Epidemiology of Suicidal Thoughts and Behaviors in Youth Victims of Human Trafficking

Youth suicide is a growing public health concern in the United States. One population at increased risk for suicide are youth victims of human trafficking, a crime involving the exploitation of a person under the age of 18 for labor, services, or commercial sex. Minimal evidence exists about suicidal behavior in this marginalized and understudied population. To address this gap, the proposed retrospective cohort study will uniquely integrate information from multiple data sources to improve our understanding of the individual, clinical, and community-level social determinates of health (SDoH) associated with suicide risk in youth victims of human trafficking. Quantitative findings will be strengthened with real-world and lived-experience informed data from subject-matter experts to advance our comprehension of suicide risk in this youth population and identify targets for interventions. Consideration will also be given to potential facilitators and barriers to intervention including when, how, and where to intervene.

Specific aims are: 1) Investigate the association between human trafficking victimization and suicidal ideation and attempts in youth aged 12-17 years, controlling for individual, clinical, and SDoH risk factors. 2) Among youth victims of human trafficking, identify specific individual, clinical, and SDoH factors that differentiate those with and without a history of suicidal ideation or attempts and 3) Gain additional insight into suicide risk among youth victims of human trafficking with input from service providers, advocates, and individuals with lived-experience to better identify and frame targets for prevention and intervention. The central hypothesis for this proposal focuses on the importance of access to physical and mental health services and continuity of care to prevent suicide in this high-risk and vulnerable youth population.

The sample for this study will include youth screened for human trafficking aged 12-17 years presenting to a large pediatric hospital (N=2536). Youth data on individual (demographics, family factors, abuse/neglect history, trafficking-related information) and clinical (physical health conditions, psychiatric diagnoses, prescription medication use, heath service utilization), characteristics will be obtained from electronic health records between January 1, 2020 and December 31, 2026. Community-level social determinants of health (poverty, unemployment, health service availability) from publicly available datasets will also be included. The outcome measures of interest include suicidal thoughts or attempts. Subject-matter experts including healthcare and victim service providers, community advisors, and individuals with lived experience will be recruited using a purposive sampling strategy to validate and expand upon quantitative findings and obtain additional detailed knowledge on suicide risk associated with youth victims of human trafficking.

This novel study is the first to characterize suicide risk using data from multiple domains associated with youth victims of human trafficking. Findings will provide feasibility and preliminary data for a subsequent study using a larger statewide or national sample to further inform the identification, development, and implementation of suicide prevention strategies tailored for youth trafficking victims. This line of inquiry will also advance the field of youth suicide research by focusing on suicide prevention in a significantly high-risk and underserved population, while generating practice-informed evidence about potential solutions for intervention and prevention.