Centering the Margins: Addressing Suicide Risks among Ethno-Racial Minority Adolescents

In the United States (US) suicide is the second leading cause of death among adolescents. Prior research has used aggregated data and focused on individual level factors as opposed to environmental factors hiding subpopulation vulnerabilities and curtailing the reach and efficacy of prevention programs. Some minority youth experience disproportionate suicide rates and risk factors - historical trauma adversity and iscrimination. Youth suicide rates are highest among American Natives and increasing among Black youth. We will assess ethno-racial minority youth suicide behaviors using disaggregated data identifying family school and community risk and protective factors; in alignment with MCHB Strategic Research Issues: social determinants of health; health equity; Adverse Childhood Experiences (ACES); protective factors; public health capacity; innovation and interdisciplinary research; intervention strategies for upstream suicide prevention.

Goals and objectives:

Our long term goal is to identify the role of family school and community factors for suicide behaviors to develop interventions and foster environments that reduce suicide behaviors. The project objectives are to: (1) identify student-reported family school and community risk and protective factors associated with suicide behaviors and differences in their distributions across ethno-racial groups; (2) examine shifts in these factors with the COVID-19 pandemic and; (3) identify teacher-reported school policies and resources associated with suicide behaviors and differences in their distribution by school characteristics.

Proposed data sets and target populations:

We will run cross-sectional and time series analyses linking Minnesota Student Survey (MSS 3 waves 2016-2022) with the CDC national school health profiles (SHP 4 waves 2016-2022); restricting to students in 15-19 years old with a special focus on ethno-racial minorities e.g. Black AIAN Hispanic and more granular ethnic groups e.g. Somali Hmong. To avoid washing out effects specific to ethno-racial minorities we will take a random sample of NH White respondents equal to the sample size of the largest minority group in each MSS wave. Our main outcomes are suicide ideation suicide attempts and non-suicidal self-injury. Main predictors include risk and protective factors at the family school and community level and the COVID-19 pandemic as a natural experiment. We will adjust for demographic and socioeconomic confounders - some condensed using Latent Class Analysis; and consider interactions e.g. with ACES. We will use chi-squared tests; multilevel logistic regression models clustered by school district; pooled over the study period as well as within each study wave; and time series analyses of risk/protective factors and suicide outcomes between 2016 and 2022.

Products:

We will publish findings in 3-5 peer-reviewed manuscripts disseminate findings in 2-4 scientific presentations via lay media and to community organizations (clinics and community organizations schools statewide and nationally especially with underserved populations and health departments). Next we will develop broad-scale interventions to reduce suicide behaviors using upstream mechanisms.

Evaluation:

We will meet biweekly and communicate via email regularly to document project progression and resolve potential issues with additional meetings as needed. We will monitor milestones and deadlines addressing hindrances to meeting our goals as they arise. We identified project activities that do not depend on prior work and could be prepared ahead of time in order to meet the project timeline.