Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Abstract

Suicide is the second leading cause of death for people aged 10–34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents ( M age = 14.99 [SD = 1.61]) from Waves I–IV National Longitudinal Study of Adolescent to Adult Health (1994–2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01–2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21–2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69–4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08–2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage. Supplementary Information The online version contains supplementary material available at 10.1007/s10488-021-01122-w.

Temporal Trends and Disparities in Suicidal Behaviors by Sex and Sexual Identity Among Asian American Adolescents

“…26 Continued efforts to reduce suicide at the structural level are needed. 13 We found increases in suicide attempts and injury by suicide attempt among Asian American female adolescents in the recent decade, although the trends of these increases were not statistically significant. These recent increases may be associated with the rising rates of cyberbullying through social media and online gaming that started to be prevalent between 2005 and 2006.…”

“…12 Co-occurrence of racial discrimination and sexual-orientation stigma could be associated with increased suicide risks and health disparities in suicide. 13 Thus far, trends of suicidal behaviors in Asian American youth who are sexual minorities have not been reported, to our knowledge. It is unknown whether living at the intersections of multiple marginalized identities, including sex, sexual identity, and sexual behavior contacts among racial minorities, would further reinforce culturally unique minority stress 14 and reflect the epidemiological outcomes of disparities in suicidal behaviors among Asian American adolescents.…”

Association of Social Determinants of Health and Vaccinations With Child Mental Health During the COVID-19 Pandemic in the US

“…Differences in risk and resilience profiles owing to racism and structural inequities demand health and economic policy adjustments. Discrimination, racism, and bias may magnify the association of SDoH with child mental health disparities as indicated in previous ABCD studies in baseline and during the COVID-19 pandemic. After a call from the US Surgeon General, it is imperative to systematically quantify, uncover, and deconstruct the multilevel and intersectional mechanisms of disparities to inform nuanced solutions to mental health disparities in children.…”

Structural indicators of suicide: an exploration of state-level risk factors among Black and White people in the United States, 2015–2019

“…Prior research has illustrated that structural inequities such as socioeconomic status; Schober et al , 2021; Xiao and Lindsey, 2021) and state-specific variables (e.g. minimum wage, overall housing vacancy rate in an area; Kaufman et al , 2020) systematically affect Black and White people differently, which may aid in explaining racial differences in suicide rates.…”

“…minimum wage, overall housing vacancy rate in an area; Kaufman et al , 2020) systematically affect Black and White people differently, which may aid in explaining racial differences in suicide rates. For example, researchers have found lower socioeconomic status to be both a risk factor for suicidal ideation and attempts among adolescents (Xiao and Lindsey, 2021), as well as significantly associated with suicide deaths (Wilkins et al , 2019). Therefore, it is imperative that structural risk factors that may increase the likelihood of suicide be assessed to inform policy and community-based interventions.…”