AACAP Policy Statement on Increased Suicide Among Black Youth in the U.S.
Since 2017, suicide has been the second leading cause of death in those 10-19 years old. Rates of suicide among Black youth have risen faster than in any other racial/ethnic group in the past two decades, with suicide rates in Black males 10-19 years-old increasing by 60%. Early adolescent Black youth are twice as likely to die by suicide as compared to their white counterparts. Understanding and changing this trajectory will require transdisciplinary efforts including those of educators, child welfare, legal and juvenile justice systems, health care professionals including child and adolescent psychiatrists, and the community at large.
Data does show us that community violence, socioeconomic stress, perceived discrimination, stigma, and interpersonal and family conflict are greater predictors for suicide in Black children and adolescents than in their white peers. Intersectionality, membership in more than one minoritized population, affecting Black females and LGBTQ identities, experience significantly increased suicide risk. Mental health and substance use problems occurring in Black youth are often under recognized, undertreated, or misdiagnosed due in part to bias, discrimination, and structural racism. Black youth who do come to clinical attention are often diagnosed with behavioral problems, rather than other mental health conditions that identify an increased risk for suicide. They are more likely to receive poor quality care and are less likely to receive follow-up care after discharge from crisis or hospital services. These well-documented inequities in health care foster distrust in health care systems, limiting opportunities for prevention, identification, and timely intervention.
Structural factors reinforce racism and discrimination and elevate exposure to potentially traumatic events. These experiences exacerbate risk for mental health concerns and suicide among Black youth who are also more likely to experience punitive treatment in the educational and juvenile justice systems. They are disproportionately affected by adverse involvement in the child welfare system and the negative impacts of policing and violence. These cumulative factors are associated with the increased risk for suicide among Black youth.
The American Academy of Child and Adolescent Psychiatry recommends that child and adolescent psychiatrists:
- Collaborate with other systems of care involved in the lives of Black youth to promote early recognition of suicide risk factors, which is crucial to increase awareness of the impact of structural racism, gender bias, discriminatory practices, and unconscious bias.
- Improve identification, access to care, and retention in mental health and substance use treatment for Black youth, with a focus on the impact of social determinants of health, discrimination, structural racism, stigma, gender and sexual minority status, interpersonal and family conflict, and intergenerational trauma.
- Support evidence-based resiliency programs in Black youth with a focus on protective factors including sense of belonging, racial and collective socialization, family strengths, and community cohesion; develop evidence-based interventions for suicide prevention.
- Promote research for potential risk factors including structural racism, bias, and incorrect diagnoses in order to help decrease under-recognition of the precursors of suicide in these children and adolescents.
- Advocate for increased investments in programs that build a more culturally competent and minority-representative pediatric health care workforce, including research and education programs that promote the inclusion of health equity as a core competency in pediatric health care professional training.
- Advocate for scholarship funding and loan forgiveness programs that target students underrepresented in medicine and child and adolescent mental health.