2005 Massachusetts Youth Risk Behavior Survey
6
CHAPTER 6
SUICIDALITY AND SELF-INFLICTED INJURY
INTRODUCTION
Nationally, youth suicide rates tripled in the second half of the 20 th century (6a). In 2003, suicide was the third
leading cause of death among young people aged 15 to 24 in Massachusetts and in the United States as a
whole (6b). One risk factor for suicide is untreated depression, yet only a small percentage of Americans who
suffer from depression are accurately diagnosed and treated (6c). Other risk factors include bullying, other
physical or sexual abuse, interpersonal losses, and school or work problems (6d).
National Health Objectives for the Year 2010 include reducing the incidence of suicide attempts and completed
suicides among adolescents. The 2005 MYRBS asked students several questions about suicidal thoughts and
behaviors during the previous year, including questions concerning (1) feeling sad or hopeless, (2) serious
considerations of suicide, (3) plans to commit suicide, (4) actual suicide attempts, and (5) medical treatment
required as the result of a suicide attempt. In addition, the MYRBS asked about intentional self-injury including
cutting, burning, or bruising.
KEY FINDINGS FROM THE 2005 MYRBS

Significantly fewer students in 2005 than in previous years seriously considered suicide (13%), made a
suicide plan (12%), or actually attempted suicide in the past year (6%). Two percent (2%) of all students
received medical attention for a suicide attempt.

Slightly less than one-fifth of all students (19%) reported hurting themselves on purpose.

Female students were more likely than male students to report suicidal thinking, feeling sad or hopeless
for two weeks or more, or to have injured themselves on purpose. Small gender differences in actual
suicide attempts were not statistically significant.

Students receiving special education services, homeless students, sexual minority youth, students who
engaged in binge drinking or illegal drug use, and students who have experienced violence were more
likely than their peers to report a suicide attempt.
RESULTS
In the past decade, suicidality has decreased significantly among Massachusetts high school students. Feeling
sad and hopeless for an extended period of time has declined, as have considering suicide, making a suicide
plan, or making an actual suicide attempt. (Figure 6a)
Female adolescents were more likely than males to have hurt themselves on purpose, to have felt sad or
depressed for two weeks or more, to have considered suicide, or to have made a suicide plan. Gender
differences in actual suicide attempts in the past year were not statistically significant. (Figure 6b)
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2005 Massachusetts Youth Risk Behavior Survey
Figure 6a: Suicidal Thinking and Behavior Among Massachusetts High School Students,
1995 - 2005
1995
30.4
28.8
28.0
26.7
35
1997
25.8
23.5
21.2
20.1
12.7
16.3
20
2001
15
2003
2005
10.4
9.5
8.3
9.6
8.4
6.4
25
1999
18.8
19.2
16.6
15.2
12.5
11.7
30
3.6
3.7
4.1
3.5
2.8
2.4
10
5
0
Felt sad or hopeless Seriously considered Made a suicide plan,
for 2 weeks or more, suicide, past year
past year (*b)
past year (*a)
(*b)
Attempted suicide,
past year (*c)
Suicide attempt with
injury, past year (*a)
(*a) Statistically significant decline from 1999 to 2005, p < .05. (*b) Statistically significant decline from 2001 to 2005, p < .05. (*c)
Statistically significant decline from 2003 to 2005, p. < .05.
