Study reveals 'concerning' racial, ethnic disparities for suicide ideation diagnoses

Key takeaways:

• Underrepresented populations with alcohol use disorder were less likely to be diagnosed with suicide ideation.
• American Indian/Alaska Native people had the lowest probability of hospitalization after diagnosis.

The prevalence of suicide ideation is comparable across people of all racial and ethnic groups who have alcohol use disorder, but those from underrepresented groups are less likely to be diagnosed, an expert told Healio.

James K. Cunningham, PhD, a professor of family and community medicine at the University of Arizona said that in recent years, suicide rates among people from underrepresented racial and ethnic groups have increased, whereas the rate for white people has decreased.

“This raises questions, one of which is: Are all of these groups getting the same level of suicide prevention care?” Cunningham said. “One of the most important settings for suicide prevention is the emergency department. We thought it would be helpful to produce some initial data on whether, at emergency departments, all racial/ethnic groups are getting a similar quality of suicide prevention care.”

So, the researchers conducted a study to assess if the comparable rates of suicide ideation prevalence extend to the likelihood of being diagnosed with suicide ideation when presenting to the ED with alcohol use disorder (AUD).

“Among people in the general population with alcohol use disorder, a top risk factor for suicide, the prevalence of suicide ideation differs little by race/ethnicity,” Cunningham said. “It might be expected, consequently, that among emergency department patients with alcohol use disorder, the prevalence of suicide ideation diagnoses would also differ little by race/ethnicity.”

However, “we found that that wasn’t the case,” he said.

Using National Emergency Department Sample data from 2019, the researchers learned that patients from underrepresented racial and ethnic populations had significantly fewer suicide ideation diagnoses, which they wrote is “a key step in ED suicide prevention care,” than white patients. Notably, the group known to have the highest suicide rate in the United States, American Indian/Alaskan Native (AI/AN), had the lowest probability of being hospitalized after being diagnosed with AUD and suicide ideation, a finding Cunningham called “especially concerning.”

“This suggests that patients of color may be receiving relatively less suicide prevention care at emergency departments, as suicide ideation diagnoses are often key to the provision of that care,” Cunningham said.

The age-adjusted probabilities of suicide ideation diagnoses for various groups of patients with AUD were:

• 4.9% (95% CI, 4.4-5.4) for Hispanic patients;
• 5.4% (95% CI, 3.7-7.1) for AI/AN patients;
• 6.7% (95% CI, 6-7.4) for Black patients; and
• 8.7% (95% CI, 8.2-9.2) for white patients.

Among patients with AUD plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for AI/AN people — 32.4% (95% CI, 20.9-44) — was less than that for Black people at 52.3% (95% CI, 47.1-57.5), Hispanic people at 49.9% (95%CI, 43.9-55.8) and white people at 49.8% (95% CI, 46.7-52.8).

In regressions with multiple control variables, the researchers wrote, the racial and ethnic differences remained statistically significant.

Cunningham said that a number of causes could be responsible for the disparities like “language challenges, differences in how cultural groups communicate, differences in the stigma various groups attach to suicide ideation (which could affect disclosure), differences in the extent to which groups view suicide ideation as a medical issue, and biases or stereotypes that some health care providers may not recognize but could affect care delivered.”

“More research is needed on this topic,” Cunningham said. “But in the meantime, when working with patients of color who have risk factors for suicide, consider whether extra effort at times may be needed to assess whether suicide ideation is occurring and follow-up care is needed.”