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Principal Investigator: Rie Sakai-Bizmark
Organization: LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER
Fiscal Year: 2024
Award: $259,773
Funding agency: National Institute of Mental Health
PROJECT SUMMARY
Suicide is a major public health problem in the U.S., ranking as the second leading cause of death among
teens, with a rate of 7.1 per 100,000 population in this age group. Previous studies have revealed seasonal
trends and day-of-the-week effects in adolescent suicidal behavior, such as higher incidence in spring, on
Sundays, and on Mondays, and lower occurrences in summer, aligning with the school calendar. A significant
gap in understanding suicidal behavior exists among adolescents experiencing homelessness (AEH), who
show higher rates and distinct seasonal patterns and day-of-the-week effects compared to their domiciled
counterparts. Our previous research showed that AEH face increased risk when away from school, evidenced
by an attenuated summer decline in suicide attempts and peak suicide deaths in summer and the beginning of
the weekend (i.e., Fridays and Saturdays). The pandemic brought new challenges, such as economic
instability, limited access to essential services, and increased social isolation, which may have
disproportionately affected the vulnerable population of AEH. We hypothesized that the pandemic has
exacerbated existing disparities between AEH and their domiciled counterparts. Additionally, recent studies
reported decreased rates in suicidal behavior among adolescents in spring 2020, coinciding with nationwide
implementation of school closures as a pandemic control measure. However, no research has focused on AEH
during this time. Expanding on our prior study that showed a higher risk for AEH when they are away from
school, we hypothesize that suicidal behavior increased among AEH in spring 2020. To test these innovative
hypotheses, we will analyze three linked datasets: 1] Homeless Management Information System (HMIS) data;
2] hospital discharge records; and 3] death records from five jurisdictions, which collectively represent 32.5% of
AEH in the U.S. and 10.8% of the U.S. adolescent population. Adolescents aged 13 to 17 will be analyzed due
to distinct suicidal behavior mechanisms within this age group compared to younger children and older
adolescents. For example, adolescents younger than 18 are subject to distinct stressors related to school
enrollment, whereas some individuals above 18 are not in school. The circumstances surrounding
homelessness may differ as well, with those below 18 often accompanied by parents and those above 18 often
living independently. Aim 1 will investigate differences in annual rates of suicidal behavior among AEH and
domiciled adolescents between 2016 and 2022 to determine whether the pandemic has exacerbated existing
disparities between the two groups. Aim 2 will assess monthly trends in suicidal behavior before, during, and
after the pandemic to determine whether suicidal behavior increased among AEH in spring 2020. Investigating
trends in suicidal behavior among AEH during the pandemic will inform whether suicide prevention measures
tailored to AEH are needed, especially before and during school breaks. The findings will also enhance
preparedness for potential school closures due to future pandemics.
Terms: <0-11 years old><Adolescent><Adolescent Youth><Adopted><Affect><Age><Area><Attenuated><Behavioral Mechanisms><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Calendar><Cause of Death><Child><Child Youth><Children (0-21)><Communities><Data><Data Set><Death Records><Deliberate Self-Harm><Development><Disparities><Disparity><Domiciles><ED visit><ER visit><Economics><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Exclusion><Exhibits><Face><Family><Friends><Future><Goals><Homelessness><Hospital Admission><Hospitalization><Hospitals><Incidence><Independent Living><Individual><Inpatients><Link><Management Information Systems><Measures><Mechanisms of Behavior and Behavior Change><Mental Health><Mental Hygiene><Mission><NIMH><National Institute of Mental Health><New York City><Parents><Pattern><Population><Position><Positioning Attribute><Preparedness><Prevention><Prevention Measures><Proxy><Psychological Health><Public Health><R-Series Research Projects><R01 Mechanism><R01 Program><Readiness><Records><Reporting><Research><Research Grants><Research Priority><Research Project Grants><Research Projects><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><School Enrollments><Schools><Seasons><Self-Injurious Behavior><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social isolation><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><Teen><Teenagers><Testing><Time><Vulnerable Populations><Washington><Work><age group><aged><ages><attenuate><attenuates><behavior mechanism><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><deliberate self harm><developmental><economic><effective intervention><experience><faces><facial><fatal attempt><fatal suicide><future pandemic><high risk><high-risk adolescents><homeless><innovate><innovation><innovative><inpatient care><inpatient service><intent to die><intentional self harm><intentional self injury><juvenile><juvenile human><kids><next pandemic><non fatal attempt><nonfatal attempt><pandemic><pandemic containment><pandemic control><pandemic disease><pandemic mitigation><pandemic response><parent><prevent><prevent suicidality><prevent suicide><preventing><school closing><school closure><self harm><self injury><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><stem><stressor><suicidal adolescent><suicidal adolescents><suicidal attempt><suicidal behavior><suicidal morbidity><suicidal youth><suicidal youths><suicidality prevention><suicide behavior><suicide death><suicide intervention><suicide morbidity><suicide rate><suicides><teen years><teenage><trend><unhoused><vulnerable group><vulnerable individual><vulnerable people><youngster>