Black Youth and Suicide
Black youth have experienced a more rapid increase in suicide rates in the past two decades than any other racial or ethnic group. From 2003 to 2011, although Black youths aged 5-11 made up only 15% of the population, they accounted for 37% of all youth suicides. Studies indicate that deaths by suicide have increased among Black youths aged 5-17, with the greatest increase seen among those aged 15-17. Recent data show that suicide rates among Black girls aged 15-19 rose from 1.2 to 4.0 per 100,000 per year from 2007 to 2017, while for Black youths aged 10-14, there has been a 131.5% increase in deaths by suicide over the past 20 years. Furthermore, very young Black youths aged 5-12 are twice as likely to die by suicide compared to their White peers. These trends are concerning and require urgent attention to address disparities and prevent further widening of the gap.
Several factors contribute to the elevated suicide risk among Black youth. Greater exposure to community violence, socioeconomic stress, perceived discrimination, stigma, and interpersonal and family conflict are key predictors. Black youth who belong to multiple minoritized populations, including Black females and LGBTQ individuals, face even higher risk. Structural racism, discrimination, and bias often lead to under-recognition, misdiagnosis, and undertreatment of mental health and substance use issues in Black youth. Those who do receive clinical attention are frequently diagnosed with behavioral problems rather than mental health conditions that put them at increased risk for suicide. Furthermore, they may receive lower quality care and less follow-up care after crisis or hospital services, contributing to distrust in health care systems and missed opportunities for prevention and timely intervention.
Structural factors that reinforce racism and discrimination, such as exposure to potentially traumatic events, also increase suicide risk among Black youth. Disproportionate involvement in the child welfare system and negative experiences with policing and violence further compound these risks. These cumulative factors contribute to the increased suicide risk among Black youth.
Intersectionality Considerations
Gender
Gender differences in suicide attempts and deaths are significant, with Black adolescent females having the highest rates of suicide attempts compared to adolescent females of other racial-ethnic groups. Data from the 2019 Youth Risk Behavior Survey reveals that 15.2% of Black adolescent females attempted suicide in the 12 months prior to the survey, compared to 11.9% of Latinx females and 9.4% of non-Hispanic White females. A study of suicide death trends found that Latinx and Black females experienced the largest increases in deaths by suicide, with a 133% and 125% increase respectively, compared to a 88% increase for non-Hispanic White females and a 61% increase for Asian and Asian American females in the same age range. Additional data support an increase in suicide rates from 2001 to 2017 for Black adolescents, with Black adolescent females experiencing a 182% increase and Black adolescent males experiencing a 60% increase, demonstrating intersectionality, a concept highlighting how marginalized identities intersect to amplify risk.
LGBTQ+
A national survey of over 2,500 Black LGBTQ youth from The Trevor Project found that the community is diverse, with 31% identifying as gay or lesbian, 35% as bisexual, 20% as pansexual, and 9% as queer. One in three Black LGBTQ youth identified as transgender or nonbinary, and more than 1 in 4 use pronouns outside of the binary gender system. However, mental health challenges are prevalent among Black LGBTQ youth, with 44% seriously considering suicide in the past year and more than half reporting symptoms of anxiety and depression. Self-harm was reported by 44% of Black LGBTQ youth, with 61% of Black transgender and nonbinary youth reporting it. Many risk factors for mental health were identified, including conversion therapy, homelessness, discrimination based on sexual orientation, gender identity, and race, and physical harm due to LGBTQ or gender identity. Almost half of Black LGBTQ youth wanted psychological or emotional counseling but were unable to access it.
Poverty
Studies have shown that poverty, as well as exposure to violence, are contributing factors to suicidal behavior, which are prevalent issues among Black adolescents. According to research, almost 40% of Black youths live in poverty, which is twice the rate of their White peers. Moreover, many Black families are disproportionately represented as low-income compared to White families. Additionally, studies have found that living in areas with concentrated poverty is associated with higher rates of suicide among young people. Poverty can lead to a range of stressors, such as financial burdens and exposure to community violence, gang activity, and drug use, which increase the risk of experiencing mental health difficulties.
Stigma
Data from the Healthy Minds Study between 2007 and 2019 suggests that Black college students experience high levels of public stigma related to mental health treatment, and this stigma is associated with a greater likelihood of past-year suicide attempts. Mental health stigma is a significant barrier to treatment, and understanding these barriers can inform mental health providers and increase access to services for Black youth. The combination of medical mistrust and stigma within the Black community can amplify mental health disparities among Black youth. Structural racism, discrimination, institutional inequities, and disparities hinder the Black community's willingness to seek mental health services. Stigma often leads to silence, shame, and fear, which are significant obstacles to receiving mental health treatment for Black adolescents. Several studies have found that Black youth are less likely to endorse suicide ideation before a suicide attempt, and they fear being teased by friends or causing shame to their family if they seek mental health support.
