Suicidal Behavior among Adolescents Experiencing Homelessness in the US during the COVID-19 Pandemic

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.