SOLUTION: Prevalence of Suicide in Minorities Essay

American Journal of Community Psychology [ajcp]
January 29, 2004
Style file version May 31, 2002
C 2004)
American Journal of Community Psychology, Vol. 33, Nos. 1/2, March 2004 (°
Risk and Resiliency Factors Influencing Suicidality
Among Urban African American and Latino Youth
Lydia O’Donnell,1,2 Carl O’Donnell,1 Dana Meritt Wardlaw,1 and Ann Stueve1
For decades, suicide rates among minority African American and Latino young people have
been stable and, when compared with Whites, relatively low. This is no longer the case, underscoring the need for documenting and understanding the problem of suicidality in this population. We report on the prevalence and predictors of suicidality among 879 urban adolescents
in the Reach for Health study. All youth resided in economically disadvantaged neighborhoods; 69% were African American, 16% Latino, and 15% reported mixed or other ethnicity.
In the past year, 15% had seriously considered suicide; 13% had made a suicide plan, 11%
had attempted suicide at least once, and 4% reported multiple attempts. Risk factors significantly related to suicidal ideation are being female, having basic needs unmet, engaging in
same-gender sex, and depression. Resiliency factors include family closeness and, marginally,
religiosity. Risk factors related to reports of suicide attempts are being female, being Hispanic,
and depression; family closeness is strong resiliency factor. Family composition, ethnic identity, coping style, peer support, and school attachment are not significant correlates of suicidal
ideation or attempts.
KEY WORDS: suicide; adolescence; minority health; mental health; depression.
Recent trends highlighted in the Surgeon
General’s Call to Action to Prevent Suicide and national data from the CDC’s (Centers for Disease
Control and Prevention) Youth Risk Behavior
Surveillance System (YRBSS) draw attention to
the growing prevalence of suicidal behavior among
Latino and African American adolescents (CDC,
1998, 2000; U.S. Public Health Service, 1999). Historically, suicide rates among African American and
Latino youth have been stable and, when compared
with Whites, relatively low (Shaffer, 1988; Shaffer,
Garland, Gould, Fisher, & Trautman, 1988). However, although reports of suicide attempts among
White high school students decreased by 15% between 1991 and 1999, there was a 14% increase in attempts among African American adolescents within
this same time period (Price, Dake, & Kucharewski,
2001). Further, the suicide rate among African
American youth more than doubled between 1980
and 1995, with a 126% increase among those aged
15–19 and a 233% increase among those aged 10–
14 (CDC, 1998). Increases have been greater among
African American males than among females (Gould
& Kramer, 2001; Shaffer, Gould, & Hicks, 1994) and
may be even higher in inner-city areas, where suicide
attempts among adolescents occur at about twice the
national rate (Price et al., 2001). Although a similar
trend is not evident among Latino youth, YRBSS data
consistently indicate that Latino adolescents are more
likely than their African American and White counterparts to make a suicide plan and to attempt suicide. During 1999, 12.8% of Latino youth reportedly
attempted suicide, compared to 7.3% of White and
6.7% of African American adolescents (CDC, 1999).
The YRBSS has helped frame the problem of suicidality among African American and Latino youth,
yet its mandate limits what can be learned about
risk and resiliency factors that influence suicidal risk.
Although these data provide a national perspective,
1 Education
Development Center, Inc., Newton, Massachusetts.
whom correspondence should be addressed at Education Development Center, Inc., 55 Chapel Street, Newton, Massachusetts
02458; e-mail:
2 To
C 2004 Plenum Publishing Corporation
0091-0562/04/0300-0037/0 °
American Journal of Community Psychology [ajcp]
January 29, 2004
relatively little is known about levels of suicidal
ideation and behavior among a particularly vulnerable group of African American and Latino
adolescents—those who reside in economically disadvantaged urban settings. Such youth are at increased
risk of engaging in behaviors that may be associated with suicide, including substance use and exposure to and involvement in other forms of violence
(CDC, 1999; Dryfoos, 1990; Moses, 1999; Yexley,
Borokowsky, & Ireland, 2002; Zweig, Lindberg, &
McGinley, 2001). They also are at elevated risk of suffering from related mental health conditions, such as
depression (U.S. Department of Health and Human
Services, 2001).
