Understanding suicide risk for youth who are both Black and Native American: The role of intersectionality and multiple marginalization

Intersectional marginalized identities as predictors of time until first reported suicide attempt among preadolescent youth using survival analysis

BACKGROUND

Suicide attempts and deaths among children are increasing in the United States, yet suicide in this preadolescent population remains understudied. A clearer understanding of which youth experience early onset of suicidal behavior is crucial for predicting risk and identifying youth best suited to early intervention. This paper examines how intersectional marginalized identities may predict the onset of suicidal behaviors among preadolescent youth.

METHODS

The Adolescent Brain and Cognitive Development (ABCD) Study is a prospective cohort study with annual assessments of youth ages 9 and 10 and their caregivers. Lifetime suicide attempts and preparatory suicidal behaviors were assessed annually. Survival models examined overall trends and demographic differences in the onset of suicidal behaviors.

RESULTS

The final sample included 11,223 participants (mean age = 9.9 years old, SD = 7.5 months). 5,280 (47%) reported a minoritized racial/ethnic identity, and 1,410 (12.6%) were categorized as sexual or gender minorities. 208 suicide attempts and 143 instances of preparatory suicidal behaviors were reported across the study period. An interaction effect was found such that youth who hold multiple minoritized identities (i.e., sexual and gender minority youth from minoritized racial/ethnic backgrounds) were at elevated risk for onset of both suicide attempts (HR = 2.97, 95% CI = 1.59-5.56, p = .001) and preparatory suicidal behaviors (b = 3.09, 95% CI = 1.38-6.93, p = .006).

CONCLUSIONS

Intersectional marginalized identities were associated with earlier onset of suicide attempts and preparatory suicidal behaviors. Findings suggest that early interventions for minoritized youth may be important to reduce the rapidly increasing suicide rate among preadolescent youth.

Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

Preventing Suicide Through Lethal Means Restriction in Pediatric Care

Suicidal ideation in the pediatric population has increased by 50% over the last decade. Suicide is the primary contributor to violent deaths and ranks as the second leading cause of mortality within the 10-24-year-old age group. The lethality of the methods selected notably elevates the likelihood of children and adolescents dying by suicide. Awareness of the commonly chosen means of suicide at each developmental stage and understanding their respective lethality are vital in developing prevention strategies. Lethal means safety counseling is a specific evidence-based suicide prevention strategy that pediatric providers can use during patient encounters to help mitigate the risk of self-inflicted injuries and suicide. Providers are well-positioned to integrate discussions of lethal means restriction with patients and their families into their protocols for suicide prevention, screening, and assessment. This article explores the data and practice evidence for lethal means restriction and counseling, focusing on clinical strategies and policy changes to reduce access to lethal means. Emphasis is given to how pediatric providers speak with parents about the importance of restricting access when developing a safety plan.

Structural adverse childhood experiences associated with suicidal ideation, suicide attempts, and repetitive nonsuicidal self-injury among racially and ethnically minoritized youth

INTRODUCTION

High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots.

METHODS

Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety.

RESULTS

Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures.

CONCLUSION

Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

Sexual Minority Stress: Preliminary Evidence of Accelerated Pubertal Development in Early Adolescence

INTRODUCTION

Societal stressors place a tremendous burden on individuals who identify with a sexual minority identity. While minority stress experienced by racial/ethnic minority groups has been linked to accelerated aging, this link has yet to be examined among sexual minority youth. This study explores whether sexual minority youth who indicate experiencing stress at home or school (Minority Stress) due to their identity show evidence of accelerated aging (pubertal status or tempo) compared to those who do not report such experiences (No Minority Stress).

METHODS

Data are from the Adolescent Brain Cognitive Development (ABCD) Study. Participants were approximately 9-10 years old at baseline, 10-11 years old at Time 1, and 11-12 years old at Time 2. Measures included child-reports of sexual minority identity and stressors, and parent-reports of adolescent pubertal development.

RESULTS

Among 432 included participants who identified with a sexual minority identity, 83.6% were assigned female at birth and 24.8% were in the Minority Stress group. There were consistent results showing that sexual minority youth in the Minority Stress group showed accelerated pubertal status over time compared to those in the No Minority Stress group. Pubertal tempo (i.e., slope) was only accelerated for those who first identified as sexual minority at Time 2.

CONCLUSION

Our findings underscore that minority stress experienced by sexual minority youth may be linked to differences in pubertal development among these youth. The developmental and clinical implications of these patterns present critical lines for future research concerned with the wellbeing of sexual minority youth.

A multi-level examination of impulsivity and links to suicide ideation among Native American youth

BACKGROUND

Despite preliminary evidence that links impulsivity to suicide risk among Native American youth, impulsivity has not been directly studied in relation to suicide ideation (SI) or behaviors in this population. We examined indexes of rapid-response impulsivity (RRI) across multiple levels of analysis (self-report, behavioral, neurobiological) and associations with SI among Native American youth ages 9-10 in the Adolescent Brain Cognitive Development Study.

