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Addressing the Crisis of Black Youth Suicide

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Each September, people in the U.S. and around the world observe Suicide Prevention Awareness Month, a time to help raise awareness and share information about this important public health concern. As director of the National Institute of Mental Health (NIMH), I have made suicide prevention one of my top priorities, and although I have written about suicide in the past, I wanted to revisit this topic to bring attention to this critical area of concern.

One often overlooked aspect of the rising rates of suicide in the U.S. is its impact on youth — and in particular, its impact on Black youth. Black people face increased rates of risk factors, including experiences of racism, higher rates of unemployment and financial and food insecurity, disparities in other aspects of health, and limited access to care, all of which result in an increased burden of mental illness in black communities. Despite this heavy burden, Black people and individuals in other racial and ethnic minority groups have historically had relatively low rates of suicide. But this has been changing recently, especially for Black youth. As of 2018, suicide became the second leading cause of death in Black children aged 10-14, and the third leading cause of death in Black adolescents aged 15-19. By combining data from 2001 to 2015, researchers were able to examine suicides among children ages 12 and younger and found that Black children were more likely to die by suicide than their White peers.

This crisis of Black youth suicide is beginning to receive the attention it deserves. Congresswoman Bonnie Watson Coleman (D-N.J.) and the Congressional Black Caucus deserve credit for raising awareness of the issue and for establishing the Emergency Taskforce on Black Youth Suicide and Mental Health. Their report, Ring the Alarm: The Crisis of Black Youth Suicide in America, was released in December 2019. This report describes key research findings related to suicide among Black youth. Most importantly, it provides research, policy, and practice recommendations to address this issue, such as improving research funding of minority scientists and increasing funding of research focused on Black youth suicide and Black youth mental health.

More research is needed on how suicide risk develops among Black youth, and how it can be best prevented. Significant questions remain in terms of understanding and predicting suicide risk among Black youth — while some risk factors have been well-researched and are clear (e.g., gender, victim of bullying and bullying others, LGBTQ+ discrimination, exposure to trauma, racial discrimination), there are other risk factors that are less clear. For example, some research suggests that Black adolescents who have contemplated or attempted suicide are less likely to have been diagnosed with a mental illness. Another significant risk factor is access to firearms — research points to higher rates of Black youth mortality due to firearms compared to other racial/ethnic groups — which is why we’re supporting infrastructure to improve research on firearm safety for youth.

One factor that may be contributing to increases in the risk of suicide in Black youth may be disparities in access to mental health services. Black youth continue to be less likely to receive mental health treatment for depression when needed, compared to White youth. Rates of engagement in and completion of treatments for depression are lower for Black adolescents (compared to White adolescents), often due to negative perceptions of services and providers and reluctance to acknowledge symptoms. Black youth are also significantly less likely than White youth to receive outpatient treatment even after a suicide attempt.

The good news is that NIMH-funded research has begun to point the way towards better risk identification and effective interventions that can help reverse these trends. Implementing universal screening for suicide risk using the Ask Suicide-Screening Questions toolkit, developed by investigators in the NIMH Intramural Research Program, can identify youth at risk, including Black youth. And, targeted efforts such as school-based mental health clinics can improve engagement in mental health care among Black youth with depression.

Nonetheless, we need considerably more research focused on solutions for Black children and adolescents if we are to truly make a difference for those in need. Accordingly, NIMH continues to expand opportunities for scientists interested in studying these issues, as articulated in our recent Notice of Special Interest (NOSI) in Research on Risk and Prevention of Black Youth Suicide. Other initiatives, including a call to establish Practice-Based Suicide Prevention Research Centers, though broader, are also designed to support work in minority communities and address disparities that affect Black youth. And we continue to look for additional opportunities to support science aimed at addressing this crisis. Black youths’ lives matter, and NIMH research must be aimed at saving lives and alleviating suffering in Black communities in need.

References

Breland-Noble, A. M., & AAKOMA Project Adult Advisory Board (2012). Community and treatment engagement for depressed African American youth: the AAKOMA FLOA pilot. Journal of Clinical Psychology in Medical Settings, 19(1), 41–48. https://doi.org/10.1007/s10880-011-9281-0

Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Sheftall, A. H., Greenhouse, J., Kelleher, K. J., & Campo, J. V. (2018). Age-related racial disparity in suicide rates among US youths from 2001 through 2015. JAMA Pediatrics, 172(7), 697–699. https://doi.org/10.1001/jamapediatrics.2018.0399

Cummings, J. R., Ji, X., Lally, C., & Druss, B. G. (2019). Racial and ethnic differences in minimally adequate depression care among Medicaid-enrolled youth. Journal of the American Academy of Child and Adolescent Psychiatry, 58(1), 128–138. https://doi.org/10.1016/j.jaac.2018.04.025

DeVylder, J. E., Ryan, T. C., Cwik, M., Wilson, M. E., Jay, S., Nestadt, P. S., Goldstein, M., & Wilcox, H. C. (2019). Assessment of selective and universal screening for suicide risk in a pediatric emergency department. JAMA Network Open, 2(10), e1914070. https://doi.org/10.1001/jamanetworkopen.2019.14070

Fowler, K. A., Dahlberg, L. L., Haileyesus, T., Gutierrez, C., & Bacon, S. (2017). Childhood firearm injuries in the United States. Pediatrics, 140(1), e20163486. https://doi.org/10.1542/peds.2016-3486

Joe, S., Baser, R. S., Neighbors, H. W., Caldwell, C. H., & Jackson, J. S. (2009). 12-month and lifetime prevalence of suicide attempts among black adolescents in the national survey of American life. Journal of the American Academy of Child and Adolescent Psychiatry, 48(3), 271–282. https://doi.org/10.1097/CHI.0b013e318195bccf

Lindsey, M. A., Chambers, K., Pohle, C., Beall, P., & Lucksted, A. (2013). Understanding the behavioral determinants of mental health service use by urban, under-resourced black youth: Adolescent and caregiver perspectives. Journal of Child and Family Studies, 22(1), 107–121. https://doi.org/10.1007/s10826-012-9668-z

Musci, R. J., Hart, S. R., Ballard, E. D., Newcomer, A., Van Eck, K., Ialongo, N., & Wilcox, H. (2016). Trajectories of suicidal ideation from sixth through tenth grades in predicting suicide attempts in young adulthood in an urban African American cohort. Suicide and Life-Threatening Behavior, 46(3), 255–265. https://doi.org/10.1111/sltb.12191