Figure 6b. Suicidal Thinking and Behavior Among Massachusetts
High School Students by Gender, 2005
Female
33.4
40
35
Male
2.5
5
2.4
5.6
20.2
10
7.2
9.8
13.5
10.2
15
15.2
20
14.2
25
22.8
30
0
Hurt self on
Felt sad or
purpose, past hopeless for 2
year (*)
weeks or more,
past year (*)
Seriously
considered
suicide, past
year (*)
Made a suicide
plan, past year
(*)
Attempted
suicide, past
year
Suicide attempt
with injury, past
year
(*) Statistically significant gender differences, p < .05
Suicidality & Self-Inflicted Injury
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2005 Massachusetts Youth Risk Behavior Survey
26.8
28.2
26.0
25.1
Figure 6c. Suicidal Thinking and Behavior Among Massachusetts High School
Students by Grade, 2005
10th Grade
11th Grade
12th Grade
Seriously
considered
suicide, past
year
Made a suicide
plan, past year
6.9
6.5
5.3
6.3
10
5
2.5
2.3
1.5
3.1
15
11.1
11.7
10.4
13.2
20
14.0
12.1
11.1
12.8
16.5
14.0
25
9th Grade
21.4
20.8
30
0
Hurt self on
Felt sad or
purpose, past hopeless for 2
year
weeks or more,
past year
Attempted
suicide, past
year
Suicide attempt
with injury, past
year
Black
Hispanic
27
Asian
5
14.8
1.9
3.6
4.8
5.8
5.9
10
9.2
15
Other/Mixed
12.9
12.4
9.7
12.2
15.5
20
11.2
10.6
12.7
13.4
20.5
25
5.2
7.7
30
25.7
25.6
35
29.8
35.4
40
36.9
Figure 6d. Suicidal Thinking and Behavior Among Massachusetts High School
Students by Race/Ethnicity, 2005
White
0
Felt sad or hopeless
Seriously
for 2 weeks or more, considered suicide,
past year (*)
past year (*)
Made a suicide
plan, past year
Attempted suicide, Suicide attempt with
past year (*)
injury, past year (*)
(*) Statistically significant racial/ethnic differences, p < .05.
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2005 Massachusetts Youth Risk Behavior Survey
Female adolescents were more likely than males to have hurt themselves on purpose, to have felt sad or
depressed for two weeks or more, to have considered suicide, or to have made a suicide plan. Gender
differences in actual suicide attempts in the past year were not statistically significant. (Figure 6b)
Nearly one in five students (19%) indicated that they had hurt themselves on purpose at least once in the past
year, for example by cutting, burning, or bruising themselves. This represents a slight, non-significant, increase
over the 18% reported in 2003, the first year the question was included on the survey.
ADDITIONAL GROUP DIFFERENCES IN SUICIDALITY
Community differences in suicidality varied by question asked. Rural youth were more likely than their urban or
suburban counterparts to indicate that they had cut, burned or hurt themselves on purpose in the past year (23%
vs. 16% and 19%). On the other hand, rural adolescents were less likely than urban and suburban peers to
report that they had made a past-year suicide attempt that resulted in an injury (1.3% vs. 3.3% and 2.2%). Other
community differences were not significant.
Special education students were more likely than general education students to report considering suicide (17%
vs. 12%), making a suicide plan (15% vs. 11%), and making a suicide attempt resulting in injury (5% vs. 2%).
Sexual minority adolescents – those who self-identified as gay, lesbian, or bisexual or who reported any samesex sexual contact – had suicidality rates nearly double those of their peers. For example, they were more likely
to have hurt themselves on purpose (44% vs. 17%), to have seriously considered suicide (34% vs. 11%), and to
have made a suicide attempt in the past year (21% vs. 5%).
Immigrant and US-born adolescents were similar in terms of suicidal thinking and behavior.
Every measure of suicidality was over twice as high among homeless youth as among adolescents living at home
with their families. For example, homeless students were significantly more likely than their peers to have hurt
themselves on purpose (38% vs. 17%), to have seriously considered suicide (28% vs. 12%), and to have made a
suicide attempt in the past year (19% vs. 6%).
RISK AND PROTECTIVE FACTORS FOR SUICIDALITY
As has been found in numerous other studies, substance abuse was significantly associated with suidicality. For
example, past-year suicide attempts were significantly more frequent among youth who reported binge drinking
than among those who did not (11% vs. 5%) and among those who had ever used cocaine than among those
who had not (24% vs. 5%).
Suicidal thinking and behavior were more common among youth who had been victimized. For example, pastyear suicide attempts were significantly more common among students who had been bullied at school than
among their peers (12% vs. 5%) and among adolescents who had experienced dating violence than among their
peers (23% vs. 5%).
