Does State-Level Structural Racism Impact Risk for Suicide Ideation and Attempts Among US Adolescents Across Race and Ethnicity?

OBJECTIVE

Our study examined the association between state-level structural racism and past year rates of suicide ideation (SI) and suicide attempts (SA) among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents.

METHOD

This secondary analysis used state- and individual-level linked data combining multiple years (ie, 2011-2019) of the Youth Risk Behavior Surveys, the 2019 American Community Survey, and the 2019 state-level Structural Racism Index (SRI), a composite measuring state-level Black-White (B-W) and Hispanic-White (H-W) racial inequities across 5 domains: residential segregation, incarceration rates, educational attainment, economic indicators, and employment status. A series of generalized estimating equations were used to examine the association between structural racism and past-year SI and past-year SA, with race/ethnicity as a moderator, adjusting for state- and individual-level covariates, among US adolescents.

RESULTS

Negative associations were observed between B-W SRI with SI (adjusted b [95% CI] = -0.011 [-0.017, -0.003], p =.004), and SA (-0.011 [-0.018, -0.004], p = .002), as well as between H-W SRI with SI (-0.008 [-0.016, -0.0002], p = .044), and SA (-0.011 [-0.018, -0.004], p = .001). These associations were significantly modified by race and ethnicity for both B-W SRI and H-W SRI. Both Black (SI= -0.011 [-0.02, -0.002]; SA= -0.011 [-0.019, -0.004]) and Hispanic (SI = -0.097 [-0.011, -0.004]; SA = -0.011 [-0.018, -0.004]) adolescents living in states with higher structural racism had lower rates of past-year SI and SA relative to White adolescents. Exploratory analyses identified a negative association between the residential segregation index and past-year SI and SA among Black and Hispanic adolescents. Meanwhile, a positive association emerged between B-W incarceration index and past-year SA, but not past-year SI, among Black adolescents.

CONCLUSION

Adolescents in states with higher SRI were at lower risk for past-year SI and SA. Racial inequities across various institutions may differentially influence suicide-related risk among adolescents. Structural racism may play an important role in conferring risk for SI and SA, and its impact may vary across Black, Hispanic, and White adolescents. Attending to institutional level markers of racism may help to improve the cultural responsiveness of youth suicide prevention strategies.

STUDY PREREGISTRATION INFORMATION

Study Preregistration: Does State-level Structural Racism Impact Risk for Suicidal Thoughts and Behaviors Among US Adolescents Across Race and Ethnicity? https://www.jaacap.org/article/S0890-8567(23)00124-7/fulltext DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.