Risk for Suicidal Ideation and Suicide Attempt: Comparison across Four Racial/Ethnic Groups in the United States

BACKGROUND The suicide mortality rate in the United States has been increasing since 2000. According to the Interpersonal-Psychological Theory of Suicide, there is a higher risk for suicide attempt when thwarted belongingness, perceived burdensomeness, and acquired capability for suicide coexist. A meta-analysis on the IPTS showed that the coexistence of two or more IPTS constructs was associated with increased risk for suicidal ideation and attempt. Previous research has primarily focused on individual risk factors. However, multiple risk factors coexist in real life and may cumulatively elevate suicide risk, as proposed by the IPTS. This study identified the combinations of suicidal risk associated with suicidal ideation and attempt with four racial/ethnic groups in the United States.

METHODS A nationally representative sample of White, Black, Latinx, and Asian adults from the Collaborative Psychiatric Epidemiology Surveys (Alegria et al., 2016) was used. Using latent class analysis (LCA), distinct patterns (combinations) of suicidal risk were identified from 14 categorical risk factors outlined in the IPTS; thwarted belongingness (living alone, exposure to interpersonal violence, sexual abuse, loss of interest), perceived burdensomeness (unemployment, financial difficulties, life-threatening physical illness, family worried due to alcohol/drug use), acquired capability for suicide (feelings of worthless, war exposure, trauma exposure, risk-taking behaviors, alcohol dependence, drug dependence). Next, the association between identified patterns of suicidal risk and suicide attempt for each racial/ethnic group were examined with 3-step method in LCA.

RESULTS For White adults, five latent classes were identified. Respondents in the (1) All Three (constructs of the IPTS) with Alcohol/Drug Problem, (2) All Three without Alcohol/Drug Problem, and (3) Thwarted Belongingness + Perceived Burdensomeness classes were more likely to demonstrate suicide attempt. For Black adults, six latent classes were identified, and respondents in the (1) All Three with Alcohol/Drug Problem and (2) All Three without Alcohol/Drug Problem classes were significantly more likely to attempt suicide than those in the Low Risk class. For Latinx respondents, four latent classes were identified, and respondents in the Thwarted Belongingness + Acquired Capability for Suicide class were significantly more likely to attempt suicide. For Asian respondents, three latent classes were identified, and respondents in Thwarted Belongingness + (Active) Acquired Capability for Suicide class had a significantly higher risk for suicidal ideation and suicide attempt.

CONCLUSIONS AND IMPLICATIONS Findings of this study supported the major tenets of the IPTS, that individuals are at the greatest risk for suicide attempt when thwarted belongingness, perceived burdensomeness, and acquired capability for suicide coexist. In addition, this study found important variation in the applicability of this theoretical framework across the four racial/ethnic groups. Findings support that clinicians working with people with higher risk for suicide should explore multiple dimensions of suicidal risk, especially clients’ capability for suicide (e.g., past exposure to trauma and pain- and fear-reducing experiences). Suicide-prevention campaigns and trainings need to include exploration of past exposure to trauma, physical violence, and risk-taking behaviors as well as access to means in training sessions so that trainees can better detect people with higher risk of suicide attempt.