Suicide attempts were reported significantly more frequently by overweight adolescents than by their peers (9%
vs. 6%).
Perceived social support appeared to exert a protective effect against suicidality. Suicide attempts were less
common among students who believed there was a teacher or other school staff member they could talk to if they
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2005 Massachusetts Youth Risk Behavior Survey
had a problem (5% vs. 11%) and among youth who reported that they could talk with family adults about things
that were important to them (5% vs. 13%).
Students who were earning passing grades – A’s, B’s, and C’s – were significantly less likely to have made a
suicide attempt in the past year than those who were not (5% vs. 12%)
CONCLUSIONS AND RECOMMENDATIONS
Massachusetts can be encouraged by the significant declines in suicidal thinking and behavior among youth over
the past decade. Even so, over one-eighth of Massachusetts high school students report having felt so much
distress and despair over the past year that they seriously consider killing themselves; many actually make
suicide attempts. All schools and communities need to address the seriousness of adolescent suicide. The
National Strategy for Suicide Prevention includes an objective to increase the proportion of school districts and
private school associations with evidence-based programs designed to address serious childhood distress and
prevent suicide (6e).
Researchers have begun to identify successful school-based approaches to youth suicide prevention (6f, 6g).
Schools can address the problem of youth suicide directly using effective prevention programs that help students
learn to recognize and manage the feelings of stress and depression that may lead to suicidal thinking and
behavior. However, research has shown that suicidal adolescents are not likely to seek help on their own (6e).
Therefore, it is important that school staff be trained to recognize early signs of depression and serious emotional
disturbances among young people (particularly among high-risk subgroups such as sexual minority youth, and
students who have been victims of violence), and be able to direct at-risk students to appropriate mental health
services.
One early sign of depression and suicidality may be self-inflicted injury. Students who reported hurting
themselves on purpose (for example, by cutting, burning, or bruising themselves) were far more likely than their
peers to have felt sad or hopeless, or to have considered, planned, or attempted suicide.
Many influences may contribute to an adolescent’s intention to commit suicide, but some promising protective
factors have also been identified. Recent research from the National Longitudinal Study on Adolescent Health
found suicidality to be significantly lower among high school students who felt emotionally connected to their
parents and/or family (6h). The 2005 MYRBS results support that view. Massachusetts students who felt there
was a parent or other adult in their family they could talk to about things that were important were less likely than
their peers to have attempted suicide. Conversely, adolescents who were threatened, bullied, or intimidated at
school or who felt so unsafe that they sometimes skipped school altogether had far higher rates than their peers
of suicidal thinking and behavior. Schools should work to foster an environment in which all students feel safe,
accepted, and supported, and where all have the opportunity for social recognition and for responsible
involvement in school activities.
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CHAPTER 6: REFERENCES
6a. U.S. Department of Health and Human Services (1990). Prevention ‘89/90: Federal programs and progress.
Washington, DC: U.S. Government Printing Office.
6b. National Center for Injury Prevention and Control, Centers for Disease Prevention and Control. (2006).
WISQUARS leading causes of death reports. Retrieved November 5,2006 from
http://webappa.cdc.gov/sasweb/ncipc/leadcaus.html
6c. American Psychiatric Association (1994). DSM-IV: Diagnostic and statistical manual of mental disorders.
Washington, DC: American Psychiatric Press.
6d. Gould, M., Greenberg, T., Velting, D., & Shaffer, D. (2006) Youth suicide: A review. The Prevention
Researcher, 13, 3-7.
6e. U.S. Department of Health and Human Services, Public Health Service (2001). National strategy for suicide
prevention: goals and objectives for action. Rockville,MD: author.
6f. Aseltine, R.H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program.
American Journal of Public Health, 94, 446-451.
6g. Kalafat, J. (2006). Youth suicide prevention programs. The Prevention Researcher, 13, 12-15.
6h. Resnick, M. et al (1999). Protecting adolescents from harm: Findings from the National Longitudinal Study
on Adolescent Health. Journal of the American Medical Association, 278, 823-832.
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