METHODS

Data from the sample (n = 284) included self-report (UPPS-P), behavioral (Stop Signal Task), and neurobiological (right inferior frontal gyrus activation) indicators of RRI. RRI indicators were modeled using variable-centered (i.e., traditional multivariable regression) and person-centered (i.e., clustering analyses) approaches in measuring their association with SI.

RESULTS

Logistic regression analysis demonstrated that higher negative urgency was associated with higher odds of SI (Adjusted Odds Ratio = 1.23, p = 0.015). Latent profile analysis clustered youth into five profiles based on within-individual variation in RRI indicators. Youth with an elevated self-reported negative and positive urgency profile had higher odds of reporting SI than "normative" youth (Adjusted Odds Ratio = 2.38, p = 0.019).

LIMITATIONS

Limitations of this study include the modest sample size particularly regarding SI (14.1 %), potential bias in estimates of lifetime SI, and generalizability to youth from specific Native American communities.

CONCLUSIONS

Negative urgency may increase risk for SI among Native American youth in late childhood. Clinical implications, including the potential for person-centered RRI profiles to act as candidate markers of suicide risk and resilience in adolescence and inform safety assessments and planning, are discussed.

Seeing adolescents grow from many angles using a multilevel approach: A tribute to the contributions of Dante Cicchetti to the field of developmental psychopathology

Dante Cicchetti propelled forward the field of developmental psychopathology by advancing this framework and championing new methods, including emphasizing the central role that multilevel analysis holds for explicating pathways of risk and resilience. His work continues to change the face of existing science. It has also paved the way for the formation of new projects, like the Research Domain Criteria initiative. This paper uses our laboratory's work on multilevel approaches to studying adolescent depression, non-suicidal self-injury, and suicidal thoughts and behaviors to shine a spotlight on Dr Cicchetti's contributions. In addition, we review recent developments, ongoing challenges, and promising future directions within developmental psychopathology as we endeavor to carry on the tradition of growth in the field.

A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

Preliminary Reporting Patterns of Suicide Ideation and Attempt Among Native American Adolescents in Two Samples

OBJECTIVE

Native American adolescents are disproportionately burdened by suicidality. Here, we examine patterns of reporting of suicide ideation and suicide attempt among Native American youth compared to those from other ethnoracial backgrounds, as this data is important for grounding commonly subscribed to frameworks of suicide risk (e.g., ideation-to-action).

METHOD

Data are from the Youth Risk Behavior Surveillance Survey (N = 54,243; grades 9-12; 51.0% female) and Minnesota Student Survey (N = 335,151; grades 8, 9, 11; 50.7% female). Comparing Native American youth to peers from other ethnoracial backgrounds, we examined two suicide reporting patterns: 1) odds of reporting suicide attempt among those who reported ideation and 2) odds of reporting suicide ideation among those who reported an attempt.

RESULTS

Across both samples, when reporting suicide ideation, youth from other ethnoracial backgrounds were 20-55% less likely than Native American youth to also report attempt. While few consistent differences were observed between Native American youth and those from other racial minority backgrounds in patterns of co-reporting suicide ideation and attempt across samples, White youth were between 37% and 63% less likely than Native American youth to report a suicide attempt without also reporting ideation.

CONCLUSIONS

The increased odds of engaging in a suicide attempt with or without reporting ideation question the generalizability of widely held frameworks of suicide risk to Native American youth and have important implications for suicide risk monitoring. Future research is needed to illuminate how these behaviors unfold over time and the potential mechanisms of risk for engaging in suicide attempts in this disproportionately burdened group.Abbreviations: YRBSS: Youth Risk Behavior Surveillance Survey; MSS: Minnesota Student Survey.

Communication dynamics and media interactions of young adults who have attempted suicide: a qualitative thematic analysis

Objective

The study examines the potential effects of communication processes and media consumption habits on suicide ideation among male and female young adults aged 18-29 who have attempted suicide at least once.

Methods

In-depth interviews were analyzed using MAXQDA Analytics Pro 2024, and thematic analysis was applied according to Braun and Clarke's model.

Results

Four themes emerged: (1) Family-related factors, (2) sociopsychological factors, (3) sociocultural factors, and (4) media-related factors. Regarding family-related factors, most participants come from broken family structures and commonly report issues with family communication and experiences of violence. Regarding sociopsychological factors, anger issues, despair, and addictions among participants were observed to increase suicide tendencies. Regarding sociocultural factors, most participants expressed difficulties in conforming to society and feeling pressures from cultural or religious expectations. Regarding media-related factors, it was noted that a vast majority of participants spend long hours consuming media daily and frequently interact with content that leads them into adverse emotional states, primarily for time passing on social media platforms.