Given the challenges that adolescents in innercity environments often face, a better understanding
of suicidality within this population is clearly needed.
In 2001, the U.S. Public Health Service called for increased and improved research and surveillance as
part of the National Strategy for Suicide Prevention
(U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, & Office
of the Surgeon General, 2001). Yet relatively few
studies on mental health and suicide include substantial numbers of urban African American and Latino
youth drawn either from clinical or nonclinical settings. What studies have been conducted indicate that
depression and suicide are significant health risks and
that they are related to other risk behaviors that are
also elevated in this population. For example, a survey of Chicago area African American and Hispanic
students, aged 11–17, found that 10% of males and
19% of females reported suicide intentions or attempts, and that the risk for suicide was increased
by involvement in risky sex and assaultive behavior
(Walter, Vaughan, Armstrong, & Krakoff, 1995). Similar findings were reported in a study of 630 New York
City teenagers: 31% reported symptoms of depression, 16% had engaged in suicidal ideation, and 10%
had attempted suicide (Pastore, Fisher, & Friedman,
To address this limitation, we report on the
prevalence and predictors of suicidality among urban
African American and Latino youth who have participated in the Reach for Health (RFH) high school
study. We examine the prevalence of suicidal ideation
and suicide attempts in a large sample of inner-city
adolescents surveyed at an average age of 17, during
their 11th-grade year. We also consider a range of risk
and resiliency factors that may influence suicidality,
including those that have been identified in previous
Style file version May 31, 2002
O’Donnell, O’Donnell, Wardlaw, and Stueve
studies with more mainstream populations as well as
other potential factors that may be especially relevant
for African Americans and Latinos (for review articles, see Canino & Roberts, 2001; Joe & Kaplan, 2001;
Washington & McCarley, 1998).
For example, the formation of a strong ethnic
identity has been posited to be protective against suicidal and other risk behaviors during the upheavals of
adolescence (French, Seidman, Allen, & Aber, 2000;
Phinney, 1991, 1992; Rotherham-Borus, 1990). Positive in-group attitudes and identification have been
associated with higher self-esteem, less stress, and less
delinquent involvement, and may be linked to reduced risk of depression (McCreary, Slavin, & Berry,
1996). If young people have a positive sense of their
roots, they are likely to feel less isolated and alone in
dealing with problems (Oyserman & Harrison, 1999).
Furthermore, a strong ethnic identity may contribute
to a greater awareness of racism, which provides an
explanation for setbacks and failures that can reduce
self-blame (Crocker & Major, 1989). The relationship between ethnic identity formation and suicidality,
however, has not been established.
Another factor that may be important for understanding why some adolescents are more vulnerable to suicidality than others is coping style, that is,
how young people respond to the multiple stresses
in their environment. These stresses often are compounded during adolescence, as youth begin to make
their own way in the world (Canino & Roberts, 2001;
Phinney, 1992). A passive coping style has been related to depression and suicidal behaviors and may be
more prevalent among those of lower socioeconomic
status (Canino & Roberts, 2001). Alternatively, it has
also been argued that minorities may possess strong
survival beliefs and utilize more active coping strategies when faced with environmental stress (Morrison
& Downey, 2000). Thus, the manner in which African
American and Latino adolescents face challenges may
contribute to their engagement in self-directed violence, and is therefore considered here.
Strong religious beliefs also may play a role
in lower rates of suicide in African American and
Latino populations (Stack, 1998). Religion may constrain suicide by condemning it as sinful, by promoting high levels of community attachment among
congregants, and by fostering attitudes that are antithetical to suicide, including optimism and resiliency
(Neeleman, Wessely, & Lewis, 1998; Range et al.,
1999; Stack, 1998). The observation that African
Americans are less accepting of suicide than White
Americans has been attributed to higher levels of
American Journal of Community Psychology [ajcp]
Suicidality and Urban Youth
religiosity (Neeleman et al., 1998). However, concerns have been expressed about the loss of this traditional protective factor among African American
and Latino youth (Halpern, 1995; Neeleman et al.,
1998). Although strong religious ties have been considered one reason why rates of suicide have been
lower among minorities, we examine whether this factor distinguishes African American and Latino youth
who report suicidal ideation and attempts from those
who do not.
