NEW YORK (AP) — The homicide rate for older U.S. teenagers rose to its highest point in nearly 25 years during the COVID-19 pandemic, and the suicide rate for adults in their early 20s was the worst in more than 50 years, government researchers said Thursday.

The Centers for Disease Control and Prevention report examined the homicide and suicide rates among 10- to 24-year-olds from 2001 to 2021.

The increase is alarming and “reflects a mental health crisis among young people and a need for a number of policy changes,” said Dr. Steven Woolf, a Virginia Commonwealth University researcher who studies U.S. death trends and wasn’t involved in the CDC report.

Experts cited several possible reasons for the increases, including higher rates of depression, limited availability of mental health services and the number of guns in U.S. homes.

Guns were used in 54% of suicides and 93% of homicides among the age group in 2021, the most recent year for which statistics were available.

“Picture a teenager sitting in their bedroom feeling desperate and making a decision, impulsively, to take their own life,” Woolf said. If they have access to a gun, “it’s game over.”

Suicide and homicide were the second and third leading causes of death for 10- to 24-year-olds, after a category of accidental deaths that includes motor vehicle crashes, falls, drownings and overdoses. Other researchers have grouped the data by the method of death, and concluded that guns are now the biggest killer of U.S. children.

Earlier this year, Woolf and other researchers looking at CDC data noted dramatic increases in child and adolescent death rates overall at the beginning of the pandemic, and found suicide and homicide were important factors.

The report also found:

—Suicide and homicide death rates remained far higher for older teenagers and young adults than they were for 10- to 14-year-olds.

—In 2021, there were about 2,900 suicides in youths ages 10 to 19, and 4,200 in 20- to 24-year-olds. About 3,000 homicide deaths were reported in the younger group, and nearly 3,900 in the adults in their early 20s.

—The homicide death rate jumped from 8.9 deaths per 100,000 teens aged 15 to 19 in 2019 to 12.3 in 2020. It rose to 12.8 deaths per 100,000 in 2021, the highest since 1997, according to CDC data.

—Homicide deaths became more common than suicide deaths among 15- to 19-year-olds, while suicide was more common in the younger and older age groups.

—While large increases were seen in homicide rates for young Black and Hispanic people in the U.S., there were not significant increases for their white counterparts, other CDC data shows.

—Among 20- to 24-year-olds, the homicide death rate jumped 34% from 2019 to 2020 — from 13.4 per 100,000 population to 18 per 100,000. It held stable in 2021, but the suicide rate rose enough in 2021 — to 19.4 per 100,000 — to surpass the homicide rate.

Suicide death rates in children and teens were rising before COVID-19, but they jumped up at the beginning of the pandemic. Dr. Madhukar Trivedi, a psychiatrist at the University of Texas Southwestern Medical Center, said the reasons may be hard to pinpoint, but that isolation during COVID-19 lockdowns could be a factor.

“There is a misperception that if you talk to young people about depression, they’ll get depressed. A don’t-ask, don’t-tell policy for depression is not effective,” Trivedi said. “The earlier we can identify the ones who need help, the better chance we’ll have at saving lives.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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As a part of VA’s comprehensive efforts to end Veteran suicide, VA also announced the grantees for the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, a first-of-its-kind program that provides VA funding for local suicide prevention programs, and the finalists for Mission Daybreak, a suicide prevention grand challenge.

These efforts are key aspects of VA’s 10-year National Strategy for Preventing Veteran Suicide and the Biden-Harris administration’s plan for Reducing Military and Veteran Suicide.

“There is nothing more important to VA than preventing Veteran suicide — it’s our top clinical priority,” said VA Secretary Denis McDonough. “This year’s report shows real progress, but there is still so much work to be done. One Veteran suicide is one too many, and VA will continue to work with our federal, state, local and private partners to tackle this problem and save Veterans’ lives.”  