Racism
Most studies have failed to fully investigate the direct and indirect effects of race-related oppressive experiences, like racial discrimination and trauma, on suicidal behavior in Black youths. To fill this gap, new theoretical frameworks emphasize the importance of examining interpersonal stress factors and culturally relevant risk factors, such as racism, to better understand suicide risk in this population. This issue is of crucial importance because racism and discrimination are among the fundamental causes of adverse outcomes, including suicide, among racial and ethnic groups. Unfortunately, Black youths experience racial discrimination far too often across various developmental stages, such as childhood, adolescence, and young adulthood. Longitudinal studies have found that perceived racism among Black children as young as 10 years old predicts later suicide. The link between racial discrimination and suicide ideation has also been noted among Black adolescents, with studies showing that perceived racial discrimination predicts depression symptoms and suicide ideation among both Black and Latinx youths. Discrimination (not specific to racial or ethnic discrimination) was significantly associated with increased capability for suicide among Black, but not White, college students. Racial discrimination has consistently been significantly associated with suicidal ideation across studies and developmental stages, although the mechanisms underlying this association require further research.
Family Dynamics
As youths may not have autonomy in determining their mental health treatment, decision making often falls to caregivers, guardians, and educators. Studies have found that youths, caregivers, and primary care providers may not believe there is a presenting mental health issue or believe that the problems are not severe enough to warrant treatment, thereby creating gatekeeping barriers to accessing care (16, 24-26). Additionally, self-reliance and refusal to attend treatment have also been found to prevent youths from seeking and receiving mental health services (15, 25). Black caregivers with children at risk of developing a psychiatric disorder may be less likely to report that their adolescents need psychological services than White caregivers (27). This finding may be related to mental health stigma, medical mistrust, lack of information on problem recognition or how and where to seek services, or preferences for culturally focused services (e.g., church). Black parents have also described navigating the school system and lack of resources as systematic barriers to youth mental health service use (14, 28). It is essential to recognize these barriers and work towards addressing them to improve access to mental health services for Black youths.
Protective Factors
A systematic review of protective factors against suicide among Black adolescents indicated that religious, social, familial, and personal factors may mitigate the risk for suicidal behaviors. Religiosity is often a focal part of the lives of Black families; therefore, several religious factors, such as intrinsic religiosity, religious awareness, perceived membership in a spiritual community, and collaborative religious problem-solving, have been found to protect against youth suicidality. Familial protective factors that are strongly supported are parent-family connectedness and family support, but familial factors have been found to be less protective among low-income youths. Additionally, several social factors, such as dense school social networks, school climate, popularity, and perceived social support have been found to be protective against suicide among Black adolescents. However, several of the factors, including popularity, teacher bonding, and perceived support have been found to be nonprotective among urban Black youths. The mixed findings of past studies suggest there may be protective factors unique to Black youths of different socioeconomic backgrounds. Additionally, several individual characteristics, including age, high self-esteem, emotional well-being, hope, academic success, reasons for living, purpose in life, and life satisfaction, have been found to protect against suicidal behavior. Other protective factors, such as racial socialization, racial pride, and racial-ethnic connectedness have shown promise in terms of promoting resiliency and, therefore, warrant further exploration.
Ways for School Personnel to Take Action:
Collaborate with school personnel to promote early recognition of suicide risk factors among Black youth, which is crucial to increase awareness of the impact of structural racism, gender bias, discriminatory practices, and unconscious bias. Encourage school personnel to participate in training programs that equip them with the knowledge and skills to identify and respond to suicide risk factors in Black youth.
Work with school personnel to improve identification, access to care, and retention in mental health and substance use treatment for Black youth. Address the impact of social determinants of health, discrimination, structural racism, stigma, gender and sexual minority status, interpersonal and family conflict, and intergenerational trauma on Black youth mental health.
Support evidence-based resiliency programs in schools with a focus on Black youth and protective factors including sense of belonging, racial and collective socialization, family strengths, and community cohesion. Encourage school personnel to develop and implement evidence-based interventions for suicide prevention.
Promote research for potential risk factors including structural racism, bias, and incorrect diagnoses in order to help decrease under-recognition of the precursors of suicide in Black youth. Advocate for school personnel to stay informed about the latest research on suicide prevention and mental health for Black youth.
Advocate for increased investments in programs that build a more culturally competent and minority-representative school personnel workforce, including research and education programs that promote the inclusion of health equity as a core competency in school personnel training.
Advocate for scholarship funding and loan forgiveness programs that target students underrepresented in education and mental health, with the goal of increasing the number of Black school personnel who are trained to address the mental health needs of Black youth.