Statement of Purpose Youth suicide is a major cause of premature death in the US; it was the second leading cause of death for youth aged 10–24 in 2018. From 2007 to 2018, the rate of suicide increased nearly 60% for this age group. This study examined suicide rates at the county-level and how county context was related to these differences.

Methods/Approach We analyzed suicide deaths among individuals ages 10–24 in Colorado included in the National Vital Statistics Surveillance dataset from 2001 to 2019. We used group-based trajectory modeling to identify groups of counties with distinct temporal patterns of suicide rates among youth. We then assessed county-level contextual variables to understand how population and community changes can predict inclusion in these trajectory groups over time.

Results We found three distinct trajectory groups of youth suicide rates among Colorado counties. The first group included 33% of counties with low suicide rates slightly increasing over time. The second group (60%) included counties that had moderate suicide rates that steadily increased over time. The third group included 7% of counties that demonstrated accelerating increases of suicide rates among youth over time. While counties with accelerating rates showed similar growth in population over time as other counties, counties in this trajectory included higher proportions of American Indian residents (mean=7.1%) and families living in poverty (mean=11.1%).

Conclusion We identified three distinct trajectories of youth suicide rates in Colorado counties, with the smallest proportion in a concerning group with accelerating suicides over time. Population demographics and other measures of context are associated with the trajectory groups.

Significance Understanding trajectories of youth suicide rates over time and the environmental and social context in which these occur can lead to population health strategies focused on community-wide supports for youth at risk for suicide.