Breaking the Spiral of Silence : Addressing Suicide Item Non-Response through Equity-Informed Mental Health Policy

Background
Suicide-related items in mental health surveys are vital for understanding risk, yet response rates remain low, leading to data bias and underrepresentation of vulnerable groups. This study focuses on two key factors shaping students’ response behavior: racial/ethnic background and experiences of discrimination. Grounded in Noelle-Neumann’s Spiral of Silence Theory (1974), which suggests that fear of isolation suppresses the expression of stigmatized views, the study conceptualizes suicide item non-response as a psychosocial coping mechanism. Marginalized students—especially those exposed to racial/ethnic discrimination—may perceive suicide questions as emotionally risky and choose not to respond. This study explores how race/ethnicity, age, sex assigned at birth, and perceived discrimination affect non-response patterns. Additionally, it examines how school-level contextual variation contributes to these behaviors. The research questions are as follows:

1. How does race/ethnicity influence suicide item non-response?
2. What roles do age and sex assigned at birth play in non-response?
3. How does perceived racial discrimination shape suicide item non-response?

Methods
Data for this study were drawn from the 2023–2024 U.S. National Mental Health Survey, including 88,221 college students from institutions nationwide. Suicide item non-response was measured as a binary outcome. Independent variables included race/ethnicity, age, sex assigned at birth, and self-reported experiences of racial/ethnic discrimination. Generalized Linear Mixed Models were used to assess effects at both individual and school levels through four sequential models, accounting for contextual variation across educational environments.

Results
The analysis showed that between-school variance in suicide item non-response decreased from 0.403 in the Null Model to 0.202 in the final model, and the intraclass correlation coefficient (ICC) declined from 0.031 to 0.008. This indicates that non-response is more influenced by individual-level characteristics than institutional differences. Regarding race and ethnicity, students identifying as Black (OR = 1.586), Asian (OR = 1.226), Hispanic (OR = 1.171), and Other (OR = 1.337) were significantly more likely to skip suicide-related items compared to White students. Age was inversely associated with non-response; older students were less likely to skip these items (OR = 0.971, p < .001). Sex assigned at birth was not a statistically significant predictor in the final model (OR = 0.998). Most notably, students who reported experiencing racial or ethnic discrimination had a significantly higher likelihood of skipping suicide questions (OR = 1.183, p = 0.006). These findings suggest that non-response to suicide-related items may reflect a protective behavioral response to anticipated stigma or judgment, especially among racially and ethnically minoritized groups.

Conclusion
This study demonstrates that experiences of racial discrimination are significantly associated with suicide item non-response, particularly among students from minoritized racial/ethnic groups. Such non-response may not reflect disinterest or survey fatigue but rather a self-protective reaction to anticipated stigma or social judgment. These findings underscore the need for mental health surveys that ensure psychological safety, address structural inequities, and apply context-sensitive strategies. This research supports SSWR 2026’s theme by advancing more inclusive, equity-focused data collection and mental health research practices.