The Moderating Role of Race/Ethnicity in Suicide Risk and Family Connectedness in Youth Presenting to the Emergency Department.

OBJECTIVE

Significant racial disparities exist in youth suicide rates. Research has identified family connectedness as a strong protective factor against suicide. However, the role of family in youth mental health can vary based on cultural factors that may differ across race and/or ethnicity. This study aimed to evaluate how race/ethnicity moderates the association between suicide risk and family connectedness.

METHOD

This secondary analysis of Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study 1 included youth ages 12 to 17 years. Data were obtained for race/ethnicity, family connectedness (combined score of 2 items, range 2 [low] to 10 [high]), and the Ask Suicide-Screening Questions (ASQ) tool. Binary logistic regression assessed the association between family connectedness and positive ASQ screen, with race/ethnicity as a moderator.

RESULTS

Data for 5,514 participants (50.9% female, 45.8% non-Hispanic White, mean [SD] age = 15.0 [1.7] years) were analyzed. Of all participants, 23.5% (1,293/5,514) screened positive for suicide risk. Overall, participants reported high family connectedness (mean [SD] = 8.2 [1.74]). Multiracial participants had the lowest average family connectedness (7.93) and the highest screen positive rate (28.34% [70/247]). For a 1-unit increase in family connectedness, the odds of screening positive were significantly lower for Black/African American participants (odds ratio 0.54, 95% CI 0.49-0.59) compared to White participants (odds ratio 0.46, 95% CI 0.43-0.49) (difference: = -3.17, = .001).

CONCLUSION

The protective effect of family connectedness for suicide risk may vary by race/ethnicity. In this study, family connectedness was less protective against suicide risk for Black/African American youth compared to White youth. Findings highlight the importance of cultural considerations in family-based interventions for suicide prevention.