Suicide-Related Risk among Racial and Ethnic Minority Youth: Important Considerations

Lillian Polanco-Roman, Ph.D., Columbia University Medical Center

(originally published 1/5/2020)

Until recently, suicide deaths have historically been higher among White youth than among their racial and ethnic minority peers. Some researchers have argued that racial differences in suicide deaths may be partly explained by a tendency to misclassify suicides among racial and ethnic minorities as being due to undetermined causes. Nevertheless, more researchers have become interested in examining culture-specific experiences relevant to the study and treatment of suicide risk in youth. Despite earlier calls for cultural considerations in youth suicide, racial and ethnic minorities are not well represented in suicide studies, and this has kept us from being able to understand the cultural context of youth suicide risk. These unanswered calls, unfortunately, may have contributed to critical oversights in the mental health needs of racial and ethnic minority youth at risk for suicide. 

Among racial and ethnic minorities, suicide deaths are most prevalent in youth. Youth suicide deaths have steadily increased in the last decade, with considerable racial/ethnic disparities observed. Native American youth have the highest rate of suicide and suicidal behaviors, compared to other racial and ethnic groups, followed by White people. But although suicide deaths among White children under 13 years old have decreased, rates have increased among Black children, who are now twice as likely as their White peers to die by suicide. Suicide attempts have also steadily increased among Black high school students, with no change detected among other racial/ethnic groups. High rates of suicide attempts have also observed among Latinx high school students in the mainland U.S., but especially in the U.S. territory of Puerto Rico. At the same time, racial and ethnic minority youth at risk for suicide have a low rate of mental health service use, further adding to concerns. Racial and ethnic minority populations are thus disproportionately burdened by youth suicide risk. And yet, we know very little about how race-related or culture-specific experiences explain youth suicide risk.

To understand suicide-related risk among racial and ethnic minority youth, we should first consider the effects of racism on health. Poverty, limited access to quality mental health care, and exposure to early life adversities – which increase suicide risk – may reflect institutional racism (i.e., racial bias in organizational policies and practices). Institutional racism has created and maintained inequitable distribution of resources. At the same time, more direct exposures or interpersonal-level forms of racism have also been linked to negative physical and mental health (including suicide risk) among racial and ethnic minority youth. Specifically, racial and ethnic discrimination (i.e., discrete and overt displays of racially/ethnically-biased unjust treatment) and microaggressions (i.e., subtle and chronic, covert displays of prejudices and biases) have gotten much of the attention in the literature. Findings suggest that discrimination and microaggressions may increase vulnerability to psychological symptoms, engender hopelessness and helplessness, compromise self-esteem, lower academic motivation and engagement, and increase association with deviant peers. The harmful effects of racism, thus, cut across many important areas in the lives of racial and ethnic minority youth. Thus, they potentially have an effect on suicide-related risk.

Another important consideration for addressing suicide-related risk among racial and ethnic minority youth is to look beyond traditional views of depression as the pathway to suicide risk. Risk for suicide looks very different in youth than in adults.Unlike in adults, for whom mood disorders like depression are more reliable indicators of suicide risk, behavioral problems like Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior Disorders are more reliably associated with suicide risk among youth. We may be missing important early signs of suicide risk if we largely focus on signs of depression. This oversight disproportionately impacts youth from racial and ethnic minority backgrounds. Additionally, depression may manifest differently among racial and ethnic minority youth. Depression in black boys is more likely expressed as somatic complaints and interpersonal conflict, and not as depressed mood. This highlights the need for greater cultural sensitivity in tools used to assess risk for suicide among youth. This also highlights how early signs of suicide risk among racial and ethnic minority youth may go undetected, and instead met with harsh punishment, particularly in school settings. This may eventually facilitate a path towards suicide. 

Current approaches to youth suicide research need a paradigm shift. We need to seriously consider the important role of race-specific and culture-specific experiences, such as racial discrimination, microaggressions, and alternative symptom pathways for suicide risk. We also need to explore culture-specific factors (e.g., strong racial/ethnic identity, religiosity) that may protect against the effects of racism on suicide risk, to inform prevention and intervention efforts with racial and ethnic minority youth. This information would broaden our understanding of youth suicide, more generally, to help combat the steady rise across all youth.

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