Researchers Call for Clinicians to Address Climbing Rates of Suicide Among Black Youth

By Linda Carroll

June 30, 2021

(Reuters Health) - With Black children under age 12 experiencing twice the level of suicide as white peers, and the gap between older Black and white youth narrowing, psychologists from Indiana University call for clinicians to address the issue in a Viewpoint article published in JAMA Pediatrics.

The authors focus on three areas in which they believe clinicians can make a difference: assessment strategies that do a better job of catching Black children at risk; interventions that take into account the lived experiences of Black youth; and advocacy that challenges current U.S. social, justice and health care systems that are "steeped in the systemic oppression of Black and African American individuals."

Coauthor Tennisha Natasha Riley, an assistant professor in the Counseling and Educational Psychology Department at Indiana University in Bloomington, told Reuters Health, "Black children and adolescents are at increased risk for suicide compared to white youth because of multiple factors that are related to race and racial discrimination in the U.S. health system. However, there is something the field of Psychology can do to address this disparity and slow rates of suicide among Black children and adolescents. Clinicians should view advocacy as an intervention and engage with learning about racial oppression in the U.S. health system."

"There is so much we do not yet understand about why children - under the age of 12 specifically - are at greater risk, but there are a few possible reasons," Riley said in an email. "The first step is awareness of the increased risk among Black children and youth, as well as acknowledgement of how health systems and the field of Psychology has contributed to the disparity. Second, clinicians have to view themselves as part of the solution through advocacy including supporting Black clinicians and scientists who are already doing the work, building community partnerships, and using their expertise in ways that are driven by Black youth's stated experiences."

Universal screening for suicide risk is certainly important, the authors write, but clinicians need to understand that expressions of suicidality and risk factors may be different for Black youth. Research in Black youth has found that those who attempt suicide are less likely than white youth to have been diagnosed with psychiatric disorders.

The lower rate of psychiatric disorders among Black youth who attempt suicide may be due to barriers to care and underdiagnoses or misdiagnosis of mental health issues in these children. For example, clinicians may not see signs of depression in Black youth. These children may be more likely to talk about physical hurts or relationship difficulties, the authors say.

Black boys will be more likely than white youth to endorse anger and irritability, which are often misdiagnosed as behavioral problems, O'Reilly and her coauthors note.

It's also important for clinicians to ask about access to firearms, since 70% of suicides in U.S. Black youth are associated with guns, the authors point out. "In conjunction, research has also demonstrated that Black communities endorse more stigmatizing beliefs about mental health issues and suicide, which may be linked to strong religious ties in Black communities," the authors write. "Suicide risk assessments should consider Black youths' own beliefs about suicide, as well as familial and community beliefs."

Interventions should take into account Black youths' lived experiences and racial identity, which are known to contribute to positive youth development, the authors advise. It's also helpful, they note, to adapt intervention materials to fit more common vernacular and depictions for Black youth.

"Clinicians have a unique role in affecting change at multiple levels and in multiple forms, from generating knowledge to disseminating knowledge to patients and organizations," the authors conclude.

SOURCE: JAMA Pediatrics, online June 28, 2021.