Exploring Risk and Protective Factors of Suicide - Related Behavior Among Black Youth Discharged from Inpatient Psychiatric Facilities

Background: Suicidality among Black youth is a serious public health concern as the suicide rates have increasingly grown among this population, nearly doubling in the last 20 years. With this increase in suicide rates, it is imperative to understand associated risk and protective factors to develop effective prevention strategies. However, few studies have examined risk and protective factors particularly among Black youth who are receiving intensive care after suicide-related behaviors. This study fills this gap in the literature by exploring risk and protective factors of suicide-related behavior among Black youth who participated in a research-informed and theoretically-driven care coordination intervention designed to mitigate suicide risk and increase referrals for mental health and other supportive services for youth discharged from inpatient psychiatric facilities.

Methods: The sample for this study included 87 Black youth (ages 10 to 19) who received care coordination services in inpatient psychiatric facilities in one southeastern state in the U.S. Most participants were female (80.4%). The mean age was 14.98 (SD=1.79), 82.7% identified as heterosexual, 81.6% were diagnosed with a mood disorder, and 41.3% reported a family history of mental illness. At baseline, 30 days, 60 days, and 90 days after baseline, care coordinators assessed mental health and suicide risk (e.g. depressive symptoms, suicide ideation, suicide-related behaviors), risk factors (e.g. access to lethal means, financial hardship, feeling of burdensomeness), and protective factors (e.g. family support, friends support, access to care) of participants. We conducted logistic regression analyses to explore the role of risk and protective factors in predicting suicide-related behavior within 90 days after discharge from inpatient psychiatric facilities.

Results: The most frequently endorsed risk factors were history of anger or hostility (47.4%), relationship conflict (42.1%), history of self-harm behavior (39.5%), and lack of connectivity (38.2%). In terms of protective factors, few participants had mentors or role models (15.8%), reported spirituality or religious belief (21.1%), and had any prior mental health treatment (27.6%). More than half of participants had access to medical care (55.3 %), mental health services (63.2%), and supportive services (56.6%). Logistic regression analysis revealed access to supportive services was the only statistically significant predictor of suicide-related behaviors (OR=.12; p= .015) while traditionally known risk and protective factors were not statistically significant in this study.

Conclusions and Implications: The finding suggests that access to supportive services can be of particular importance in reducing suicide-related behaviors among Black youth discharged from intensive care. Interestingly, spirituality or religious belief, the historically well-known protective factor in the Black community, was not significantly associated with suicide-related behaviors in this study. This may suggest a developmental uniqueness and cultural shift of the sample. Further research should identify risk and protective factors unique to Black youth for designing and implementing a culturally responsive suicide prevention program. Also, very few participants endorsed having a mentor or role model. Given the developmental characteristics of the sample, this can be of particular concern. Further attention should be given to developing mentorship for Black youth with a history of suicide-related behavior.