Self-Inflicted Injury Hospitalizations

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Learn More About Youth Suicide and Self-Inflicted Injury

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.

*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
Bullying and Harassment at School
Children's Emotional Health
Deaths
Pupil Support Services
Hospital Use
Youth Alcohol, Tobacco, and Other Drug Use
School Climate
Injuries
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 2017 survey estimated that more than 1 in 6 high school students nationwide seriously considered suicide in the previous year, a figure nearly 20% 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 in the previous year 18% of high school students had engaged in NSSI at least once, 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. (2018). Youth Risk Behavior Survey: Data summary and trends report 2007-2017. Retrieved from: https://npin.cdc.gov/publication/youth-risk-behavior-survey-data-summary-trends-report-2007-2017

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 2015-2017, an estimated 16% of California 9th and 11th graders and 12% of non-traditional students seriously considered attempting suicide in the previous year; in Grades 9 and 11, at least 20% of girls seriously considered suicide, compared with less than 12% 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 (46%) was more than three times the estimate for straight youth (12%) and more than double the estimate for students unsure of their sexual orientation (22%).

The rate of hospitalization for non-fatal self-inflicted injuries among California children and youth ages 5-20 was 43 per 100,000 in 2014, 25% lower than the U.S. rate of 58 per 100,000. While the state's rate of self-inflicted injury hospitalization has fluctuated over time, and has been on the rise since 2011, the latest figures are similar to those recorded 20 years earlier. Across counties with data in 2014, hospitalization rates for self-injury ranged from 24 per 100,000 young people (Riverside) to 71 per 100,000 (San Mateo). Youth ages 16-20 account for the majority of discharges for self-inflicted injuries statewide: 2164 of 3575 in 2014 (61%).

In 2016, 176 California teens ages 15-19 and 294 young adults ages 20-24 were known to have committed suicide. Statewide, the rate of youth suicide was 7.7 per 100,000 in 2014-2016, down from 9.4 per 100,000 in 1995-1997. Since 1999-2001—the first time period for which national comparison data are available—California's youth suicide rate has been lower than the U.S. rate, which has risen above 10 per 100,000 in recent years. Statewide and nationally, many more male than female youth die by suicide; in 2016, males accounted for more than three-quarters of youth suicides in California (372 of 470).
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:
  • 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)
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.

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: http://www.heardalliance.org/help-toolkit

2.  Stone, D. M., et al. (2017). Preventing suicide: A technical package of policy, programs, and practices. National Center for Injury Prevention and Control. 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/full/10.1002/jocc.12115

5.  As cited on kidsdata.org, Youth needing help for emotional or mental health problems, by receipt of counseling (California and L.A. County only). (2020). 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: http://www.ascd.org/publications/educational_leadership/dec17/vol75/num04/Hurting_From_the_Inside_Out@_Understanding_Self-Injury.aspx

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
Key Reports and Research
County/Regional Reports
More Data Sources For Youth Suicide and Self-Inflicted Injury