Risk factors associated with adolescent suicidality before and during the COVID-19 pandemic

Objective To evaluate the impact of the coronavirus disease 2019 pandemic on youth suicidal behaviors. Method This study examined two national surveys of high school students, the 2019 Youth Risk Behavior Survey (YRBS) and the 2021 Adolescent Behaviors and Experiences Survey (ABES). Results The YRBS 2019 had 13,677 entries: 18.6% (17.5–19.8) (weighted percentage and 95% confidence intervals [CIs]) of youth had suicidal ideation (SI) and 8.9% (7.9–10.0) had at least one suicide attempt (SA). The ABES 2021 had 7705 entries: 19.9% (18.0–22.0) of youth had SI and 9.0% (7.7–10.5) had SA. In ABES 2021, both the percentage of youth with SI or SA was highest at age 14, at 21.8% (16.9–27.8) and 10.0% (6.6–14.8), respectively. The top factors associated with both SI and SA were parental abuse, sexual violence, illicit drug use, misuse of prescription pain medicine, and being bullied electronically. Screen time ≥3 h per day (not including schoolwork) was associated with a lower risk of SA (odds ratio [OR] 0.553, 95% CI: 0.382–0.799), but not SI (OR 1.011, 0.760–1.344). Conclusions Earlier onset of adolescent suicidality, at age 14, was noted during the pandemic. The association of higher non-school work-related screen time with lower SA is unexpected and warrants validation.