Exploring breakthroughs from the NIH Pathways to Prevention Workshop and the latest research on addressing this public health crisis
Imagine a classroom of twenty adolescents—statistically, five of them have seriously considered suicide in the past year, and two have actually attempted it. These aren't just numbers; they represent a deepening public health crisis that has been evolving for decades. Suicide is now the second leading cause of death for young people aged 10-24 in the United States, with rates that have been steadily rising 2 6 .
Suicide is the second leading cause of death among youth aged 10-24 in the United States.
Behind these sobering statistics lie heartbreaking personal stories and a complex scientific puzzle. What drives a young person to consider ending their life? Why do some groups face higher risks than others? Most importantly, how can we better identify at-risk youth and intervene before it's too late? These are the questions that prompted the National Institutes of Health (NIH) to convene a special Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide in 2016, bringing together leading experts to develop a road map for the future of suicide prevention 1 5 .
The Pathways to Prevention (P2P) program is the NIH's innovative approach to tackling complex public health issues that have incomplete or underdeveloped research. When it comes to youth suicide, the traditional fragmented approach wasn't working—researchers, clinicians, and community organizations needed to align their efforts. The workshop cosponsored by the NIH Office of Disease Prevention, National Institute of Mental Health, National Institute on Drug Abuse, and National Center for Complementary and Integrative Health represented a recognition that suicide prevention requires a collaborative, multidisciplinary approach 1 5 .
The workshop focused on five critical questions that would shape the next decade of research:
This comprehensive framework acknowledged that to prevent youth suicide effectively, the scientific community needed to address not just what we study, but how we study it.
Integrating perspectives from psychiatry, psychology, sociology, and public health
Linking multiple data sources for comprehensive understanding
Developing new approaches to identify and evaluate interventions
Recent research has revealed troubling patterns that are reshaping our understanding of youth suicide. One groundbreaking study published in the American Journal of Psychiatry analyzed data from over 119,000 high school students and found that in 2021, nearly one in four students reported suicidal ideation in the past year, while one in ten reported a suicide attempt 3 .
Youth with suicidal ideation
Youth suicide attempts
Black female youth at higher risk
Receiving treatment at time of death
Perhaps even more alarming were the disparities uncovered. While suicide affects youth from all backgrounds, the research identified particularly sharp increases in suicidal thoughts and behaviors among female, Black, and White students. A separate analysis of three large datasets revealed that Black girls are experiencing significantly higher rates of both suicidal ideation and suicide attempts compared to their White and male peers 3 .
| Metric | Overall Rate | High-Risk Groups | Key Findings |
|---|---|---|---|
| Suicidal Ideation | 22.5% 3 | Black female youth | Higher rates than White and male peers 3 |
| Suicide Attempts | 8.6% 3 | High school students (2021) | 1 in 10 students reported an attempt 3 |
| Rising Trends | Significant increases 2017-2021 | Students using cigarettes or cannabis | Disproportionately large increase in suicidal thoughts/attempts 3 |
| Mental Health Treatment | 24.3-30.3% 6 | Youth suicide decedents | Only quarter to third were receiving treatment at time of death 6 |
These findings challenged previous assumptions about which youth face the greatest suicide risk. The researchers pointed to several potential factors underpinning the elevated rates among Black girls, including "intimate partner violence, racial discrimination, cyberbullying, and underdiagnosis of depression" 3 .
Dr. Ran Barzilay, one of the lead researchers, expressed hope that "the evidence of elevated suicide ideation and attempts among Black adolescent girls leads to greater clinical awareness of the concern and an increase in suicide prevention efforts created for, and disseminated to, Black girls in particular" 3 .
One of the most significant recent studies in youth suicide prevention emerged from the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) study—a large-scale, NIMH-funded project that addressed a critical question: How can we best identify youth at risk for suicide in healthcare settings?
The ED-STARS researchers recruited 2,740 adolescents from emergency departments across the country, creating a geographically diverse sample. They compared two screening approaches: the Ask Suicide-Screening Questions (ASQ), a brief 4-item questionnaire, and the Computerized Adaptive Screen for Youth Suicide Risk (CASSY), a more sophisticated computerized assessment that adapts questions based on previous responses 7 .
The study design was rigorous and prospective—rather than just measuring concurrent suicidal thoughts, researchers followed participants for three months to see who actually attempted suicide. This approach provided crucial data on the predictive validity of the screens—not just whether they could identify current suicidal thoughts, but whether they could predict future suicide attempts 7 .
