Typologies and Phenotypes of Youth Suicide Decedents

Youth suicide continues to rise, yet prevention relies largely on adult-derived evidence. We aimed to identify data-driven phenotypes of youth suicide decedents to guide age-appropriate, targeted prevention and to highlight subgroups that current strategies may miss.

We conducted a cross-sectional latent class analysis of 10,442 youth 10 to 17 years of age who died by suicide recorded in the US National Violent Death Reporting System (2013-2022). A total of 35 demographic, circumstantial, toxicologic, and method variables were modeled in 2- to 10-class solutions; the optimal model was chosen using the Bayesian information criterion (BIC), Akaike information criterion (AIC), entropy, and interpretability. Class distributions by age, calendar year, and race/ethnicity were compared with χ² and trend tests.

A 5-class solution best fit the data. "Crisis" decedents (25%) experienced acute interpersonal or school crises without prior care. "Disclosing" (12.6%) had documented attempts, treatment, and recent intent disclosure. "Hidden" (21.2%) lacked recorded risk factors and had negative toxicology results. "Identified" (12.2%) was majority female and included more poisoning/asphyxia deaths. "Surveillance" (29%) showed pervasive missing data. Older adolescents clustered in the "Disclosing" class. The "Surveillance" class grew from 22% to 36% between 2013 and 2022 (p < .001).

Nearly half of youth suicides occurred in groups with no clinical contact or with investigative data gaps, constraining treatment-centered prevention. Universal screening, safe firearm storage, crisis-oriented outreach, and strengthened death scene surveillance are needed to reach and understand these youth.

The authors analyzed a Centers for Disease Control and Prevention (CDC) database (2013-2022) of 10,442 youth 10 to 17 years of age who died by suicide. Five groups were identified. "Crisis" decedents (25%) experienced acute interpersonal or school crises without prior care. "Disclosing" decedents (12.6%) had documented attempts, treatment, and recent intent disclosure. "Hidden" decedents (21.2%) lacked recorded risk factors and had negative toxicology results. "Identified" decedents (12.2%) were majority female and included more poisoning/asphyxia deaths. "Surveillance" decedents (29%) showed pervasive missing data. Almost half of the youth were in groups with little or no mental health contact. These findings suggest the need for prevention efforts to extend beyond clinical settings to reach schools, families, and communities.

Study Preregistration: Typologies and Phenotypes of Youth Suicide Decedents; https://doi.org/10.1016/j.jaac.2025.03.020.