Disparities in suicide risk trajectories among youth during the COVID-19 pandemic

The pandemic contributed to an ongoing youth mental health crisis, though mental health burdens are disproportionately distributed within youth populations. The objective of this study was to identify latent trajectories of youth suicide risk during the COVID-19 pandemic and examine differential risk by demographic subgroups. We leverage a national crisis dataset (n = 6741 youth in crisis) and employ latent Markov models and multinomial logistic regression to identify suicide risk classes and model within-person suicide risk trajectories from pre-pandemic to the extended pandemic response period (2019-2022) among a cohort of young people (ages 24 and younger). This analysis identified three suicide risk classes: low risk (sample ranges from 4831 to 5199 texters across periods), high risk (sample ranges from 1246 to 1030 texters across periods), and very high risk (sample ranges from 664 to 506 texters across periods). Overall, suicide risk declined during the pandemic (e.g., low risk class +5.4 percentage points). Yet, person-centered results emphasize variable risk for younger youth, transgender and gender diverse (TGD) youth, and Black/African American youth across pandemic periods. Specifically, younger youth (i.e., 13 and under) were associated with 50% higher odds than youth 18-24 years to transition from low to very high (OR: 1.50, CI: 1.05-2.15) and 93% higher odds to transition from very high to low risk (OR: 1.93, CI: 1.44-2.61). TGD youth were associated with the highest odds of transitioning to high-risk classes during the early pandemic (OR_{Low_VeryHigh}: 1.79, CI: 1.33-2.41), compared to girls/women. Black/African American youth were associated with 122% higher odds of transitioning to very high risk during the extended pandemic period (OR: 2.22, CI: 1.24-3.97), compared to White youth. Gender identity, race, and age were significantly associated with changing suicide risk among youth during the COVID-19 pandemic. Results emphasize the immediate and prolonged need for effective suicide risk reduction efforts among young people.