Testing the Suicide Minority Paradox: The Role of Race/Ethnicity with Suicide-Related Behaviors

Background and Purpose: According to the suicide minority paradox, high school students of color (SOC) (Black, Latino, Multiracial) report higher rates of suicide-related behaviors (ideation, planning, attempts) than White students, yet have lower rates of death by suicide (Wong et al., 2013). Futhermore, predictors of suicide-related behaviors are contradictory and vary based on race. This study utilized the escape theory of suicide (Baumeister, 1990) for exploring predictors of suicide-related behaviors among a robust sample comprised of a majority of SOC in a southeastern urban school district (Milner, 2012) and to test race/ethnicity as a moderator. The research questions for this study included: 1) Does cyberbullying, sadness, loneliness, and SOC predict teen suicide-related behaviors among high school students?; 2) Does race moderate the relationship between suicide-related behaviors and identified predictors for SOC?

Methods: Utilizing the 2017 Centers for Disease Control and Prevention Youth Risk Behavior Survey district data, a logistic regression model was designed with contributing variables of cyberbullying, social isolation, sadness, and SOC. SPSS PROCESS was utilized to test moderation. Regression coefficients were reported to understand the moderating effects of race/ethnicity (Black, Latino, Multiracial = 1 and White = 0) as a moderator. The dependent variable suicide-related behaviors were computed as a binary variable based on if participants affirmed experiencing suicide-related ideation, suicide planning, and/or suicide-related attempts (suicide-related behaviors or no suicide-related behaviors). The sample included 2,007 high school students in an urban school district with 67.4% (n=1,352) identified as SOC and 32.6% (n=655) identified as White.

Results: All variables were statistically significant predictors of suicide-related behaviors, cyberbullying (OR = 2.6, p < .001), social isolation (OR = 2.8, p < .001), sadness (OR = 5.7, p < .001), and Students of Color (OR = 1.4, p < .05). Findings indicated that only the interaction between SOC and sadness was statistically significant, (b = -.6217, 95% confidence interval [-1.1592 - .0842], t = -2.2669, p < .05). This indicated that the relationship between sadness and suicide-related behaviors was moderated by the SOC variable. SOC who did not report experiencing sadness had a higher probability of suicide-related behaviors than White student.

Conclusion and Implications: Findings suggest that participants who reported experiencing cyberbullying, loneliness, sadness or identified as SOC had a higher likelihood of engaging in suicide-related behaviors. Interestingly, race/ethnicity was a moderator for sadness and SOC who reported less sadness were still more likely to engage in suicide-related behaviors than White students. Implications include culturally adapted prevention models to meet the needs of diverse youth. Essentially, the failure to critically examine higher rates of suicide-related behaviors among SOC could hurt future attempts to inform responsive suicide prevention efforts for an already vulnerable, yet growing, demographic (Joe et al., 2016).