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- Definition: Number of hospital discharges among children and youth ages 5-20 for non-fatal self-inflicted injuries (e.g., in 2015, there were 3,136 hospitalizations for self-inflicted injuries among California children and youth).Number of hospital discharges for non-fatal self-inflicted injuries per 100,000 children and youth ages 5-20 (e.g., in 2015, there were 36.5 hospitalizations for self-inflicted injuries per 100,000 California children and youth).
- Data Source: California Dept. of Public Health, EpiCenter (Feb. 2020); California Dept. of Finance, Population Estimates and Projections (Jan. 2020); CDC, WISQARS (May 2020).
- Footnote: Data are based on the number of hospitalizations, not the number of children hospitalized. Data are limited to hospital admissions; emergency room visits that do not result in admission are excluded. County-level data reflect the patient's county of residence, not the county in which the hospitalization occurred. The most common types of non-fatal self-inflicted injuries are related to poisoning and cutting or piercing. Due to coding changes in mid-2015, data for 2015 may not be comparable with data from earlier years. The notation S refers to rates that have been suppressed because there were fewer than 20 discharges for self-inflicted injuries. N/A means that data are not available.
- Measures of Youth Suicide and Self-Inflicted Injury on Kidsdata.org
Kidsdata.org provides the following indicators of youth suicide and self-inflicted injury:
Data on student suicidal ideation come from the California Healthy Kids Survey (CHKS). State-level CHKS estimates, although derived from the Biennial State CHKS, may differ from data published in Biennial State CHKS reports due to differences in grade-level classification of students in continuation high schools.
- The percentage of students in grades 9, 11, and non-traditional programs who seriously considered attempting suicide in the previous year, by grade level, gender, level of school connectedness,* parent education level, race/ethnicity, and sexual orientation
- The rate of suicide per 100,000 youth ages 15-24, along with the number of youth suicides by age group, gender, and race/ethnicity
- The number and rate of hospital discharges for self-inflicted injuries among children and youth ages 5-20 overall, and the number of discharges by age group
*Levels of school connectedness are based on a scale created from responses to five questions about feeling safe, close to people, and a part of school, being happy at school, and about teachers treating students fairly.
- Youth Suicide and Self-Inflicted Injury
- Suicidal Ideation (Student Reported), by Grade Level
- Number of Youth Suicides, by Age Group
- Youth Suicide Rate
- Self-Inflicted Injury Hospitalizations
- Children's Emotional Health
- Hospitalizations for Mental Health Issues, by Age Group
- Depression-Related Feelings, by Grade Level
- Youth Needing Help for Emotional or Mental Health Problems
- Students at School Are Well Behaved (Staff Reported)
- Student Depression or Mental Health Is a Problem at School (Staff Reported)
- School Emphasizes Helping Students with Emotional and Behavioral Problems (Staff Reported)
- Pupil Support Services
- Number of Pupil Support Service Personnel, by Type of Personnel
- Ratio of Students to Pupil Support Service Personnel, by Type of Personnel
- School Provides Adequate Counseling and Support Services for Students (Staff Reported)
- School Provides Services for Substance Abuse or Other Problems (Staff Reported)
- School Collaborates with Community Organizations to Address Youth Problems (Staff Reported)
- School Climate
- School Connectedness (Student Reported), by Grade Level
- School Supports (Student Reported), by Grade Level
- Caring Relationships with Adults at School (Student Reported), by Grade Level
- High Expectations from Adults at School (Student Reported), by Grade Level
- Meaningful Participation at School (Student Reported), by Grade Level
- Adults at School Care About Students (Staff Reported)
- Adults at School Believe in Student Success (Staff Reported)
- School Welcomes and Facilitates Parent Involvement (Staff Reported)
- School Gives Students Opportunities to Make a Difference (Staff Reported)
- School Fosters Youth Resilience or Asset Promotion (Staff Reported)
- Hospital Use
- Why This Topic Is Important
Suicide is the second leading cause of death among young people ages 10-19 in the U.S., and rates of youth suicide and self-injury hospitalization are on the rise, especially among younger adolescents (1, 2). A 2019 survey estimated that about 1 in 5 high school students nationwide seriously considered suicide in the previous year, a figure more than 35% higher than findings from a decade earlier (3). Between 2007 and 2015, suicide rates rose 130% for U.S. children ages 10-14 and 46% for youth ages 15-19 (2). Similar to suicide trends, from 2001 to 2015 self-injury hospitalization rates increased by more than 130% for ages 10-14 and by 47% for ages 15-19 (2). While self-inflicted injuries typically are not the result of suicide attempts and do not involve intent to die, non-suicidal self-injury (NSSI) is a risk factor for suicide (4). Data from a 2015 national survey show that 18% of high school students had engaged in NSSI at least once in the previous year, and 6% had engaged in NSSI six or more times (4).