The findings were revealing. For adolescents who didn't present with behavioral health complaints, both screens performed similarly. However, for the growing number of youth arriving at EDs with behavioral health concerns, the CASSY screen performed significantly better at identifying those who would later attempt suicide 7 .
Perhaps equally important was the cost analysis. Researchers conducted a micro-analysis of site-specific personnel and resource costs and found that universal screening with CASSY cost just $5.77 per adolescent. When analyzing only those presenting with non-psychiatric complaints—patients who wouldn't typically receive mental health screening—the cost dropped to just $2.60 per adolescent 7 .
| Screening Tool | Format | Key Features | Best For | Cost Considerations |
|---|---|---|---|---|
| ASQ (Ask Suicide-Screening Questions) | 4-item self-report | Public domain, readily available | Patients with non-psychiatric complaints 7 | Free to use |
| CASSY (Computerized Adaptive Screen for Youth Suicide Risk) | Computerized adaptive (mean 11 items) | Adapts questions based on responses | Patients with behavioral health complaints 7 | Requires licensing and tablets |
| Columbia Suicide Severity Rating Scale (C-SSRS) | Triage version | Previously documented validity | Healthcare settings 7 | Available for clinical use |
These findings were particularly significant given that suicide is the second leading cause of death among adolescents. The study demonstrated that universal screening in emergency departments is both feasible and cost-effective—removing a major barrier to implementation in busy healthcare settings.
Advancing youth suicide prevention requires specialized tools and methodologies. From large-scale surveillance systems to targeted interventions, researchers have developed a diverse toolkit to address this complex public health challenge.
| Tool/Resource | Function | Application in Research |
|---|---|---|
| NVDRS (National Violent Death Reporting System) | Links multiple data sources (death certificates, coroner reports, law enforcement) | Provides comprehensive picture of circumstances surrounding suicide 6 |
| YRBSS (Youth Risk Behavior Surveillance System) | National survey of adolescent health behaviors and experiences | Tracks trends in suicidal ideation and attempts 3 |
| Gatekeeper Training Programs (QPR, SOS, safeTALK) | Educates professionals to recognize at-risk youth | Enhances early identification in schools and communities |
| Evidence-Based Psychotherapies (DBT-A, IPT-A) | Targeted treatment for suicidal youth | Reduces suicide risk in clinical populations 7 |
| Web-Based E-Learning Modules | Flexible training for gatekeepers | Improves knowledge and self-confidence in suicide prevention |
One promising development in the toolkit is the emergence of effective web-based gatekeeper training. A randomized controlled trial of the Mental Health Online program, consisting of 8 short e-learning modules, demonstrated significant improvements in gatekeepers' actual knowledge, perceived knowledge, and self-confidence in adolescent suicide prevention—with effects remaining significant at 3-month follow-up .
The versatility of this toolkit allows researchers and clinicians to implement strategies at multiple levels—from broad public health surveillance to targeted clinical interventions—creating a comprehensive approach to suicide prevention.
The NIH Pathways to Prevention workshop and subsequent research have highlighted several promising strategies for moving the field forward. The Blueprint for Youth Suicide Prevention, developed by the American Academy of Pediatrics in collaboration with the American Foundation for Suicide Prevention and experts from the National Institute of Mental Health, serves as an educational resource to support pediatric health clinicians 2 .
Identifies previously unrecognized risk at a reasonable cost in healthcare settings 7 .
Programs such as Sources of Strength increase perceptions of adult support for suicidal youths 6 .
Strengthening Families 10-14 improves parents' skills for communicating with their children 6 .
Research has identified acute warning signs that parents and community members can recognize. Youth and parents have independently identified suicidal communications, withdrawal from people and/or usual activities, and sleep problems as critical red flags 7 .
"Despite substantial effort, we have been unable to move the youth suicide rate downward in a significant and sustained manner. Suicide is widely considered to be a preventable, albeit frustratingly intractable, public health problem" 7 .
However, with improved data systems, enhanced screening methods, strengthened research collaborations, and targeted interventions for vulnerable populations, the scientific community is building the infrastructure needed to reverse these troubling trends.
The journey to prevent youth suicide requires integrating multiple approaches—from the emergency department to the school classroom to the family home. Through concerted scientific effort and collective action, we can create a future where fewer young lives are lost to suicide, and more youth receive the support they need during their most vulnerable moments.