Setting a ground zero research agenda for preventing black youth suicide

In December 2019, the Congressional Black Caucus released “Ring the Alarm: The Crisis of Black Youth Suicide in America,”1 which called for attention to rising rates of suicide and suicidal behavior among Black youth in the United States. Indeed, data from the Centers for Disease Control and Prevention (CDC) suggest suicide for Black youth, 5 to 17 years, has changed over the past decade. In 2008, suicide was the fifth leading cause of death for Black youth, and in 2018, suicide was deemed the third leading cause of death (2.33 per 100 000 population). Additionally, the rate of suicide in Black youth younger than 13 years is approximately 2 times higher compared with their White counterparts.2 Suicidal ideation and attempts have also increased in Black youth, with data from 2009 to 2019 showing the percentages of Black youth who considered suicide (12.95% vs 16.89%, P < .001), made a suicide plan (9.79% vs 15.02%, P < .001), and attempted suicide (7.94% vs 11.85%, P = .05) all increased significantly.3

The Congressional Black Caucus report specifically calls on the National Institutes of Health to fund more Black scientists and mobilize a research agenda focused on preventing Black youth suicide. In response, the National Institute of Mental Health (NIMH) requested information on key points related to preventing Black youth suicide. We responded to this call, along with other members of the Youth Suicide Research Consortium—a group of scholars focused on suicide prevention in diverse youth. Here we share a condensed version of our group’s response to NIMH regarding the necessary steps for suicide prevention research addressing Black youth suicide.

Need for Theory and Tests of Culturally Relevant Risk Factors

Ground zero is a term used to describe the center or origin point of a substantial event or problem. It can also suggest the very beginning of something. We argue the lack of knowledge and published literature concerning Black youth suicide requires a ground zero approach that may not be best assessed with traditional, quantitative research methods. Further, research on Black youth suicide cannot simply apply the White-centric lens that has directed suicide research for decades. For example, common risk factors for suicidal behaviors may not apply equally to Black youth compared with those of other races or ethnicities. Indeed, Robinson et al4 synthesize research showing there is a less consistent link between psychiatric illness and suicide attempts, and depression diagnosis may not be as strongly linked to Black youth suicidal ideation and behavior compared to other racial or ethnic groups.

In addition, recent data5 suggest that traditional risk factors, such as mental health problems and suicide attempt history, were significantly less likely to precede Black youth suicide compared with White, Asian, and Pacific Islander American youth. Together, these findings suggest that common risks associated with suicidal behavior (eg, depression) may not be linked to these behaviors in Black youth.

Further, predominant theories of suicide are assumed to apply universally, regardless of developmental age, race, ethnicity, and culture, but limited evidence exists for applying these theories to minoritized racial and ethnic groups, let alone Black youth. Because of the lack of culturally sensitive theories, we have little information about how unique, race-related stressors may contribute to disparities in suicide rates among Black youth. Unique risks could include trauma exposures, racism (structural/institutional, interpersonal), and stereotypes (both individual and generational). A particular area of concern is the direct exposure to killings of unarmed Black men, which has been associated with negative mental health outcomes in the Black community.6 It is currently unclear how both direct and indirect (eg, media coverage) exposure of the murders of Black youth (Trayvon Martin, aged 17 years; Jordan Davis, aged 17 years; Tamir Rice, aged 12 years; and Michael Brown, aged 18 years), sometimes by White police officers, affect Black youth mental health.

Culturally sensitive theories will help guide research on unique risk factors faced by Black youth. For example, Opara and colleagues7 offer a conceptual framework for Black youth suicide. Their framework suggests that established risk factors, such as interpersonal stress, may intersect with culturally relevant risk factors, such as exposure to racism, to increase suicide risk. Although this is a promising start, much work remains as theories examining culturally relevant, race-related risks have not been studied on a large scale in Black youth, an omission which greatly limits our knowledge.

We argue that to best inform the why and how of Black youth suicidal behaviors, researchers must take a ground zero approach that encompasses a mixture of quantitative and qualitative methodology (eg, interviews and focus groups with youth, their families, and clinicians). This approach will increase insight on culturally relevant and race-related risk/protective factors, assessment of suicidal ideation and behaviors, and recommendations for intervention. Without this baseline understanding, the unique risks associated with Black youth suicide and the assessment of these behaviors will not be fully understood, thereby hindering prevention efforts.

Developmental Trajectory of Black Youth Suicidal Ideation and Behavior

While theory development, research on culturally relevant risk factors, and prevention efforts are needed immediately, research identifying the developmental trajectory of Black youth suicide is warranted to inform and identify prevention targets in the community. Black youth may not report suicidal ideation preceding suicidal behavior. Evidence from pilot research conducted by Denton8 suggests that Black youth have higher rates of suicide attempts and do not report suicidal ideation preceding their attempts. Preliminary findings also suggest the level of parental awareness of their children’s suicidal ideation and behavior is lower among Black parents than among White and Latinx parents.9 We cannot distinguish whether these are true differences in the phenomenology of Black youth suicide or reflect assessment issues. Also, research is needed to replicate these findings with larger samples, identify barriers for Black youth for sharing suicidal ideation and behaviors, and identify unique features of suicidal ideation/behaviors among Black youth.

Engaging Trusted Community Organizations in Suicide Prevention Efforts

Preventing Black youth suicide is going to take nontraditional approaches built on a system of trust within communities of color. Existing community settings where trust may already exist include faith communities and churches, Black Greek organizations, Boys and Girls Clubs of America, after-school programs (eg, YWCA/YMCA), and barber and beauty shops. The latter setting has already been tested as a potential site in the Black community to tackle other health problems, such as high blood pressure.10 These organizations can normalize suicide screenings and prevention efforts from within the community. Additionally, prevention efforts for Black youth must target institutional racism, particularly in schools and mental health agencies. Addressing stigma among adults and mental health providers is required for lowering barriers to providing adequate mental health services in local communities.

The research available on Black youth suicide and suicidal behaviors is limited. We strongly recommend that funding agencies and journals prioritize research on Black youth suicide. Journals that publish research on suicide should require authors to report on the race and ethnicity of study participants and encourage publication of studies that examine disparities in suicide risk and prevention among racial and ethnic minority groups. Funding agencies at all levels can also explicitly fund research studies aimed at understanding Black youth suicide and monitor the enrollment of funded research to ensure samples are diverse and match the demographics of the community. Low representation of Black youth in research and lower rates of funding for Black researchers compared with their White peers should not be accepted as the status quo. Increased innovation and discovery within suicide research is needed to understand why Black youth suicide rates are increasing and how we can intervene.

Sheftall, A. H., & Miller, A. B. (2021). Setting a ground zero research agenda for preventing black youth suicideJAMA Pediatrics175(9), 890–892. https://doi.org/10.1001/jamapediatrics.2021.1112