A Youth Suicide Research Consortium Focused on Diversity
Regina Miranda, Ph.D., Hunter College and The Graduate Center, City University of New York
(originally published 1/9/2019)
Over 32,000 people died by suicide in the United States in 2004, the year that I began to study suicide. That year also saw the first increase in the youth suicide rate in over a decade. The controversy over prescribing antidepressants among youth had reached its peak, with the FDA issuing its "black box" warning against their use to treat children and adolescents, due to concern that they might increase risk of suicidal thoughts and behavior. Efforts to implement universal suicide screening encountered resistance, some of it by groups concerned that screening would lead to labeling and over-medication of children. Studies of teenagers who had died by suicide, such as those published by David Shaffer, my postdoctoral mentor, along with epidemiological research, had already suggested particular demographic, psychosocial, and clinical risk factors that merited focus, but there was also an increasing realization of a need to move beyond suicide risk assessments that relied on what people told their clinicians, as those at highest risk would not always disclose their suicidal thoughts. Thus, soon after I entered this field, research focusing on more “objective measures,” ranging from laboratory-based implicit measures of suicide risk to genetic and neurobiological variables, also flourished. At the same time, much progress was made in theory development, with a number of contemporary models of suicide published in the US and in the UK that continue to guide research to date.
Unfortunately, recent analyses suggest that while decades of suicide research have helped to identify predictors of long-term risk, these variables provide little help in identifying who is at imminent risk of suicide and also provide little help in predicting who will think about or attempt suicide. Despite a proliferation of theories and research, more people have continued to die by suicide in the US than they did when I entered this field. In 2017, over 47,000 people died by suicide in the US. The global suicide rate has been declining during the 21st century, but not in the US, where it has been rising. Among adolescents and emerging adults, suicide is currently the second leading cause of death. More people attempt suicide during adolescence than at any other time in life. In adulthood, people more often think about and attempt suicide between ages 18 and 25than when they are older. Because so many more people attempt suicide than actually die by suicide in adolescence and emerging adulthood, youth suicide is difficult to predict. There are currently no comprehensive contemporary models of youth suicide to guide investigation, leaving researchers to extrapolate from models -- developed with adults -- that may not fit younger age groups.
Further complicating the study of youth suicide is the fact that this research has failed to keep pace with the increasing diversity of the US population. A little over half of the US adolescent population is White (non-Hispanic), and that number is estimated to decrease to about 40% by 2040; yet over 70% of people who take part in longitudinal studies of suicide risk are White (and this percentage is likely an underestimate, because not all suicide research studies have reported on demographic characteristics such as race). National data suggest that the highest rate of suicide death occurs in middle age. However, this is only true among non-Hispanic White Americans and not among Asian, Black, Hispanic, and Native American individuals, for whom the period of highest risk occurs in their early twenties. Furthermore, recent data suggest that black children have higher suicide rates than white children (the opposite of what is found among adolescents and adults). Our current models fail to account for such differing demographic trends. Thus, to keep pace with the increasing diversity of youth in the US, we need theories and research that address issues of diversity, not only in terms of race and ethnicity, but also socioeconomic, sexual, and gender diversity. Such models do exist for particular racial and ethnic groups (e.g., Latina adolescents) but tend to be studied as culturally-specific and are not integrated into the more “universal” theories that guide the field.
We have come together as a Youth Suicide Research Consortium (YSRC) to help fill this knowledge gap. As per our mission statement, "We are an interdisciplinary network of researchers dedicated to the study of youth suicidal behavior among diverse populations (i.e., diversity based on race, ethnicity, socioeconomic status, gender, sexual orientation, and ability), with an emphasis on understanding and decreasing disparities.” Using our collective expertise, we aim to improve research on the understanding, assessment, treatment, and prevention of youth suicidal behavior, increase research on youth suicidal behavior in underrepresented populations, and advance the careers of researchers from a variety of backgrounds and disciplines. Over the coming months, this blog will highlight our ongoing work in this area. Knowing that diversity among researchers yields higher-impact research, we look forward to working with our colleagues and communities to make meaningful contributions to youth suicide research and ultimately help to reduce risk of suicidal behavior in this vulnerable population.