Developing Racially and Socioculturally Tailored Suicide Interventions for Black Men: Adjustment for Demographic Covariates of Suicide Among Black Men with and without Major Depressive Episode

Background/Purpose: Suicide is considered the second leading cause of death among Black males aged 10–14, the third leading cause in those aged 15–34, and the fifth leading cause in those aged 35–44 years old. Past studies have shown that Black men with major depressive episodes (MDE), as well as those without MDE, had an equal risk for suicidal ideation (SI) and suicide attempts (SA) when compared to White men. However, a growing body of literature suggests the importance of assessing the relationship between demographic characteristics, such as age, education, economic well-being, and mental health among Black men. To date, there is a lack of evidence on SI, suicide plans (SP), and SA risk among Black men with and without MDE with adjustment for potential covariates associated with suicide outcome variables.

The present study's goal was to examine suicide risk among Black men with and without MDE while adjusting for age, education, and income. It was hypothesized that Black men with MDE would be at a higher risk for SI, SP, and SA than those without MDE while adjusting for the covariates of age, education, and income.

Methods: Data and samples: Data from the 2018 National Survey on Drug Use and Health were extracted and analyzed. The public-use file contained 56,313 records of non-institutionalized individuals, representing a weighted population of 273,753,042.56. Of these, 2,301 were Black men, representing a weighted population size of 13,210,069.53. The participants included in the study were aged 18 years and older, with or without MDE based on the DSM 5^th edition diagnostic criteria.

Measures: The independent variable was MDE. The covariates included age, education, and income. The outcome variables were SI, SP, and SA during the past 12 months. SI was assessed by asking about any suicidal thoughts the individual may have had, SP was assessed by asking whether they had made any plans to commit suicide, and SA was assessed by asking about attempts to kill oneself.

Results: The results partially confirmed the hypothesis. After adjusting for covariates, Black men with MDE had a higher risk for SI and SP than Black men without MDE. The pseudo-R² analysis showed the adjusted model explained 30.1% of the variation in risk for SI and 28.8% of the variation in risk for SP among men with and without MDE. The chances of attempting suicide among those with and without MDE remained equal even after adjusting for covariates. However, the pseudo-R² analysis showed that the adjusted model explained 28.9% of the differences in risk for attempts between men with and without MDE.

Conclusions and Implications: Black men with and without MDE are not a homogeneous group with equal risk for suicidal thoughts and plans. These results can inform the design and implementation of racially and socioculturally tailored community-centered interventions that address the unique needs of Black men at risk for suicide. Overcoming barriers that block Black men's full access to community-centered care can ameliorate the burden of suicide in the community.