Suicide risk is higher for some groups than for others. While female youth more often attempt suicide, males are more likely than females to die by suicide—although the gap is narrowing (1, 3). Nationally, American Indian/Alaska Native youth have the highest suicide rate among racial/ethnic groups with data (2). In addition, sexual and gender minority youth are more likely to engage in suicidal behavior than their non-LGBTQ peers (3, 5). Other common risk factors for youth suicide include mental illness, past suicide attempts, a family history of suicide or mental disorders, poor family communication, stressful life events, access to lethal means, and exposure to suicidal behavior of others (6).Find more information about youth suicide and self-injury in kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Ruch, D. A., et al. (2019). Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA Network Open, 2(5), e193886. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733430
2. Ballesteros, M. F., et al. (2018). The epidemiology of unintentional and violence-related injury morbidity and mortality among children and adolescents in the United States. International Journal of Environmental Research and Public Health, 15(4), 616. Retrieved from: https://www.mdpi.com/1660-4601/15/4/616
3. Centers for Disease Control and Prevention. (2020). Youth Risk Behavior Survey: Data summary and trends report 2009-2019. Retrieved from: https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm
4. Westers, N. J., & Culyba, A. J. (2018). Nonsuicidal self-injury: A neglected public health problem among adolescents. American Journal of Public Health, 108(8), 981-983. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050854
5. Johns, M. M., et al. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report, 68(3), 67-71. Retrieved from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a3.htm
6. Bilsen, J. (2018). Suicide and youth: Risk factors. Frontiers in Psychiatry, 9, 540. Retrieved from: https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00540/full
- How Children Are Faring
In 2017-2019, an estimated 16% of California 9th and 11th graders and 17% of non-traditional students seriously considered attempting suicide in the previous year. At least 20% of girls in each grade level seriously considered suicide, compared with less than 13% of boys. Students with low levels of school connectedness were much more likely to have serious suicidal thoughts (32%) than their peers with medium (19%) or high (9%) connectedness. The proportion of gay, lesbian, and bisexual youth who seriously considered attempting suicide (44%) was about one and a half times the estimate for students unsure of their sexual orientation (29%) and more than three times the estimate for straight youth (13%).
The rate of hospitalization for non-fatal self-inflicted injuries among California children and youth ages 5-20 was 37 per 100,000 in 2015, down from 49 per 100,000 in 1991. While the state's rate of self-inflicted injury hospitalization has fluctuated over time, it has remained lower than the U.S. rate since 2010. Across counties with data in 2015, hospitalization rates for self-injury ranged from 22 per 100,000 young people (San Bernardino) to 68 per 100,000 (San Mateo). Youth ages 16-20 account for the majority of discharges for self-inflicted injuries statewide: 1,949 of 3,136 in 2015 (62%).
In 2019, 157 California teens ages 15-19 and 341 young adults ages 20-24 were known to have committed suicide. The rate of suicide among youth ages 15-24 in 2017-2019 was 8.9 per 100,000, up from 6.7 per 100,000 in 1999-2001. Over this period California's youth suicide rate was consistently lower than the U.S. rate, which rose from 10 suicides per 100,000 to 14.3 per 100,000. Statewide and nationally, many more male than female youth die by suicide; in 2019, males accounted for more than 80% of youth suicides in California (402 of 498).
- Policy Implications
Youth suicide and self-inflicted injury are complex issues that are not caused by any single factor. Addressing these prevalent, preventable public health problems requires comprehensive, cross-sector commitments focused on risk and protective factors at the individual, family, community, and system levels (1, 2). Additionally, experts recommend that policy strategies go beyond preventing and treating problems to promoting positive mental health (1, 3).