Discussion

This research not only reinforces information in the literature but also presents unique findings compared to similar studies, particularly in cultural and geographical contexts. The results uniquely highlight the diversity in perceptions of the relationship between religion and suicide. While literature generally notes religion as a deterrent to suicide, this study reveals that intense religious pressure could increase suicidal tendencies through effects like rejection and hatred of religious values. Media also plays a reinforcing role in this context.

Conclusion

In conclusion, this study elucidates the complex interactions underlying suicide attempts among young adults and provides a solid foundation for policies and interventions aimed at better managing media interactions, which play a critical role in suicide prevention efforts.

Longitudinal panel networks of risk and protective factors for early adolescent suicidality in the ABCD sample

Rates of youth suicidal thoughts and behaviors (STBs) are rising, and younger age at onset increases vulnerability to negative outcomes. However, few studies have investigated STBs in early adolescence (ages 10-13), and accurate prediction of youth STBs remains poor. Network analyses that can examine pairwise associations between many theoretically relevant variables may identify complex pathways of risk for early adolescent STBs. The present study applied longitudinal network analysis to examine interrelations between STBs and several previously identified risk and protective factors. Data came from 9,854 youth in the Adolescent Brain Cognitive Development Study cohort (Mage = 9.90 ± .62 years, 63% white, 53% female at baseline). Youth and their caregivers completed an annual measurement battery between ages 9-10 through 11-12 years. Panel Graphical Vector Autoregressive models evaluated associations between STBs and several mental health symptoms, socioenvironmental factors, life stressors, and substance use. In the contemporaneous and between-subjects networks, direct associations were observed between STBs and internalizing symptoms, substance use, family conflict, lower parental monitoring, and lower school protective factors. Potential indirect pathways of risk for STBs were also observed. Age-specific interventions may benefit from prioritizing internalizing symptoms and early substance use, as well as promoting positive school and family support.

Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review

Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.

Relations between discrimination, rejection sensitivity, negative affect, and decrements in problem-solving ability following social rejection: An experimental investigation

INTRODUCTION

While negative affect and problem-solving deficits have been consistently linked to suicidal thoughts and behaviors, the latter are often conceptualized and studied as time- and/or context-invariant. Though requiring additional empirical support, theory suggests that discrimination may strengthen the relation between rejection sensitivity and increases in negative affect as well as declines in problem-solving abilities following rejection. The aim of the current study was to test this claim using a social rejection paradigm (i.e., Cyberball) with young adults experiencing past-month suicidal ideation.

METHODS

The sample consisted of 50 participants. Lifetime discrimination and rejection sensitivity were assessed prior to Cyberball. Negative affect and problem-solving abilities were assessed pre- and post-Cyberball. SPSS and the PROCESS macro were used to test relations among variables of interest.

RESULTS

Rejection sensitivity predicted greater problem-solving decrements, but not negative affect, following rejection among individuals who had experienced higher (vs. lower) levels of lifetime discrimination.

CONCLUSION

Addressing rejection sensitivity and sources of discrimination within the context of treatment may reduce the impact of social rejection on problem-solving abilities among young adults at risk for suicide.

Mental health outcomes of multiracial individuals: A systematic review between the years 2016 and 2022

BACKGROUND

Emerging evidence suggests that multiracial individuals are at high risk for mental health problems. Systematic and ongoing synthesis of literature is necessary to understand mental health among multiracial individuals.

METHODS

We conducted a systematic review of scholarly articles published during the years 2016-2022. Studies must have focused explicitly on mental health outcomes of biracial/multiracial individuals using quantitative methods. A total of 22 articles met criteria for this review.

RESULTS

Studies were mainly from the United States, with one study from the United Kingdom and one from the Netherlands. Sample sizes ranged from 57 to 393,681. Findings revealed a complicated picture between multiracial identity and mental health, which may be a function of how multiracial identity is defined and empirically examined. Among studies comparing multiracial individuals with monoracial groups, multiracial individuals tended to have worse mental health, with notable exceptions depending on the multiracial subgroup, the mental health outcome, and the reference group. Among studies that only examined multiracial individuals, discrimination and ethno-racial identity emerged as complex explanatory factors that can shape mental health, though each of these constructs can be explored more deeply across social milieu.

LIMITATIONS

The review focused on studies explicitly examining multiracial mental health, published during a limited time frame.

CONCLUSION

Multiracial individuals tended to have worse mental health outcomes compared to their monoracial counterparts, with variations depending on the outcomes, populations/subgroups, contexts, and reference groups. Racial discrimination and ethno-racial identity may shape mental health trajectories of multiracial people, calling for more research to inform targeted interventions.