ArticlePublic health2026
Trends in missing responses to suicide-related indicators among U.S. adolescents by race/ethnicity and sex, 2001-2021.
Article in Public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesMissingness to suicide-related survey items may bias adolescent suicide surveillance and limit subgroup comparisons. Prevalence and trends of missingness to suicide-related indicators were examined among U.S. adolescents from 2001 to 2021. STUDY
designTrend analysis of repeated cross-sectional surveys.
methodsData were drawn from a nationally representative sample of U.S. high school students (N = 163,489) participating in the 2001-2021 Youth Risk Behavior Survey. Weighted prevalence of missingness was estimated for four suicide-related indicators (ideation, plan, attempt, injury) in the total sample, and subgroups stratified by race/ethnicity, sex, and both race/ethnicity and sex together. Because ideation and plan missingness were rare, regression-based annual percentage changes (APCs), and average APCs (AAPCs) were estimated for attempt and injury missingness only among the total sample and the same subgroups.
resultsMissingness to ideation and plan items was rare (<2%), whereas attempt (11.1%) and injury (13.9%) missingness were higher. Black, Hispanic, and AI/AN adolescents had higher attempt missingness (21.6%, 14.6%, 14.5%) than white adolescents (7.1%). Attempt missingness declined from 2001 to 2005 (APC = -7.99; 95% CI = -11.40, -4.46), then increased 3.91% annually through 2017. Black adolescents lacked a significant post-2017 decline. Injury missingness increased 2.99% annually (AAPC 95% CI = 2.28, 3.71), with a 6.49% annual increase from 2011 to 2021. Injury missingness averaged 9.7% among white adolescents compared to 25.8%, 16.9%, and 19.4% for Black, Hispanic, and AI/AN adolescents. AI/AN adolescents had the highest annual increase in injury missingness (AAPC = 5.82; 95% CI = 2.04, 9.75). Trends were similar by sex.
conclusionsSuicide attempt and injury missingness were substantial, but disproportionately impacted ethnoracially minoritized adolescents, and may obscure suicide risk. Complete data are essential to strengthen risk assessment and prevention planning.
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