(see Poster Gallery) Building Solutions for the Complex Relationship between Rurality, Distress, Major Depression, and the Risk for Suicidal Ideation Among African American Adults

Background/Purpose: Suicide is considered the second leading cause of death among African Americans (AAs) aged 15–24. Recent statistics indicate that 15% of AA adults seriously considered suicide in the past 30 days compared to 8% of Whites and 10.7% of all respondents. However, a growing body of literature suggests the importance of assessing the social determinants of mental health and the risk for suicide among AA adults. There is a lack of evidence on whether rurality, distress, and Major Depressive Episode (MDE) can predict differences in risk for suicidal ideation (SI) among AA adults.

The present study aimed to examine if rurality, distress, and lifetime MDE can predict the risk for SI among AA adults aged 18 and older. It was hypothesized that rurality, lifetime MDE, and distress in the past month could significantly predict the risk for SI in the past month among AA adults.

Methods: Data and samples: Data from the 2018 National Survey on Drug Use and Health (NSDUH) 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, 7,892 were AA adults, representing a weighted population size of 29,113,418.58. The participants included in the study were AAs, aged 18 years and older, with or without MDE based on the DSM 5^th edition diagnostic criteria.

Measures: The independent variables were rurality, lifetime MDE, and distress in the past month. Rurality was measured by asking whether participants lived in a large metropolitan, small metropolitan, or non-metro areas. Participants were considered lifetime MDE if they met the DSM-5 diagnostic criteria of lifetime MDE; distress was calculated via questions about whether the individual had serious psychological distress in the past 30 days. The outcome measure SI was measured by asking about SI over the past 12 months wherein the individual had seriously considered taking his/her life.

Results: Study results confirmed that rurality, lifetime MDE, and distress in the past month could significantly predict the risk for SI among AA adults. Those who lived in non-metro areas had a decreased risk for SI than those who lived in large metro areas; AAs with MDE had an increased risk for SI than those without MDE, and those who exhibited distress in the past month had a higher risk for SI than those who did not. Pseudo-R² showed that the model explained 25% of the variation in risk for SI among AA adults (Nagelkerke R² =25%).

Conclusions and Implications: AA adults are not a homogeneous group with equal risk for SI. Study results can inform the design and implementation of solutions to battle inequities in suicide risk among AA adults and improve access to tailored mental health services and community-centered suicide prevention programs that address the unique needs of AA adults at risk for suicide. Battling inequities that block AA adults` from full access to community-centered care can ameliorate the burden of suicide in the community.