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Suicidal thoughts, attempts rising among black teens
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Between 1991 and 2017, nearly one in five high school students reported suicidal ideation, and more than one in 10 had a plan for suicide, according to research published in Pediatrics. Although researchers observed an overall downward trend in suicidal ideation and plans during the study period, they noted a rise in ideation and attempts among black adolescents.
According to Michael A. Lindsey, PhD, MSW, MPH, executive director of the McSilver Institute for Poverty Policy and Research and the Constance and Martin Silver Professor of Poverty Studies at the New York University Silver School of Social Work, and colleagues, the most influential risk factor for suicide-related death is a suicide attempt.
“These results matter because they show that whatever is happening to result in a downward trend among teens in the general population is missing black teens,” Lindsey told Infectious Diseases in Children. “We need to get to the bottom of why with additional research and resources so that we can intervene effectively before the worst happens.”
He suggested that in previous generations, mental health treatment may have been more accessible to some populations than others. Lindsey said many factors could have contributed to this lack of care, including racial bias, cost of treatment, mistrust of mental health care providers and stigma, which could deter the acknowledgement of mental health problems.
In their study, Lindsey and colleagues analyzed data from the annual Youth Risk Behavior Survey collected between 1991 and 2017. The analysis included responses from 198,540 high school students.
Self-reported suicidal ideation significantly decreased for all sex and race and ethnic groups during the study period, as did reported suicide plans. Specifically, the researchers highlighted a significant decrease in suicide attempts among female students over time (OR = 0.98; P < .001).
However, 18.8% of adolescents reported suicidal ideation, and 14.7% reported having a suicide plan.
Lindsey and colleagues identified an increase in suicide attempts for black adolescent boys (OR = 1.04; P < .001) and girls (OR = 1.02; P = .003).
According to the researchers, the increasing rate of suicide attempts among black adolescents could be caused by decreased access to mental health treatment and social etiologic factors that affect black adolescents more than adolescents of other races and ethnicities.
Black adolescent boys also had significant increases in injuries resulting from these attempts (OR = 1.04; P = .048). Lindsey and colleagues suggest that this may be a result of using increasingly lethal means during suicide attempts.
“Pediatricians have a vital role to play. We know that suicidality can stem from untreated depression. Therefore, pediatricians need to be trained on the warning signs of depression, which can have nuanced differences in black children and teens,” Lindsey said.
These differences, he said, could present in the form of physical complaints, including persistent headaches or stomachaches, rather than classic signs of depression. Black children and teens with depression may also have interpersonal challenges, including anger, which could be interpreted as behavioral issues rather than depression.
“Pediatricians can convey those warning signs to parents and make referrals to appropriate support,” Linsey added. “Meanwhile, parents should check in with their children frequently, ask them how they are doing and feeling and not simply encourage them to be tough in the face of adversity. Finally, everyone should advocate for more mental health professionals in schools, proportionate to the number of students in the school.”
In a related editorial, Benjamin N. Shain, MD, PhD, a child and adolescent psychiatrist at the NorthShore University Health System, wrote that the increase in suicidal ideation and attempt among black adolescents could be a result of a shift from externalizing blame for difficulties experienced by this population to internalizing the blame.
“Regardless of the reasons, the increases in rates of suicide and suicide attempts by black adolescents are concerning and should influence prevention and intervention efforts,” he wrote. “Future research should be aimed at delineating the reasons for increases and suggesting approaches useful for clinicians, schools and leaders in charge of health care and social policy.” – by Katherine Bortz
Resources:
Lindsey MA, et al. Pediatrics. 2019;doi:10.1542/peds.2019-1187.
Shain BN. Pediatrics. 2019;doi:10.1542/peds.2019-1912.
Disclosures: The authors report no relevant financial disclosures.
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Manivel Rengasamy, MD
The article sheds important light on ethnic subgroup differences in suicidal behaviors among adolescents. Clinically, this study emphasizes the importance of careful screening of black adolescents — particularly black male adolescents — for suicidality, given the rising rates of suicide attempts in this population. Clinicians should be aware of the risk for suicide in this population and the relation of suicide risk to the quality of mental health treatment, social factors and stigma related to mental health.
However, the study also highlights the high percentage of adolescents across all ethnic groups who have suicidal thoughts or a suicide plan, emphasizing the need for a comprehensive assessment of suicidality in adolescent populations.
Lastly, these findings emphasize the need for close collaboration of providers with effective suicide intervention and suicide prevention programs in high-risk adolescent populations.
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