A joinpoint analysis of 1991 to 2021 YRBSS data found suicidal ideation among US high school students declined through 2009, then increased through 2021.
Multiple adolescent mental health indicators showed inflection points beginning around 2009 to 2010, according to research presented at the American Academy of Pediatrics (AAP) 2026 National Conference & Exhibition in San Diego, California.¹,² These included a reversal in suicidal ideation after nearly 2 decades of decline. The authors noted causality cannot be inferred from the analysis.²
The authors described adolescent mental health indicators in the United States as fluctuating substantially over the past 3 decades.² They noted long-term temporal patterns remain incompletely characterized despite recent reports of rising suicidality and depressive symptoms.² The researchers examined national trends to identify potential inflection points in adolescent mental, behavioral, and academic indicators.²
“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,” Niyati Sharma, a study author and junior at Horseheads High School in Horseheads, New York, said in a press release.
Joinpoint analysis of 30 years of YRBSS data identifies inflection points
Investigators conducted a repeated cross-sectional trend analysis of nationally representative Youth Risk Behavior Surveillance System (YRBSS) data from 1991 to 2021.² The data set comprised US high school students in grades 9 through 12.²
Primary outcomes included suicidal ideation, attempted suicide, persistent feelings of sadness or hopelessness, insufficient sleep, obesity, and school grades.² A statistician performed joinpoint regression analysis to identify statistically significant changes in trend direction and to estimate the annual percent change (APC) for each outcome.² Statistical significance was defined as P < .05.²
Suicidal ideation declined significantly from 1991 to 2009 (APC, −3.61%; P < .001) but increased from 2009 to 2021 (APC, +3.66%; P < .001).² Attempted suicide also increased significantly after 2009 (APC, +3.42%; P = .032).²
Persistent sadness or hopelessness increased modestly from 2009 to 2017 (APC, +1.71%; P = .046) and accelerated from 2017 to 2021 (APC, +7.67%; P < .001).²
Sleep, obesity, and academic trends also shifted among US high school students
Insufficient sleep increased after 2013 (APC, +1.58%; P = .002), and obesity increased after 2011 (APC, +2.68%; P < .001).² Academic performance declined steadily from 2001 to 2019 (APC, −1.83%; P < .001).²
The authors noted the timing of these shifts parallels several changes, including the rapid expansion of digital connectivity and social media engagement, the 2008 economic recession, evolving academic pressures, and changes in health care access.² They stated further investigation is warranted to understand how these social and environmental factors are associated with changes in adolescent mental health trajectories.²
“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,” Sharma said in the press release.
According to the press release, the researchers hope identifying when these changes began will help researchers, educators, physicians, families, and policymakers develop more targeted prevention strategies.¹
The analysis used repeated cross-sectional survey data and cannot establish causes of the observed trends. Inflection years varied by outcome, and the decline in academic performance began before 2009. The abstract also did not report the direction of the attempted suicide trend before 2009.
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American Academy of Pediatrics. Adolescents’ uptick in suicidal thoughts increased after 2009, 2010. Eurekalert. October 2, 2026. Accessed October 2, 2026. https://www.eurekalert.org/news-releases/1145256
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Sharma N, Sharma S, Rao A. A turning point in adolescent mental health in the United States: a 30-year analysis of U.S. high school students using YRBSS data. Abstract presented at: American Academy of Pediatrics 2026 National Conference & Exhibition; October 2-6, 2026; San Diego, CA.