“Suicide is one of the most serious public health issues facing our Veterans today, and VA cannot do this work alone,” said VA Under Secretary for Health Shereef Elnahal, M.D. “With the Staff Sergeant Fox Grants and Mission Daybreak, VA seeks to engage not only organizations traditionally focused on suicide prevention, but also to bring in new groups and individuals who may have fresh ideas on how we address this issue.”

Key findings from the 2022 National Veteran Suicide Prevention Annual Report include: 

• In 2019 and 2020, Veteran suicides decreased in consecutive years by 307 and 343 deaths — the biggest decrease in the suicide count and rate since 2001. 
• From 2018 to 2020, the age- and sex-adjusted suicide rate among Veterans fell by 9.7%
• Among women Veterans, the age-adjusted suicide rate fell by 14.1%, compared to 8.4% among non-Veteran women. The age-adjusted suicide rate for women Veterans in 2020 was the lowest since 2013, and the age-adjusted suicide rate for Veteran men was the lowest since 2016.  
• From 2019 to 2020, Veteran suicide rates fell across all racial groups. 
• Comparisons of trends in Veteran suicide and COVID-19 mortality over the course of 2020 and across Veteran demographic and clinical subgroups did not indicate an impact of the COVID-19 pandemic on Veteran suicide mortality.

VA also recognizes that eliminating Veteran suicide requires a sustained commitment and all-of-the-above approach that engages expertise from all sectors of society. To that end, VA announced the grantees for the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program and the finalists for Mission Daybreak.

• Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program: Today, VA announced that it will grant more than $52 million to 80 community-based organizations in 43 states, the District of Columbia, and the American Samoa. This funding will help these organizations provide or coordinate the provision of suicide prevention services for Veterans and their families. More information can be found here. 
• Mission Daybreak: Today, VA announced the finalists for Mission Daybreak —  a grand challenge aimed at developing suicide prevention solutions. Mission Daybreak awarded $250,000 to 30 finalists and $100,000 to 10 Promise Award recipients. The goal of Mission Daybreak is to transform how our nation addresses suicide by engaging Veterans, community-based organizations, health tech companies, startups and universities that are not traditionally engaged in suicide prevention but could bring cutting edge solutions to the effort. More information can be found here. 

This year, VA has announced or continued several additional efforts to end Veteran suicide, including establishing 988 (then press 1) as a way for Veterans to quickly connect with caring, qualified crisis support 24/7; proposing a new rule that would reduce or eliminate copayments for Veterans at risk of suicide; conducting an ongoing public outreach effort on firearm suicide prevention and lethal means safety; and leveraging a national Veteran suicide prevention awareness campaign, “Don’t Wait. Reach Out.” 

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A recently published study out of China found that children confined at home by the coronavirus lockdown had elevated rates of depression and anxiety, raising concerns about the risk for American kids as the pandemic sweeps the nation.

Nearly 23% of the 1,784 children who responded to a survey reported feeling depression, likely due to “the reduction of outdoor activities and social interactions,” researchers noted in JAMA Pediatrics. Almost 19% said they had anxiety symptoms. Both figures were higher than the baseline rates of 17.2% for depression and 9.3% for anxiety. The study surveyed children in grades two through six in and around Wuhan.

With psychiatric problems already on the rise for American children, mental health experts weighed in on what interventions and policies might prevent similar trends here.

“I think everyone in our field is worrying about increasing depression. The suicide rate, as it is, has been going up,” said Mary Alvord, a practicing psychologist in Maryland and author of multiple books on children’s mental health.

She has observed that the pandemic has been hardest for social kids who thrive on in-person interaction and children who are naturally pessimistic. The China study found that youth who were less optimistic were more likely to experience symptoms of depression.

She recommends that parents and those who work with kids acknowledge the reality of the pandemic to children but emphasize that it’s temporary, with comments like: “It’s a bad situation. Nobody would have chosen this. We don’t know what’s coming up next. We’re trying to stay as safe as possible with the precautions, and it’s not going to last forever.”

Robin Gurwitch, a psychologist and professor of psychiatry and behavioral sciences at Duke University Medical Center, said building resiliency starts with parents.

