Risk and protective factors for suicidal thoughts and behaviors among Black female and male youth with depression symptoms — United States, 2004–2019

Suicide rates among Black youth have increased in recent years. In 2019, suicide was the third leading cause of death for non-Hispanic Black youth aged 12–17 years in the United States (CDC, 2019a). Although Black persons experience lower suicide rates than most other racial/ethnic groups, suicides among Black youth have increased in recent years. From 2015 to 2019, suicide rates among Black youth aged 12–17 years increased by 39 % (CDC, 2019a). During that same time, suicide rates increased by 10 % for White youth and 20 % for Asian or Pacific Islander youth (CDC, 2019a). Additionally, 15 % of Black female youths and 9 % of Black male youths reported attempting suicide in 2019; these rates were higher than those reported for White youth (9 % females; 6 % males) and Hispanic youth (12 % females; 6 % males) (CDC, 2019b). Suicidal behaviors, such as suicide attempts, are one of the strongest predictors of future suicide (Franklin et al., 2017).

Recent research has highlighted several risk factors that are associated with suicide and suicidal behaviors among Black youth such as racism, discrimination, stigma, lack of social support, and relationship problems (Walker et al., 2016; Assari et al., 2018; Madubata et al., 2022; Wahby et al., 2018; Lee and Wong, 2020; Lu et al., 2021; Boyd et al., 2022; US Department of Health and Human Services, 2020; Meza et al., 2022; Sheftall et al., 2022). One longitudinal study of Black children aged 10–12 years found that perceived racism predicted suicide later in life (Walker et al., 2016). Racial discrimination has also been found to be associated with depression symptoms and suicidal ideation among Black youth (Assari et al., 2018; Madubata et al., 2022). Longstanding disparities within the United States healthcare system have led to inadequate care for Black people and internalized stigma associated with seeking mental health treatment (Wahby et al., 2018). Some research suggests that Black youth may avoid seeking mental health support because they fear their friends and family members would be ashamed (Lee and Wong, 2020; Lu et al., 2021). Black youth who reported they lacked emotional support from their parents have also been found to be more likely to experience suicidal ideation and attempt suicide (Boyd et al., 2022). The Report to Congress on African American Youth Suicide found that Black youth who died by suicide were more likely to have experienced a crisis in the preceding weeks and had relationship problems compared to White youth who died by suicide (US Department of Health and Human Services, 2020). The intersectionality of racism, discrimination, and family conflict may influence suicide risk, which highlights the need to address the structural factors that reinforce racism and discrimination as apart of preventing suicide among Black youth (Meza et al., 2022; Sheftall et al., 2022).

A few studies have identified important protective factors, such as social support and positive relationships with family and peers, which may decrease suicidal behaviors and depressive symptoms among Black youth (Boyd et al., 2022; Matlin et al., 2011; Rose et al., 2019). One study found that Black youth who reported close relationships with their parents were more likely to disclose both suicidal ideation and attempts (Boyd et al., 2022). Another study of Black youth found that peer support and community connectedness were associated with a decrease in both depressive symptoms and suicidality (Matlin et al., 2011). However, despite the evident protective effects of social support in decreasing suicidal behaviors, there is an overall lack of research focused on how family cohesion and positive relationships may prevent suicidality among Black youth.

Although previous research has identified lack of emotional support and relationship problems as risk factors for suicide among Black youth, less is known about how Black youths' perceptions of interpersonal relationships, social support, and parental involvement may contribute to suicidal behavior. In addition, the current literature is lacking in our understanding of how these factors may impact Black female and male youth differently (Meza et al., 2022). Furthermore, this epidemiological study was guided by the interpersonal theory of suicide which aims to understand key reasons why individuals may engage in suicidal behaviors (Ribeiro and Joiner, 2009). This theory suggests that two key constructs, perceived burdensomeness (i.e., the belief that one is a burden to others) and thwarted belongingness (i.e., the degree to which an individual feels accepted by others), contribute to suicidal behavior (Van Orden et al., 2010). The purpose of this study was to explore how perceptions of interpersonal relationships, social support, and parental involvement may contribute to suicidal behaviors among Black youth aged 12–17 years, with a specific focus on how these factors may impact females and males differently. We predicted that lower levels of social support and parental involvement and higher levels of interpersonal problems would be associated with nonfatal suicidal thoughts and behaviors (i.e., suicidal ideation, making a plan, and nonfatal suicide attempts).

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