In addition to factors that may be particularly relevant for African American and Latino youth, other
predictors and correlates of suicidal behaviors have
been identified in predominately White populations
(Berman & Jobes, 1991; Garland & Zigler, 1993).
These may play a similar role for African American
and Latino youth. Prominent among these are gender,
same-gender sexual behavior, a history of depression,
low levels of family and school attachment, and limited social support. Females across ethnic groups are
approximately twice as likely as males to attempt suicide, whereas males are more than four times more
likely to commit suicide (U.S. Department of Health
and Human Services, 1999). Recent studies also confirm that gay, lesbian, and bisexual youth are at greater
risk for suicide ideation and attempts than are heterosexual youth (McDaniel, Purcell, & D’Augelli,
2001; Morrison & L’Heureux, 2001; Remafedi, 1999;
Russell & Joyner, 2001). This factor may interact with
culture to place African American and Latino youth
at greater risk because African American and Latino
adolescents who engage in same-gender sex may be
less likely than Whites to “come out” to family or
friends (Stokes & Peterson, 1998).
At any given time, between 10 and 15% of the
child and adolescent population have some symptoms of depression (Smucker, Craighead, Craighead,
& Green, 1986). Although the majority of depressed
youth do not commit suicide, over 90% of children
and adolescents who do commit suicide had some
type of mental disorder before their death (Shaffer
& Craft, 1999)—most commonly a mood or anxiety
disorder (Shaffer et al., 1996). In addition to mental
disorders, adolescents’ levels of attachment to family and school, as well as perceived social support,
have been associated with risk for suicide. Lower levels of family attachment, including infrequent and
unsatisfying communication, low cohesiveness, high
conflict, and lack of support and warmth, have been
associated with increased risk for suicidal behaviors
(Gould & Kramer, 2001; Kandel, Raveis, & Davies,
1991; Mandara & Murray, 2000; Marcenko, Fishman,
January 29, 2004
Style file version May 31, 2002
& Friedman, 1999; Zayas, Kaplan, Turner, Romano,
& Gonzalez-Ramos, 2000). For example, one study
found that African American youth who reported
an inability to get along well with their parents were
6.4 times more likely to also report having attempted
suicide (Price et al., 2001). In the large ethnically
and racially diverse sample of urban adolescents living in poverty recruited for the Adolescent Pathways
Project, the quality of family transactions was related
to both depression and antisocial behavior (Seidman
et al., 1999). Similarly, a longitudinal study of 173 urban adolescent males found that parental support predicted less depression over time; however, youths’
psychological symptoms did not appear to activate
or increase levels of support provided (Zimmerman,
Ramirez-Valles, Zapert, & Maton, 2000).
Low levels of school attachment and school difficulties, such as poor attendance and academic problems, also have been found to correlate with suicidal
ideation and behaviors (Gould & Kramer, 2001; Lyon
et al., 2000). Just as their connections to the specific
social contexts of family and school seem to impact
adolescents’ suicide risk, so too does their perception
of the level of support that is available to them across
social groups. The presence of a supportive network of
family and friends may operate as a buffer against depression and suicide (Chance, Kaslow, Summerville,
& Wood, 1998). Such support has been found to be
especially important for urban adolescent girls living
in high-risk neighborhoods (Stevenson, 1998).
Despite the fact that the prevalence of suicidal ideation and attempts are disturbingly high
among Latino adolescents and rapidly rising among
African American adolescents, in general, prevention research has devoted more attention to the study
of outwardly aggressive delinquent behavior than
the inwardly directed violence of suicide (Loeber,
Farrington, Stouthamer-Loeber, Moffitt, & Caspi,
1998; for an exception see Stiffman, Cheuh, & Earls,
1992). This is due in part to a historical perception of relative immunity to this risk within African
American and Latino populations and in part to the
challenges associated with recruiting sufficient numbers of African American and Latino youth for indepth investigations of mental health problems within
a community, nonclinical, population.