Screening, early identification, access to services, and receipt of services are critical in preventing and reducing mental health problems associated with suicidal behavior (2). Youth who hurt themselves without suicidal intent are at risk for suicide and do not often seek treatment (4). In fact, most youth who need mental health services, in general, do not receive them (3, 5).
California law requires public school districts and charter schools serving grades 7-12 to establish suicide prevention policies that address high-risk groups, including LGBTQ youth, those who are homeless or in out-of-home settings, youth bereaved by suicide, and youth with mental health problems, disabilities, or substance use disorders (1).
Policy and practice options to prevent suicide and self-injury and promote youth mental health include:
For more policy ideas and information on this topic, see kidsdata.org’s Research & Links section or visit the Suicide Prevention Resource Center, Centers for Disease Control and Prevention, and Self-Injury Outreach and Support. Also see Policy Implications for related topics in kidsdata.org’s Emotional and Behavioral Health category.
- Continuing to support K-12 schools in creating positive school climates and implementing a whole-child approach to education that includes evidence-based systems to address students’ physical, emotional, behavioral, and other needs; related to this, promoting efforts to integrate social-emotional learning—such as problem-solving, help-seeking, and coping skills—into PreK-12 education (1, 2, 6, 7)
- In accordance with California law, ensuring effective implementation of suicide prevention policies in public and charter schools serving grades 7-12; also, encouraging K-6 and private schools to establish similar policies, and urging all schools to develop clear protocols for addressing non-suicidal self-injury (1, 6)
- Assuring adequate training for those who work directly with youth—teachers, school staff, coaches, clergy, juvenile justice staff, and others—to recognize signs of suicidal behavior and self-injury and to respond effectively, including helping youth find and receive services (1, 2, 6)
- Promoting health care systems change to support mental health and prevent suicide and self-injury, including enhanced workforce training, systematic screening and risk assessment, and improved coordination and continuity of care (2)
- Ensuring that all youth with mental health needs have access to high-quality, culturally appropriate services with consistent coverage through insurance plans; as part of this, expanding the workforce of qualified mental health professionals, especially in underserved communities (2)
- Ensuring that families have access to affordable, high-quality parenting and relationship skills programs, which help improve family interactions and children's emotional health (2)
- Promoting community efforts to provide youth with connections to caring adults and access to safe, positive activities, such as quality mentoring, after-school, and social norming programs, particularly in communities with limited resources (1, 2)
- Promoting local strategies to reduce access to lethal means (e.g., bridges and railway tracks) and improve safe storage of medications, firearms, and other lethal items (2)
- Supporting public education to reduce the stigma associated with mental illness, increase help-seeking, and improve knowledge of warning signs and appropriate responses (2, 6)
- Encouraging media to avoid sensationalizing youth suicide (e.g., by keeping coverage brief and not explicit), which can help prevent contagion, and to balance suicide coverage with prevention messages, stories of hope, and resources for help (2)
Sources for this narrative:
1. Joshi, S. V., et al. (2017). K-12 toolkit for mental health promotion and suicide prevention. HEARD Alliance. Retrieved from: https://www.heardalliance.org/help-toolkit
2. Stone, D. M., et al. (2017). Preventing suicide: A technical package of policy, programs, and practices. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf
3. Murphey, D., et al. (2014). Are the children well? A model and recommendations for promoting the mental wellness of the nation's young people. Child Trends & Robert Wood Johnson Foundation. Retrieved from: https://www.childtrends.org/publications/are-the-children-well-a-model-and-recommendations-for-promoting-the-mental-wellness-of-the-nations-young-people
4. Lewis, S. P., et al. (2019). Addressing self-injury on college campuses: Institutional recommendations. Journal of College Counseling, 22(1), 70-82. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1002/jocc.12115
5. As cited on kidsdata.org, Youth needing help for emotional or mental health problems, by receipt of counseling. (2021). California Health Interview Survey.
