In the United States, suicide is the second leading cause of death among youth between 5 and 17 years of age, and the rates of suicide and suicidal behavior among youth have been steadily increasing over the last decade. A national study combining suicide mortality data from 2001 to 2015 found that Black youth younger than 13 years of age are approximately two times more likely to die by suicide than their white counterparts.
Understanding the risks for Black youth suicide and suicidal behavior, which are likely to differ from those seen in youth of other races and ethnicities, is vital for the development of effective prevention programs, yet the literature investigating Black youth suicide remains extremely limited. Thus, the Congressional Black Caucus Emergency Taskforce on Black Youth Suicide and the National Institute of Mental Health (NIMH) has made it a priority for researchers to examine antecedents associated with suicide risk in Black youth.
Along with other members of the Youth Suicide Research Consortium, we responded to this call by delineating the necessary steps for suicide prevention research addressing Black youth suicide. We suggest that to address the why and how of Black youth suicide behaviors a ground zero approach — to identify the origin of these behaviors — is necessary and that traditional, quantitative research methods may not be sufficient to do so.
We argue that one, a baseline understanding of the unique risks associated with Black youth suicide and tests of theories in the field of suicide are needed to determine their relevance for Black youth; two, tracking the developmental trajectory of Black youth suicidal ideation and behavior is warranted and necessary to inform and identify prevention targets; and three, engaging trusted community organizations in suicide prevention efforts may be the way forward for suicide prevention programming for Black youth.
To begin establishing the requisite baseline understanding of risk factors, my colleagues and I have, for the first time, examined the current trends and precipitating circumstances of suicide by age group and sex in Black youth only.
For our study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, we used data from two national databases, the Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS) and the National Violent Death Reporting System (NVDRS). From 2003 to 2017, 1,810 suicide deaths occurred in Black youth and during this period all age groups (5-11, 12-14, and 15-17 years) experienced a significant upward trend in suicide, with the largest annual percentage change among adolescents between 15 and 17 years of age, at 4.9 percent, followed by 5–11-year-old youth at 3.9 percent.
The annual percent increase among Black girls, 6.6 percent, was twice that of Black boys, which was very surprising as this finding suggests the discrepancy between male and female suicides in Black youth may be decreasing. This is quite concerning and signals that something is happening among our Black girls that warrant further study.
Predominantly, Black youth suicide decedents were boys (71.4 percent), non-Hispanic (96.5 percent), and older (15 and 17 years of age (58.9 percent). Overall, the decedents were more likely to have died by hanging, strangulation, suffocation (62.1 percent) and did so in their own residence (78.9 percent).
We also found that several clinical characteristics and precipitating circumstances varied by sex and age group. For example, Black girls were more likely to experience a boyfriend and/or girlfriend crisis prior to death and died by suicide within 24 hours of an argument compared to Black boys. Black boys were more likely to experience a recent criminal and/or legal problem and less likely to have received mental health treatment prior to suicide compared to Black girls. Younger children, especially those 5 to 11 years of age, were more likely than older decedents to have experienced family problems or crises and school problems, and if diagnosed with a mental health concern, more likely to be diagnosed with attention deficit disorder or attention deficit hyperactive disorder.
With this knowledge, we can return to our concept of starting from ground zero. We have identified some risk factors for Black youth, and we can now start to examine which theories may be most relevant for Black youth suicide and evaluate which prevention programs are beneficial or if adaptation of the prevention programs is needed.
We believe nontraditional approaches built on a system of trust within communities of color are needed to bring suicide prevention to youth. Such settings, those that bring people together and have always been staples in the Black community, including the church and other faith-based organizations, community centers and after-school programs (e.g., YWCA/YMCA), summer programs, Black Greek organizations, Boys and Girls Clubs of America, and barbershops and beauty salons.
These settings can be used to normalize suicide screenings and prevention and address mental health stigma. However, prevention efforts for Black youth must also target institutional racism and discrimination, particularly in schools and mental health agencies to provide adequate mental health services in local communities.
Additionally, large-scale changes in the social and physical environment and revisions to the policies that guide mental health and health care are needed to benefit Black communities. Examples of broad, impactful solutions could include reducing the socioeconomic barriers of youth and their families through improved educational opportunities, improving public infrastructure to ensure timely access to health care facilities and mental health professionals, and developing public health initiatives that increase dialogue and trust between mental health care providers and members of the Black community.
Arielle Sheftall, Ph.D., is a principal investigator in the Center for Suicide Prevention and Research and the Abigail Wexner Research Institute at Nationwide Children’s Hospital.