19.

Without adjusting for stigma, suicide increased from 2005-07 to 2016-18 by 136% and 56% for age groups 10-14 and 15-19, respectively.

With adjustment for stigma, suicide increased from 2005-07 to 2016-18 by 80% and 47% for age groups 10-14 and 15-19, respectively.

Despite stigma having a large potential impact, the rise of suicide within the younger (tween) age group is still much greater than in the older teen group: instead of being three times as fast, it is twice as fast.


Youths and Adults

The potential impact of declining stigma, at least within this data analysis, would actually increase the difference between suicide rise among older teens (15-19) and middle-aged adults (30-59), since the adult counts in 2005-07 would have to be increase by a third (7%/21%).

Limitations

It is absolutely crucial to keep in mind that we did not link the declining share of accidents in self-inflicted suffocation to decrease in suicide stigma -- that is so far merely plausible speculation.

An alternative explanation could be that there has been a real decline in actual accidents, perhaps because parents are getting more protective regarding their children (compare how kids could roam outside alone in the past without supervision -- I suspect anyone over 30 has noticed huge changes in such areas of parenting).

Differentiating between these two plausible explanations is complicated and likely impossible with the data available in the CDC WISQAR tool.

Furthermore, the stigma explanation would impact middle-aged adults more than older teens, at least until more detailed data is available.


Conclusion:

If the decreasing share of 'accidental' suicides is caused by decreasing stigma of suicide, then 'true' suicide increases among younger teens would be less extreme but still considerably higher than those of older teens; furthermore, youths would still have far higher proportional increases in suicide than adults.

Thus decreasing suicide stigma is unlikely to explain why youth have a far higher suicide rise than adults or why younger teens have higher increases than older teens, but it remains a plausible explanation (subject to further analysis) for significantly reducing the extreme rises in younger child suicide rates.


Note:

Unintentional suffocation deaths are not decreasing for the age group 0-9 (e.g. 1150 in 2007, 1252 in 2017); however, it turns out these counts are dominated by infant deaths. By age 9 such deaths are so rare (in single digits per year) that any trend is dubious.

A wider analysis, such as looking at firearms data or overall accidents data, may illuminate the issue a bit more, but I am skeptical it can go far without more detailed data and without the insight of practitioners.

Technical note:

The 31% calculation: 20/65 since we presume the 65% share should have been 20 percentage points (not percents) higher.  Similarly for age 15-19 (5/90) and for adults (7/21).