Keenan Kate, Stepp Stephanie, Anderson Leslie A, Humphries Marisha, Hipwell Alison E, Mbayiwa Kimberley
Department of Psychiatry and Behavioral Neuroscience, University of Chicago.
Department of Psychiatry, University of Pittsburgh.
Mental Health Sci. 2024 Dec;2(4). doi: 10.1002/mhs2.96. Epub 2024 Nov 19.
Suicide is currently the 5 leading cause of death among children aged 5-11, a rate that has more than tripled in the last decade (CDC, 2020), and one that has increased significantly more among Black compared to White children (Ruch et al., 2019). Specifying early childhood phenotypes of suicidality is critical for prevention of suicidal behavior. Such phenotypes need to be culturally relevant and rigorously tested in Black youth to yield data that will inform prevention science.
We used the Interpersonal Theory of Suicide (IPTS; Joiner, 2007), to guide both the development of a theoretical model and a research protocol to conduct a study on suicidality in young Black children. The model was informed by an ecological adaptation which considers the context of structural, systemic, and interpersonal racism as critical for conceptualizing suicidal risk and identifying factors that reduce the likelihood of suicidal ideation and behaviors among Black youth (Robinson et al., 2022). Developmental adaptations of IPTS components were based on existing research supporting associations between theoretically similar constructs and early childhood depression and/or later suicidality.
Model components include loneliness and lack of family connectedness, low self-worth and hopelessness, and impulsivity. The components are measured via questionnaires and reactivity to behavioral probes as measured by facial emotion, heart rate variability, and self-reported mood. Risk and protective factors include exposure to racism and discrimination and racial identity and socialization, respectively. An accelerated, longitudinal design, enrolling 5-9-year-old children for 6 repeated assessments over 45 months will allow us to test stability from early childhood to early adolescence.
Conducting robust tests of early risk and stability of suicidality in the context of culturally relevant risk factors (e.g., racism) and protective factors (e.g., racial socialization and identity) will contribute to efforts to reverse recent trends in Black youth suicide.
自杀目前是5至11岁儿童中第五大死因，这一比率在过去十年中增长了两倍多（美国疾病控制与预防中心，2020年），而且与白人儿童相比，黑人儿童的自杀率增长更为显著（鲁奇等人，2019年）。明确自杀倾向的幼儿期表型对于预防自杀行为至关重要。此类表型需要与文化相关，并在黑人青少年中进行严格测试，以产生可为预防科学提供依据的数据。
我们运用自杀人际理论（IPTS；乔伊纳，2007年）来指导理论模型的构建和研究方案的制定，以开展一项关于黑人幼儿自杀倾向的研究。该模型基于一种生态适应性，这种适应性将结构性、系统性和人际性种族主义背景视为概念化自杀风险以及识别降低黑人青少年自杀意念和行为可能性因素的关键（罗宾逊等人，2022年）。IPTS各组成部分的发展适应性基于现有研究，这些研究支持理论上相似的构念与幼儿期抑郁和/或后期自杀倾向之间的关联。
模型组成部分包括孤独感和缺乏家庭联结、低自尊和绝望感以及冲动性。这些组成部分通过问卷以及面部表情、心率变异性和自我报告情绪所测量的对行为探测的反应性来衡量。风险因素和保护因素分别包括遭受种族主义和歧视以及种族认同和社会化。一项加速纵向设计，招募5至9岁儿童进行45个月内的6次重复评估，这将使我们能够测试从幼儿期到青春期早期的稳定性。
在与文化相关的风险因素（如种族主义）和保护因素（如种族社会化和身份认同）背景下，对自杀倾向的早期风险和稳定性进行有力测试，将有助于扭转黑人青少年自杀的近期趋势。
