# Prospective Risk and Protective Factors for Suicide Attempts Among Black Adolescents Seeking Emergency Department Services

## TL;DR

This study identifies factors that increase or decrease the risk of future suicide attempts in Black adolescents who visited emergency departments.

## Contribution

The study provides new insights into specific risk and protective factors for future suicide attempts among Black youth.

## Key findings

- Sexual and gender minority status, prior suicidal behavior, and hopelessness were significant predictors of future suicide attempts.
- Feeling connected to family, peers, and school was associated with a lower likelihood of suicide attempts.
- A multivariable model with an area under the curve of 0.91 effectively predicted suicide attempts.

## Abstract

Suicide rates among Black youth have been rising at an alarming rate, with a 54% increase between 2018 and 2022. This study investigated sociodemographic, suicide-related, clinical, and interpersonal risk and protective factors of lifetime (cross-sectional) and 6-month (prospective) suicide attempt in a large sample of Black youth who visited the emergency department.

Data from 1,719 Black youths (girls = 1,046 [61%], mean [SD] age =14.98 [1.66] years) were obtained from the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) Study 1 cohort recruited from 13 nation-wide pediatric emergency departments (Pediatric Emergency Care Applied Research Network [PECARN]). Among 784 youths selected for follow-up interviews based on level of suicide risk, 616 (78.6%) participated in 3- and/or 6-month follow-up interviews. Univariable logistic regression models examined cross-sectional and longitudinal relations between sociodemographic, suicide-related, and other clinical and interpersonal risk and protective factors and suicide attempt. A multivariable logistic regression model predicting follow-up suicide attempt was examined.

Cross-sectional and follow-up univariable models found that gender identity, sexual minority status, suicidal ideation/behavior, nonsuicidal self-injury, hopelessness, depression, agitation, anxiety, sexual abuse history, level of impairment, connectedness (family, peer, school), and impulsivity predicted suicide attempt. The final multivariable model included lifetime suicidal behavior, baseline suicidal ideation in the past week, impulsivity, and all forms of connectedness (area under the curve = 0.91, 95% CI 0.87-0.95) as predictors of suicide attempt, although impulsivity and social/school connectedness were nonsignificant predictors that were retained for improved fit indices.

Our findings highlight the importance of suicide-related factors, hopelessness, functional impairment, sexual and gender minorities, and connectedness at baseline in predicting future suicide attempts in Black youth. Future work should incorporate race-related risk and protective factors.

Suicide rates among Black youth are climbing at an alarming rate. This study examined which array of factors predicted suicide attempts 3-6 months later among 784 Black youth who visited the emergency department through follow-up interviews. Results identified several factors that predicted suicide attempts, including sexual and gender minority identity, prior suicidal experiences, and feeling hopeless, amongst others. Feeling connected to family, peers, and school reduced the likelihood of attempting suicide.