Racialized Gender Stress, Mental Health, and Suicide Risk Among Black Women: A Longitudinal Test of the Vance-Wade Intersectional Suicide Risk Model

Background: Black females, ages 15-24, experienced a 125% increase in suicide from 1999 to 2017. The recent shift in Black women’s suicide risk calls for a new paradigm, focused on predictors of increased risk and not the low prevalence of Black women’s mental health and suicide-related behaviors. The Vance Wade Intersectional Suicide Risk Model (VWISRM) was introduced to contextualize this unexpected spike. According to the VWISRM, for Black women, psychosocial risk factors, gendered racism, and the Strong Black Woman script (SBW) leads to racialized gender stress (RGS) which results in mental health outcomes which are established predictors of suicide- related behaviors. Here we use the National Longitudinal Study of Adolescent Health to test for empirical evidence supporting the VWISRM.

Methods: Our sample consisted of 418 Black female respondents who fully participated in data collection during Waves 1, 3, and 4. Wave 1 provided demographic information. Wave 3 provided measures of psychosocial risk factors, SBW traits, and RGS and was collected when respondents were 18 to 26 years old. Wave 4 provided measures of gendered racism and our mental health outcomes of interest, which were collected when the respondents were 25 to 33 years old. We ran bivariate analyses with mental health outcomes as dependent variables (e.g., depression, anxiety, PTSD, and suicidality). We then added psychosocial factors (e.g., education, employment, health insurance, and religiosity) as controls in a series of regression models.

Results: Those who experienced RGS were more likely to have a PTSD diagnosis and have attempted suicide significantly more. Scoring lower on the SBW traits was significantly associated with having an anxiety diagnosis, a PTSD diagnosis, and contemplating suicide. Those who experienced RGS were more likely to have a depression diagnosis, have an anxiety diagnosis, and contemplate suicide, in comparison to those who had not. Having both lower scores on the SBW traits and experiencing gendered racism is associated with a PTSD diagnosis. Specifically, it explained 30% of the variation in PTSD diagnoses among Black women. Similarly, having both lower scores on the SBW traits and RGS is associated with an anxiety diagnosis. Lastly, having both lower scores on the SBW traits and having to grow up faster is associated with contemplating suicide. Importantly, there were no moderating effects among these VWISRM factors on PTSD, anxiety, or suicidality.

Conclusions and Implications: The findings from this study highlight important research and clinical implications for Black women’s mental health. The VWISRM analysis contributed to the development of a modified version of the model, the Gendered Racism Intersectional Trauma model (GRIT) to better understand the breadth of mental health outcomes for Black women. Specifically, GRIT considers three unique factors of Black womanhood (SBW traits, RGS, and gendered racism) and their relationship to negative psychological outcomes and therefore should be addressed and targeted in assessments and interventions. Notably, our findings make a new contribution to the scientific inquiry of PTSD in Black women.