As described later, the RFH study provides access to a large sample of African American and Latino
youth who have been followed from their entry into
middle school through their 11th-grade year, at which
time suicidality was accessed. From this sample, we
can learn more about the prevalence of suicidality in
American Journal of Community Psychology [ajcp]
January 29, 2004
a group that is at increased risk for engaging in other
risky health behaviors, as well as about what risk and
resiliency factors influence whether or not adolescents
are likely to report suicidal ideation and behaviors.
The Reach for Health Study
In 1994, the Reach for Health (RFH) study was
initiated at three public middle schools in Brooklyn,
New York. RFH was one of seven sites collaborating
in a multisite research agreement (RSVPP) supported
by the Office of Minority Health and the National
Institute of Child Health and Human Development
to explore strategies for promoting health and reducing risk in minority communities. All youth attending seventh or eighth grade during two consecutive
school years (1994–95 and 1995–96) were eligible for
participation. Subsequent funding provided resources
for following youth from the eighth grade into their
high school years. At each assessment point (fall 7th
grade; spring 7th grade; spring 8th grade; spring 10th
and 11th grade), participants have provided information on a range of health issues related to the major
causes of disproportionate morbidity and mortality
among young African American and Latino men and
women: early and unprotected sex, violence, and substance use. Initial recruitment and study procedures
are described more fully elsewhere (O’Donnell et al.,
1997; O’Donnell, O’Donnell, & Stueve, 2001).
In response to growing concerns about the problem of suicide among African American and Latino
youth, at the time of the 11th-grade survey, the Center
for Violence and Injury Prevention at the Centers for
Disease Prevention and Control provided funding to
add a supplemental module on mental health. We report on findings from this survey, which was conducted
during two consecutive years (1999–2000), when respondents were at an average age of 17 years. For this
first presentation of data on the prevalence and correlates of suicidal ideation and attempts we restrict
our analyses to 11th-grade reports. This information
is important in and of itself and for guiding future
longitudinal analyses.
The RFH Sample
Three middle schools in Brooklyn, New York
provided access to a sample of urban African
Style file version May 31, 2002
O’Donnell, O’Donnell, Wardlaw, and Stueve
American and Latino young adolescents. Each of
the schools is located in an economically disadvantaged area of the city where health statistics indicated high rates of teen pregnancy, HIV/STD infection, violence-related injuries, and other sources of
morbidity. Each school also has a high-risk profile (i.e.,
>80% of students eligible for free lunch programs;
below grade level and city averages on standardized
test scores; comparatively low high school graduation rates). All seventh- and eighth-grade students
attending classes in one of the three middle schools
were invited to participate. Following procedures approved by the Institutional Review Boards at EDC
and the New York City Public Schools, we obtained
written parental permission and youth assent prior to
study enrollment. Field procedures for getting written
permission, survey administrations, and initial survey
completion rates are described elsewhere (O’Donnell
et al., 1997). Parental consent was provided for 89%
of eligible middle school students; completed baseline
surveys were obtained from over 95% of those with
parental permission.
The RFH sampling pool for the following analyses includes youth who completed at least one eighthgrade survey, the eligibility criterion that was established for the high school follow-up surveys. Tracking
youth from middle to high school within New York
City presents a special challenge because there is an
open policy on high school enrollment. Many families took advantage of this option: RFH middle school
students enrolled in over 120 high schools across all
five boroughs. Locating and resurveying youth was
accomplished with the cooperation of the 5 district
superintendents, more than 100 principals, and many
local school administrators throughout the city. With
their approvals, we recontacted youth through mailings to homes and direct contacts in each of the high
schools in which students were registered.
Of the 1,554 youth who completed an 8th-grade
survey, 1,185 (76.2%) were successfully located and
surveyed during the 11th-grade spring follow-up.
There are no significant differences in follow-up rates
by year of study enrollment. By offering surveys in
multiple locations (including schools as well as other
community sites) and on different days and times, we
were able to include youth who attended school regularly as well as those who did not. Of the 1,185 youth
who took an 11th-grade survey, this study reports on
the 879 youth (74%) who completed a supplemental mental health module in addition to the regular
RFH survey. Because of the sensitivity of asking adolescents about suicidality, the protocols approved by
American Journal of Community Psychology [ajcp]
January 29, 2004
Suicidality and Urban Youth
the Institutional Review Boards required that written

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