Suicide and suicidal behavior among youth and young adults is a major public health crisis. Suicide is the 2nd leading cause of death among people 10-24 years of age in the United States (US), and rates have been rising for decades. Our children should grow, thrive, and live long, healthy lives; yet among youth in the US who die, over a quarter die from suicide.

As today’s youth navigate their social and emotional development, various forms of health inequities, systemic discrimination, and recent challenges from the COVID-19 pandemic have added stress and barriers to overall health. Stressors such as social isolation, losses, grief, academic and extracurricular disengagement, and financial hardships for families have exacerbated mental health symptoms and other suicide risk factors. According to a Centers for Disease Control and Prevention (CDC) report, the proportion of mental health–related emergency department (ED) visits for suicide attempts in early 2021 among adolescents 12–17 years of age increased 31% compared with the same period in 2019.

Suicide is complex but often preventable. Pediatric health clinicians, adults working with youth in school and community settings, families, and peers can play a critical role in identifying and supporting youth at risk for suicide. 

Suicide affects all populations. Youth of any race, ethnicity, gender identity, sexual orientation, socioeconomic status, or community may be at risk for suicide.

Health equity is critical to suicide prevention. Research shows significant disparities in suicide rates, risk, and care for youth across cultures and communities. Race is a social construct, and a history of systemic racism within the healthcare system and scientific research community has resulted in an evidence base that does not include sufficient information about trends in suicidal thoughts, behaviors, and risk factors among Black youth, Indigenous youth, Latino youth, Asian American youth, and youth from other communities of color. Few studies have fully assessed the impacts of racism, discrimination, and historical or intergenerational trauma on suicidal ideation among affected youth; yet research has shown that experience with discrimination impacts youths’ risk for suicidal thoughts. Furthermore, youth access to developmentally and culturally responsive mental health services is limited in many communities, clinics, and schools.

In order to truly serve all youth, there is a critical need for dedicated research and suicide prevention programs to support Black youth, Indigenous youth, Latino youth, Asian American youth, and youth who identify as lesbian, gay, bisexual, transgender, queer, or two-spirit (LGBTQ2S+). There is also a critical need to understand and address suicide prevention in communities that have been marginalized or underserved, including (but not limited to) youth in rural communities, youth in low-resource urban settings, youth with special healthcare needs, youth in the child welfare system, youth who have experienced family disruption, youth who are homeless, and youth involved in the juvenile justice system. Multi-sectoral strategies are needed to identify and support youth at risk, as well as to address the upstream factors and social determinants of health (SDOH) that cause and intensify disparities.

Call to Action

These sobering realities are a call to action –pediatric health clinicians and other adults who work with youth can make a difference. Now more than ever there is an urgent need for national leadership and partnerships to advance youth suicide prevention.

Purpose of this Blueprint

The American Academy of Pediatrics (AAP) and American Foundation for Suicide Prevention (AFSP), in collaboration with experts from the National Institute of Mental Health (NIMH), created this Blueprint for Youth Suicide Prevention as an educational resource to support pediatric health clinicians in identifying strategies and key partnerships to support youth at risk for suicide. 

To develop this Blueprint, AAP, AFSP, and NIMH convened a Virtual Summit on Youth Suicide Prevention, including listening sessions with partners serving youth from under-resourced communities, as well as federal agencies. Key multidisciplinary collaborators who focus on strategies to promote health equity offered insights that inform this resource.

Data and considerations presented in this Blueprint are based on the current landscape and gaps in science, practice, and programs related to youth suicide prevention. This Blueprint is intended to serve as a complementary effort to ongoing, large-scale comprehensive suicide prevention initiatives supported by the US Centers for Disease Control and Prevention, the National Action Alliance for Suicide Prevention, the Substance Abuse and Mental Health Services Administration, the US Surgeon General’s Advisory on Protecting Youth Mental Health, the Suicide Prevention Resource Center, and other leaders in the field.

This Blueprint is designed to outline clinical and community strategies and partnership opportunities that pediatric health clinicians can use to better identify and support youth at risk for suicide. To complement these strategies, AAP and AFSP have created an Advocacy resource to help those interested in advocating for policies to prevent suicide among youth. The National Institute of Mental Health (NIMH) did not contribute to the Advocacy section of this Blueprint and any information described in this section does not necessarily reflect the views of NIMH, the National Institutes of Health, the Department of Health and Human Services, or the US government broadly.  

Language Note

Throughout this document, we refer to “pediatric health clinicians.” This term is intended to include all health clinicians who provide care to youth and young adults, including (but not limited to) pediatricians, pediatric medical subspecialists, pediatric surgical subspecialists, family physicians, subspecialists, mental and behavioral health professionals, nurses, nurse practitioners, physician assistants, medical assistants, school nurses, and any other clinician who provides health care to youth.

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American Academy of Pediatrics