A joinpoint analysis of Youth Risk Behavior Surveillance System (YRBSS) data from 1991 to 2021 shows that suicidal ideation among US high school students declined until 2009, after which it increased through 2021. This research, presented at the American Academy of Pediatrics (AAP) 2026 National Conference & Exhibition in San Diego, identified notable inflection points in multiple adolescent mental health indicators beginning around 2009 to 2010, including a reversal in the long-term decline in suicidal thoughts.
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The authors cautioned that their analysis does not establish causality. They described adolescent mental health trends over the past three decades as significantly variable, noting that while recent reports indicate a rise in suicidality and depressive symptoms, long-term patterns remain poorly characterized. The study assessed national trends to pinpoint potential shifts in mental, behavioral, and academic indicators.
Niyati Sharma, a junior at Horseheads High School in New York and a co-author of the study, noted the findings: "Our study identified a clear turning point in adolescent mental health around 2009-2010 across various mental health indicators like suicidal thoughts, suicide attempts, sadness, sleep, obesity, and academic performance."
The researchers used a national dataset of high school students to analyze trends in suicidal ideation, suicide attempts, persistent feelings of sadness or hopelessness, sleep deprivation, obesity, and academic performance. The joinpoint regression analysis revealed that suicidal ideation significantly decreased from 1991 to 2009 (annual percent change, APC, of -3.61%; P < .001), but increased from 2009 to 2021 (APC of +3.66%; P < .001). Suicide attempts also rose significantly following 2009 (APC of +3.42%; P = .032).
Persistent feelings of sadness or hopelessness modestly increased from 2009 to 2017 (APC of +1.71%; P = .046) and accelerated from 2017 to 2021 (APC of +7.67%; P < .001). Additionally, insufficient sleep and obesity among high school students began trending upwards after 2013 (APC of +1.58%; P = .002) and after 2011 (APC of +2.68%; P < .001), respectively, while academic performance declined steadily from 2001 to 2019 (APC of -1.83%; P < .001).
The authors noted that the timing of these changes coincides with several societal factors, including the rise of digital connectivity and social media, the 2008 economic recession, changing academic pressures, and variations in healthcare access. They emphasized the need for further investigation to explore how these social and environmental factors may relate to changes in adolescent mental health. Sharma stated, "While our study cannot determine what caused these changes, the coordinated shift suggests we may be observing the impact of broader societal changes rather than isolated problems."
The researchers hope that identifying the timing of these shifts will assist educators, physicians, families, and policymakers in developing targeted prevention strategies. However, the analysis, based on repeated cross-sectional survey data, does not confirm the causes of the observed trends, and some inflection years varied by outcome.