Discrimination and Suicide Risk Among Black Americans

Background and Purpose: The emerging literature suggests that perceived discrimination is a neglected stressor that adversely affects the health of Hispanics, Asian Americans, American Indians, and Whites (Paradies, 2006a; Williams et al., 2003). Discrimination has been conceptualized in the literature as a social stressor that can broadly affect physical and mental health. The relationship between discrimination and mental health outcomes and strongest related to distress, depressive symptoms and depression. Despite numerous studies with findings supporting poor mental health outcomes as a major outcome of discrimination for Black Americans (Paradies, 2006; Williams and Mohammed, 2009), lacking is research on the effects of perceived discrimination on suicide ideation and suicide attempts risk. The study assesses the extent to which race-related stressors and general stressors can account for ethnic and gender differences in suicide risk among Black Americans.

Method: Nationally representative data are from the National Survey of American Life (NSAL), a national household probability sample of 5193 African and Caribbean American adults aged 18 and older designed to investigate the nature, severity, and impairment of mental disorders among national samples Blacks in the US, with a special emphasis within the study focused on the nature of race and ethnicity within the black population. Standard measures of major and everyday discrimination were employed. The Composite International Diagnostic Interview (CIDI 3.0; Kessler & Ustun, 2004) was used to assess suicidality (lifetime ideation, planning, and attempts) and the presence of DSM-IV disorders. All analyses were carried out using the SAS Version 9.1.3 software package (SAS Institute, 2005). The data were weighted to adjust for the stratified multistage sample design, clustering of the data and for differential non-response. Correlation coefficient and F statistics are also reported and have been adjusted for design effects. Multivariate tests are based on Rao-Scott ÷2's computed from coefficient variance-covariance matrices that were adjusted for design effects.

Results: Differences in suicide risk vary significantly among ethnicity-gender groups. Material hardship may be more of an indicator of suicide risk, among Black Americans, than discrimination. African American males were more likely to report perceived lifetime discrimination than Black females and Caribbean males. African American females, were more likely to report perceived everyday discrimination than Black males and Caribbean females. Suicide risk is higher among Black Americans that report experiences of major discrimination or perceived everyday discrimination. The results provide evidence that material hardship as a general stressor contributes more to suicide risk than lifetime discrimination or everyday discrimination.

Conclusions and Implications: The burden of suicide risk among Black Americans is related to differences in the types of social stressor experienced. The study findings suggest that material hardship and race-related stressors are measuring different types of social stressors. Recognition of such differences is essential for appropriately designing suicide prevention efforts in lieu of social stressors experience by Black Americans. Future research must examine if different attributes of discrimination ( i.e., race, age) might contribute to suicide risk, and account for some of the variance noted in this study.