Understanding the Effects of Perceived Racial Discrimination on Suicidal Behaviors Among Racial and Ethnic Minority Adolescents in the United States

Background and objectives: Suicide has been identified as the second leading cause of death among adolescents in the United States (U.S.). While the rate of death by suicide among adolescents in the U.S. declined in 2019 and 2020, this trend was not observed across all races/ethnicities, as racial/ethnic minority adolescents saw the highest increase in death by suicide over the same period. Although documented rates of suicide attempts among racial/ethnic minority adolescents are high, these estimates are likely underestimated due to cultural stigma in reporting suicidal behaviors among racial/ethnic minority adolescents. Research also indicates that perceived racial discrimination (PRD) is a major social determinant of health and a critical driver of systemic inequities in health outcomes. Although studies have examined the impact of PRD on mental health outcomes among adults, there is a dearth of research investigating the effects of PRD on suicidal behaviors among racial/ethnic minority adolescents using a nationally representative sample. Therefore, the objectives of this study were to investigate: 1) the prevalence of PRD, and 2) the effects of PRD on suicidal behaviors among racial/ethnic minority adolescents in the U.S. Guided by minority stress theory and intersectionality, we hypothesized that racial/ethnic minority adolescents who experienced PRD would have higher odds of reporting past-year suicidal ideation, suicide planning, and suicide attempts than their counterparts who did not experience PRD.

Methods: Data for this study came from the 2021 Adolescent Behaviors and Experiences Survey conducted by the CDC between January-June 2021. Data from a sample of 3,241 racial/ethnic minority adolescents (53.7% female) were analyzed. The outcome variables examined included suicidal ideation, suicide planning, and suicide attempts and were all measured as binary variables. The main explanatory variable examined was PRD, and was measured using an item from the Perceptions of Racism in Children and Youth scale. Binary logistic regression models were fitted to examine the effects of PRD on each outcome variable after controlling for demographic characteristics, cyberbullying victimization, feelings of sadness/hopelessness, and poor mental health during the pandemic.

Results: About 21% of racial/ethnic minority adolescents reported experiencing PRD. Controlling for other factors, racial/ethnic minority adolescents who experienced PRD had 1.57 times higher odds of experiencing suicidal ideation (95% C.I.=1.09-2.25), 1.64 times higher odds of making a suicide plan (95% C.I.=1.09-2.49), and 1.67 times higher odds of attempting suicide (95% C.I.=1.04-2.68) during the past year. Other factors associated with suicidal behaviors included self-identifying as lesbian/gay, bisexual; experiencing cyberbullying; feeling sad or hopeless; and poor mental health during the pandemic.

Conclusions: The findings of this study extend past research by using a nationally representative sample and demonstrate that racial/ethnic minority adolescents who experienced PRD were more likely to report suicidal behaviors over and above other well-established risk factors for suicidal behaviors. In addition to screening for mental health problems such as depression and anxiety, school social workers and clinicians should screen for and consider the impact of discrimination and racism, particularly among racial/ethnic minority adolescents. Future studies that employ longitudinal designs are needed to elucidate the mechanisms underlying these associations.