Culturally Relevant Suicide Prevention Mechanisms for Black Youth

Written by Sureshi Jayawardene

Youth suicide is a major public health issue in the United States. A 2015 study published in JAMA Pediatrics noted that suicide was the second leading cause of death among adolescents aged 12-19. Suicide accounts for more deaths in this age group than cancer, influenza, heart disease, diabetes, HIV, stroke, and pneumonia
combined.

Suicide and Black Youth
Suicide rates among Blacks have typically been lower in all age groups compared with Whites. However, this study showed a steep rise in suicide among Black children, from 1.36 per one million to 2.54 per one million children—more than double since the 1990s (Bridge et al, 2015). This rate was also significantly higher than the rate among White children, which had declined from 1.14 per one million children to 0.77 (Bridge et al, 2015).
Researchers noted that it was the first time a national study found a higher suicide rate for Blacks than for Whites (Bridge et al, 2015). They used national data based on death certificates that listed suicide as the cause of death. Researchers in this study offered some explanations for this stark difference: that Black children are exposed to greater violence and traumatic stress; and that Black children are more likely to experience early onset of puberty which can lead to a higher risk of depression and impulsive aggression (Bridge et al, 2015). However, there was no indication as to how these characteristics had changed during the period of the study and if they alone were sufficient to explain the sharp rise in the Black youth suicide rate. Additionally, gun deaths for Black boys remained the same while suicide by hanging had more than tripled (Bridge et al, 2015). For White boys, on the other hand, gun deaths fell by about half and suicide by hanging remained the same. Researchers surmised that access to guns might be greater among Black boys while gun safety education may not be reaching them (Bridge et al, 2015). Traditionally lower suicide rates among Blacks were explained as the result of protective factors such as strong social networks, family support, religious faith, and other cultural influences. Given the sharp change in suicide among Black children since the 1990s, the researchers in this study questioned the strength of these protective factors in curbing suicide (Bridge et al, 2015).  

Culturally Relevant Interventions for Suicide Prevention
In a recently published study, Robinson et al (2016) explain that suicide is one of the most pressing issues facing Black youth today—one that has become more prevalent in the last 20 years, but remains largely overlooked. According to the CDC, documented suicide is the third leading cause of death for African Americans ages 15-24. However, Robinson et al (2016) caution that: 1) suicide rates among Black adolescents may be underreported or misclassified due to cultural stigma and; 2) subject-precipitated homicides and “suicide-by-cop” may contribute to the high volume of undetermined suicide intent classifications. Suicide-by-cop is when a person deliberately acts in a threatening manner to provoke a lethal response from a law enforcement officer. Nonetheless, the need for effective prevention interventions is extremely high. Moreover, Robinson et al (2016) call for culturally grounded suicide prevention programs that are designed to address the complexity of psychosocial stressors facing African American youth. These stressors include: developmental changes, racial discrimination, and resource poor living environments (Robinson et al, 2016). Poverty is also linked to chronic stress and suicidality (Robinson et al, 2016). Particularly for young Black males, these conditions are more likely to result in suicide (Robinson et al, 2016).

Culturally Adapting the Adolescent Coping with Stress Course
Black youth are already one of the most vulnerable populations in the nation, regularly threatened by different types of violence and trauma. These youths are also three times more likely to grow up in resource poor neighborhoods than any other ethnic group in the US (US Census Bureau, 2014). Robinson et al (2016) noted that there are few school-based suicide prevention programs that are culturally grounded for African American adolescents. Their study culturally adapted Clarke and Lewinson’s (1995) empirically validated Adolescent Coping with Stress Course (CWS), representing “a synthesis of culturally specific contextual material” (p. 119-120). The researchers maintained the original length of the CWS (15 sessions of 45 minutes each) and the theoretical framework (multifactorial approach that included identifying feelings and expressions of stress, reducing negative cognitions and increasing positive thoughts, acknowledging and identifying risk factors for stress, and developing and enhancing personal competencies for coping with stress). However, they incorporated substantive cultural, structural and environmental adaptations to Clarke and Lewinson’s (1995) original program in the following ways:

1. Language: language and names that reflected common vernacular of African American youth
2. Persons: facilitated open discussions about the difference between facilitators and participants
3. Metaphors: incorporated African American proverbs, drawings, icons, and cartoons
4. Content: used material congruent with African American heritage, culture, and values
5. Concepts: activities included themes and ideas common to African American values and beliefs
6. Goals: adjusted to be culturally congruent
7. Methods: trainings were centered on strategies to help youth collaborate with peers, parents, and mentors
8. Context: discussions brought into view the characteristics of the community environment where youth lived

Ten students from the ninth-grade student body at one randomly selected high school of the four public high schools in the study were randomly selected to identify the necessary adaptations to the Clarke and Lewinson (1995) CWS.  Based on focus groups with these students, the researchers developed the adaptation, A-CWS.

Preliminary Findings of a Culturally Grounded Intervention
A-CWS was implemented at four public high schools in a large Midwestern metropolitan area with a predominantly African American student body and each of these schools had an on-site student-based health center. The schools also reported dropout rates between 24% and 31%, compared with the city-wide rate of 16%. Participants in the study were 9th, 10th, and 11th grade students (a total of 758) who were mostly African American (91%) and female (60%). All participants qualified for free or reduced lunches based on family income. The participation rate was 73% and highest for 9th graders and lowest for 11th graders, who, after age 16, are not legally required to attend school.
Researchers analyzed only the responses of the African American study participants (N=686) and of them, 682 completed the suicidality measure and almost half (N=330) reported some level of suicide risk. Female students overrepresented the entire sample (n=416, compared to n=266 for males) as well as all levels of risk (i.e., low, moderate, high). The researchers found that students who participated in the A-CWS evidenced an 86% relative suicide risk reduction at posttest, compared to youth in the standard care control group who displayed similar risk at pretest. This is significant and supports the many arguments Black psychologists (Myers and Speight, 2010; Goddard, 1993; Nobles and Goddard, 2015; Nobles and Goddard, 1977) in particular have made in favor of culturally relevant solutions to issues in the Black community. Indeed, more intervention strategies that address African American stress reduction need designing and testing to address the glaring problems of suicide in Black communities. Robinson et al (2016) also recommend future studies examine causal links between individual and ecological variables that lead to suicide among Black youth.


Works Cited
Bridge, J. A., Asti, L., Horowitz, L. M., Greenhouse, J. B., Fontanella, C. A., Sheftall, A. H., & Campo, J. V.   (2015). Suicide trends among elementary school–aged children in the united states from   1993 to 2012.  JAMA Pediatrics, 169(7): 673-677.

Goddard, L. L. (1993). An African-Centered Model of Prevention for African-American Youth  at High Risk.

Myers, L. J., & Speight, S. L. (2010). Reframing mental health and psychological well-being   among persons of African descent: Africana/black psychology meeting the challenges of fractured social and cultural realities.The Journal of pan African studies, 3(8).

Nobles, W. W., & Goddard, L. L. (2015). An African-Centered Model of Prevention for African- American Youth cat High Risk. REPORT NO CASP-TR-6; DHHS-(SMA) 93-2015, 115.

Nobles, W. W., & Goddard, L. L. (1977). Consciousness, adaptability and coping strategies:   Socio-Economic characteristics and ecological issues in Black families. The Western Journal of Black Studies, 1(2), 105.

Robinson, W.L., Whipple, C.R., Lopez-Tamayo, R., Case, M.H., Gooden, A.S., Lambert, S.F., and Jason,  L.A. (2016). Culturally grounded stress reduction and suicide prevention for African American adolescents. Practice Innovations 1(2): 117-128.