Number 1917 Explaining the Rise in Youth Suicide By David M . Cutler

Suicide rates among youths aged 15-24 have tripled in the past half-century, even as rates for adults and the elderly have declined. And for every youth suicide completion, there are nearly 400 suicide attempts. This paper examines the dynamics of youth suicide attempts and completions, and reaches three conclusions. First, we suggest that many suicide attempts by youths can be viewed as a strategic action on the part of the youth to resolve conflicts within oneself or with others. Youths have little direct economic or familial power, and in such a situation, self-injury can be used to signal distress or to encourage a response by others. Second, we present evidence for contagion effects. Youths who have a friend or family member who attempts or commits suicide are more likely to attempt or commit suicide themselves. Finally, we show that to the extent we can explain the rise in youth suicide over time, the most important explanatory variable is the increased share of youths living in homes with a divorced parent. The divorce rate is more important for suicides than either the share of children living with step-parents or the share of female-headed households. David M. Cutler Edward Glaeser Department of Economics Department of Economics Harvard University Harvard University Cambridge, MA 02138 Cambridge, MA 02138 [email protected] [email protected] and NBER and NBER Karen Norberg NBER 1050 Massachusetts Avenue Cambridge, MA 02138 [email protected] Emile Durkheim’s Suicide documented a monotonically increasing relationship between age and suicide. Such a relationship has been observed repeatedly since the beginning of the 19 century, making it one of the most robust facts about suicide. The differences in suicide rates by age are very large. In the United States in 1950, for example, suicide rates were 4 times higher for adults (25-64) than for youths (15-24), and 8 times higher for the elderly (65+) than for youths. Economic theory explained this relationship naturally, with the young having the most life to loose and also having the least information about what their life will be like (Hamermesh and Soss, 1974). In recent decades, however, the monotonic relationship between age and suicide has disappeared. Figure 1 shows suicide rates by age in 1950 and 1990. Between 1950 and 1990, youth suicide rates tripled (particularly among young men), while suicide rates for adults fell by 7 percent and suicide rates for the elderly fell by 30 percent. In 1990, suicide rates for young adults (ages 2024) were equal to those for prime-age adults, and were only 25 percent below suicide rates for the elderly. Suicide is now the second or third leading cause of death for youth in the US, Canada, Australia, New Zealand, and many countries of Western Europe. If youth suicide is an epidemic, attempted suicide is even more so. For every teen that commits suicide (one-hundredth of one percent each year), 400 teens report attempting suicide (4 percent per year), 100 report requiring medical attention for a suicide attempt (1 percent per year), and 30 are hospitalized for a suicide attempt (.3 percent per year). Why have youth suicide rates increased so much, even as suicide among adults and the elderly has fallen? Why are there so many suicide attempts? It is easier to say what suicide is not than what it is. The US rise in youth suicide has not been centered in America’s troubled inner cities. The states with the largest increase in youth suicides between 1950 and 1990 are predominantly rural states: Wyoming, South Dakota, Montana, New Mexico, and Idaho. The states with the most troubled inner cities in fact have the smallest increases: the District of Columbia, New 1 Throughout the paper, we refer to the 15-24 year-old age group as youths. We sometimes divide this into teens (ages 15-19) and young adults (ages 20-24).