6. Whitlock, J., & Hasking, P. (2017). Hurting from the inside out: Understanding self-injury. Educational Leadership, 7(4), 24-30. Retrieved from: https://www.ascd.org/el/articles/hurting-from-the-inside-out-understanding-self-injury
7. Alliance for Continuous Improvement. (n.d.). California education GPS. Californians Dedicated to Education Foundation. Retrieved from: https://www.caledgps.org
- Websites with Related Information
- American Foundation for Suicide Prevention
- California Children’s Trust
- California Dept. of Education: Youth Suicide Prevention
- Child Mind Institute
- Children's Mental Health. Centers for Disease Control and Prevention.
- Cornell Research Program for Self-Injury Recovery: Self-Injury and Recovery Resources
- HEARD Alliance (Health Care Alliance for Response to Adolescent Depression)
- MentalHealth.gov. U.S. Dept. of Health and Human Services.
- National Action Alliance for Suicide Prevention. Education Development Center.
- Recommendations for Reporting on Suicide. ReportingOnSuicide.org.
- Self-Injury Outreach and Support. University of Guelph & McGill University.
- Stanford Center for Youth Mental Health and Wellbeing. Stanford Medicine.
- Suicide Prevention. Centers for Disease Control and Prevention.
- Suicide Prevention Resource Center. University of Oklahoma Health Sciences Center.
- Tribal Training and Technical Assistance Center: Suicide Prevention Resources. Substance Abuse and Mental Health Services Administration.
- VetoViolence. Centers for Disease Control and Prevention.
- Youth.gov. Interagency Working Group on Youth Programs.
- Key Reports and Research
- Addressing Self-Injury on College Campuses: Institutional Recommendations. (2019). Journal of College Counseling. Lewis, S. P., et al.
- California Reducing Disparities Project: Strategic Plan to Reduce Mental Health Disparities. (2018). California Pan-Ethnic Health Network.
- Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- Hospitalization for Suicide Ideation or Attempt: 2008–2015. (2018). Pediatrics. Plemmons, G., et al.
- Hurting from the Inside Out: Understanding Self-Injury. (2017). Educational Leadership. Whitlock, J., & Hasking, P.
- K-12 Toolkit for Mental Health Promotion and Suicide Prevention. HEARD Alliance. Joshi, S. V., et al.
- National Estimate of LGBTQ Youth Seriously Considering Suicide. (2019). Trevor Project. Green, A. E., et al.
- National Strategy for Suicide Prevention: Implementation Assessment Report. (2017). Substance Abuse and Mental Health Services Administration.
- Overview of Homicide and Suicide Deaths in California. (2019). California Dept. of Public Health.
- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity. (2015). California Dept. of Public Health, Office of Health Equity.
- Preventing Suicide: A Technical Package of Policy, Programs, and Practices. (2017). Centers for Disease Control and Prevention. Stone, D. M., et al.
- Self-Injury – A General Information Guide. (2018). Self-Injury Outreach and Support.
- Suicide After Deliberate Self-Harm in Adolescents and Young Adults. (2018). Pediatrics. Olfson, M., et al.
- The Epidemiology of Unintentional and Violence-Related Injury Morbidity and Mortality Among Children and Adolescents in the United States. (2018). International Journal of Environmental Research and Public Health. Ballesteros, M. F., et al.
- Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016. JAMA Network Open. Ruch, D. A., et al.
- County/Regional Reports
- 2021 California County Scorecard of Children's Well-Being. Children Now.
- Annual Report on the Conditions of Children in Orange County. Orange County Children's Partnership.
- Community Health Improvement Plan for Los Angeles County. Los Angeles County Dept. of Public Health.
- Los Angeles County Youth Suicide Prevention Project. Los Angeles County Dept. of Mental Health & Los Angeles County Office of Education.
- San Mateo County All Together Better. San Mateo County Health.
- Undetermined Risk Factors for Suicide Among Youth, Ages 10-24 – Santa Clara County, CA, 2016. (2017). Santa Clara County Public Health Dept.
- More Data Sources For Youth Suicide and Self-Inflicted Injury
- California School Climate, Health, and Learning Surveys Public Dashboards. WestEd & California Dept. of Education.
- FastStats: Injuries. National Center for Health Statistics.
- Health, United States, 2019 – Data Finder. National Center for Health Statistics.
- Mental Health Data and Publications. Centers for Disease Control and Prevention.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Data. U.S. Dept. of Health and Human Services.
- Youth Risk Behavior Surveillance System (YRBSS). Centers for Disease Control and Prevention.
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