Rates of Adolescent Suicidal Ideation in Self-Reported AI/AN race: A Cross Sectional Analysis of the Youth Risk Behavior Surveillance System

Background: Suicide is among the leading causes of death among children in the United States, ranking second among ages 10-14 and third among those 15-24. Non-Hispanic American Indian/Alaska Native (AI/AN) individuals are disproportionately impacted by suicide with a reported 28.1 out of 100,000 individuals dying from suicide. In an examination of suicidal ideation and suicide attempts among adolescent students aged 12-19 in the Minnesota Student Survey, individuals reported as AI/AN demonstrate elevated rates compared to other ethnic groups.¹ While current statistics indicate that the suicide rate is highest among non-Hispanic AI/AN, actual rates of suicide and suicidal ideation may vary due to the number of AI/AN individuals who are classified as multiracial. Thus, our primary objective was to compare the rates of suicidal ideation among adolescents using the calculated raceeth variable in the Youth Risk Behavior Surveillance System (YRBSS) to self-reported ethnoracial identity.

Methods: We conducted a cross-sectional analysis of the 2021 YRBSS survey to determine rates of suicidal ideation and suicidal attempts between AI/AN adolescents using the raceeth variable and self-reported ethnoracial categories that include AI/AN alone and in combination with other races—with and without Hispanic/Latino ethnicity (HL). We reported the sample rates and the population-weighted percentages using sampling weights and survey design provided by YRBSS.

Results: The population-weighted percentage of suicidal ideation for the AI/AN category of the raceeth variable was 27.3% and for suicide attempts was 21.85%— which corresponded to only those who self-reported as AI/AN alone (non-HL). Among other self-reported groups, those who only selected AI/AN race, but reported HL ethnicity, had rates of ideation and attempts of 25.1% and 22.13% respectively. While these groupings were similar, self-selected ethnoracial combinations with much higher percentages of suicidal ideation were AI/AN + White (HL) at 42.3%, AI/AN + Black or African American (non-HL) at 33.3%, and AI/AN + Black or African American + White (non-HL) at 41.05%. For suicide attempts, groups with the highest rates included self-reported as AI/AN + Black or African American + White (non-HL) at 43.6% and AI/AN + White (HL) at 32.43%.

Discussion: While the raceeth variable within YRBSS is in line with other national estimates of suicidality among AI/AN, our study demonstrates that those estimates are likely missing key segments of the AI/AN community. We found that rates of both suicidal ideation and attempts are much higher among adolescents reporting as AI/AN in combination with White with HL ethnicity and among who reported as non-HL, AI/AN in combination with Black or African American and White—both groups having rates 12-21% higher than AI/AN alone (non-HL) from the raceeth variable. Our study highlights the need for healthcare workers focused in pediatrics, family medicine, and psychiatry to be aware of these disparities, as well as the need for more public health research with an expanded view of Indigenous identity.