Examining Suicidality in Youth With Disabilities: 2021-2023 National Survey on Drug Use and Health

To assess associations between disability severity, multimorbidity (number of disabilities), and suicidality among US adolescents, including suicidality specifically attributable to COVID-19.

We analyzed 28,402 adolescents (ages 12-17 years) from the 2021-2023 National Survey on Drug Use and Health. Survey weights and design variables produced estimates representative of the US civilian, noninstitutionalized adolescent population. Disability severity (none, mild, moderate/severe) was derived from self-reported functioning across six domains-vision, hearing, cognition, mobility, self-care, and communication. Multimorbidity was the count of moderate/severe disability domains (0, 1, 2, ≥3). The primary outcome was past-year suicidality, categorized as none, any ideation or plan (general suicidality), and COVID-19-attributed suicidality.

In the weighted sample, 45.5% had mild disability and 17.9% had moderate/severe disability. Relative to peers without disabilities, youth with mild disability had higher odds of general suicidality (adjusted odds ratio [AOR] = 2.25; 95% confidence interval [CI]: 1.82-2.77), whereas their elevated odds of COVID-19-attributed suicidality were not statistically significant (AOR = 1.64; 95% CI: .99-2.72). Youth with moderate/severe disability had higher odds of general suicidality (AOR = 3.81; 95% CI: 3.02-4.81) and of COVID-19-attributed suicidality (AOR = 2.58; 95% CI: 1.50-4.44). A dose-response by disability count was observed; adolescents with three or more disabilities had the highest risk of general suicidality (AOR = 2.20; 95% CI: 1.45-3.33).

During the COVID-19 era, adolescents with disabilities-particularly those with greater severity or multiple disabilities-faced elevated risk for suicidality. Findings underscore the need for disability-informed suicide risk screening and uninterrupted access to mental-health services, including flexible, accessible care modalities during periods of system disruption.