“What the science tells us is that one of the biggest predictors of how well children will do after a large-scale event, a big danger like a pandemic, is how well the parents are doing,” she said. “It’s not that kids can’t see a parent or caregiver stressed or worried, because everyone is. The next step is equally important, that they can see their parent or caregiver cope and talk about, ‘This is what we’re going to do to pull it back together.’”

Beginning with the Oklahoma City bombing in 1995, Gurwitch has been studying how children and young adults respond to crises. This one, she noted, is different.

“A pandemic like this is unique because it’s invisible,” she said. “It’s not like you can look outside and see where it is. People can be asymptomatic. This is more anxiety-provoking because we don’t know how long it’s going to last.”

To keep children mentally well during this unprecedented time, she recommends having them help other people (by writing hopeful messages with sidewalk chalk, for example), focus on what they can control (such as washing their hands), and reframe negative thoughts. Instead of “I haven’t seen my friends. They won’t remember who I am,” think: “I can’t see my friends. That’s hard, but how great will it be when I see them again? And here’s how I can stay connected.”

Ann Garland, a professor of counseling and marital and family therapy at the University of San Diego, said it’s important that public health officials, through the media, educate parents and caregivers on which responses are normal for kids to have these days and which might require professional attention.

“If there’s a pattern of emotional and social withdrawal, hopelessness, lack of interest in any of the activities that used to bring some pleasure, I would say a parent would want to reach out to a mental health professional,” Garland said. She noted that community mental health agencies and county health departments are good resources for people who are uninsured or have public insurance.

“It’s a slow-dripping kind of struggle that everybody is experiencing. With that said, I think one of the first and useful silver linings here is clearly an increased recognition of mental health needs and the impact of stress.” — Prof. Steven Berkowitz, University of Colorado

Even though most psychiatrists and therapists are currently offering services only remotely, Garland has been involved in research showing that so-called “telemental health” can be just as effective as in-person care. She noted that state and federal restrictions on telemedicine have been eased in the wake of COVID-19, a development she believes could expand access to mental health care even after the virus subsides.

Erica Fener Sitkoff, executive director of Voices for Georgia’s Children, said governments and communities can protect kids’ mental health amid the pandemic by supporting families.

That could include setting up mental health hotlines and “warmlines” (meant to avert crisis), and offering summer programs, even if they must be virtual, with a strong social-emotional component.

It also means helping families meet basic necessities, she said, such as providing food to those in need, increasing internet access, and arranging child care for essential workers. She noted that schools in Georgia have continued to supply free lunches to students and internet providers have furnished families with free broadband connections.

She said her nonprofit is working on a mental health awareness campaign to educate kids and families that it’s normal, and understandable, to feel a variety of emotions nowadays. The campaign, set to start in June, will target parents, teachers, child care providers and middle- to high-school students through social media, newsletters and online summer programs.

“Every child has experienced some level of stress, from missing friends to more extreme things like, ‘I’ve lost my home’ or ‘My family has to get food from the food bank,’” Fener Sitkoff said. “We’re operating at a new baseline of how kids are feeling and we need to adjust to that.

“Acknowledging that is the first step. That allows and opens things up for parents to seek support and for kids to seek support. We don’t need to pretend everything is OK and they should be OK and keep it moving, because they’re not.”

Families should also have regular mental health check-ins, where parents voice how they’ve been feeling as well, said Steven Berkowitz, a University of Colorado professor of psychiatry and director of the START (Stress, Trauma, Adversity Research, and Treatment) Center.

“Another useful approach, particularly in teens, is to ask them what their friends are saying,” he said. “A lot of teens don’t want to disclose their own thoughts and vulnerabilities. If you ask what their friends are saying, it gives you an opportunity to say, ‘What do you think about that? How are you doing with that?’”

Berkowitz said it’s inevitable the pandemic will cause increased psychiatric problems.

“It’s a slow-dripping kind of struggle that everybody is experiencing,” he remarked. “With that said, I think one of the first and useful silver linings here is clearly an increased recognition of mental health needs and the impact of stress.”

By Giles Bruce

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