ABSTRACT
Background Suicide is a significant public health concern among the pediatric population in the United States. This study aims to comprehensively analyze suicide attempts among adolescents using data from the Youth Risk Behavior Surveillance System (YRBSS) maintained by the Centers for Disease Control and Prevention (CDC). Methods The pediatric population of grades 9-12 students (13-17 years old) was included in the study population, and data were collected from multiple cycles of the YRBSS survey. Descriptive statistics and time-trend analyses were conducted to examine attempted suicide rates based on location, gender, race/ethnicity, school grade level, and sexual orientation. Results Significant variations in attempted suicide rates were observed among different demographic groups. In 2021, of the subset with suicide attempt, females reported a higher prevalence of attempted suicide (13.3%, n=211), while males exhibited a lower rate (6.6%, n=104). Of the total studied population in 2021, Palau had the highest attempted suicide rate (25.2%, n=3924), followed by the Northern Mariana Islands (17.6%, n=2740). Over 1991-2021, no significant location-based variations were observed. In 2021, American Indian/Alaska Native adolescents had the highest attempted suicide rate at 16% (n=2491), followed by Black adolescents (14.5%, n=2258). Ninth-grade students reported higher rates in 2021 (11.6%, n=1806). Adolescents reporting both opposite-sex (36.7%, n=5715) and same-sex-only sexual contacts or both (32.9%, n=5123) exhibited notably higher rates in 2021. Conclusion This study highlights alarming attempted suicide rates in the US pediatric population, emphasizing the need for tailored prevention efforts and mental health support. It offers essential guidance for policymakers, researchers, and mental health professionals in developing evidence-based strategies to promote youth well-being and combat the impact of suicide attempts.
ABSTRACT
BACKGROUND: Online interventions can be a cost-effective and efficient way to deliver programs to large numbers of people regardless of geographic location. However, attrition in web-based interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed a web-based dietary intervention as part of The My Food & Mood study which aimed to optimize ways to engage participants with low mood or depressive symptoms to promote dietary behavior change. Different versions of the My Food & Mood program were tested during optimization. Iterations were developed based on user feedback and usage analysis. OBJECTIVE: The purpose of this study was to compare engagement and nonusage attrition across 4 program iterations-which differed by platform format, delivery mode, and activity type-to create an optimized version. METHODS: Each program version contained modular videos with key activities with respect to implementing behavior change techniques of equivalent levels of required participation and length: version 1.0, desktop program and smartphone app; version 2.1, desktop or smartphone program; version 2.2, desktop program; and version 3.0, smartphone app. Adults with PHQ-8 scores of 5 or greater were recruited online and assigned to 1 of the 4 versions. Participants were asked to use the program for 8 weeks and complete measures at weeks 4 and 8. Engagement data were collected from the web-based platform system logs and customized reports. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort. RESULTS: A total of 614 adults participated. Kruskal-Wallis tests showed significant differences across the 4 cohorts in all engagement measures. The smartphone app (version 3.0) had the greatest engagement as measured by weeks engaged, total usage time, total time key activities, number of active sessions, percentage of activities completed against protocol, goals completed, and percentage of videos watched. Cox regression multivariate survival analysis showed referral from a health practitioner (hazard ratio [HR] 0.344, P=.001) and greater proficiency with computers (HR 0.796, P=.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition. CONCLUSIONS: My Food & Mood version 3.0, a dietary intervention delivered via smartphone app with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood or depression. The iterative design techniques employed and analysis of feedback from participants resulted in a program that achieved lower rates of nonusage attrition and higher rates of intensity of use.
