• What Can Be Learned From Differing Rates of Suicide Among Groups

    The following originally appeared on The Upshot (copyright 2020, The New York Times Company). 

    U.S. suicide rates vary widely across racial and ethnic groups in ways that can upend expectations. The explanations may suggest avenues for prevention.

    Suicide in America has been rising for two decades, with rates for white Americans consistently well above those for Asian-Americans, Black Americans and Hispanics.

    In data released in 2017, the rate for white Americans was around 19 per 100,000, and it was about 7.1 for both Hispanics and Asian-Americans/Pacific Islanders, and 6.6 for Black Americans, according to the Centers for Disease Control and Prevention.

    Emotional and social stress is associated with suicide. From this, a puzzle emerges.

    Because of pervasive racism, Black Americans experience substantial stress, fewer opportunities for advancement and more threats to well-being. These negative experiences can degrade mental and physical health, as well as limit education, employment and income — all of which can increase suicide risk. Unemployment, which is higher for Black Americans than white Americans, is itself a source of stress.

    Yet the Black suicide rate is about one-third that of whites.

    “Social stressors — lower socioeconomic status and racism among them — are more prevalent and severe for the Black population than the white one,” said Joshua Breslau, a senior behavioral and social scientist at RAND. “But suicide and some risk factors for it, like mental health conditions, are less prevalent in the Black population. This is puzzling.”

    One explanation may be a racial disparity in suicide data. Ian Rockett, an epidemiologist with West Virginia University, studies mortality data. “Because suicides can be difficult to prove, many may be misclassified as undetermined intent or accidents,” he said. “This problem is greater for Black Americans than white Americans.”

    His work, and that of others, shows that deaths of Black Americans are far more likely to be coded as undetermined than those of white Americans, in part because Black Americans dying by suicide are less likely than whites to leave a note and to have a record of mental disorders. (Lower rates of mental health diagnoses reflect at least in part poorer access to health care and treatment that stems from racism.)

    But misclassification cannot fully explain the racial difference in suicide. Other factors may help protect Black Americans from suicide, despite conditions that would seem to place them at higher risk. Dawne Mouzon, a sociologist and associate professor at Rutgers University, suggested that religious involvement is one source of protection. Black Americans overwhelmingly identify as Christian. “Because of their faith, Black Americans are more likely to believe suicide precludes reaching heaven after death,” she said.

    Although church membership has trended downward over the last two decades, it has been lower and fallen faster for white Americans than Black Americans. According to a national survey by the Pew Research Center, by almost any measure of religiosity, Black Americans are more religious than whites. Emotional and social support from a church congregation may also confer mental health benefits, Professor Mouzon added.

    It’s a much debated connection. A recent systematic review of studies found that attending religious service is not especially protective against suicidal ideation (thinking about or planning suicide), but it does protect against suicide attempts, and possibly protects against suicide.

    Other types of group activities may confer a similar sense of belonging. Volunteers with caregiving responsibility maintain a significantly reduced suicide risk, a 2019 study found. As a 1976 study put it, social support is anything that leads someone “to believe that he/she is cared for and loved, esteemed, and a member of a network of mutual obligations.”

    Jonathan Lee Walton, dean of the School of Divinity at Wake Forest University, sees another angle to Black religiosity that could reduce suicide rates. “It’s in the Black theological tradition that in this life you will experience trouble and hardship,” he said. “Unfortunately, this is born of tragic experiences in this nation. This prepares one for paths of despair, for traveling the lonely road of heartbreak, perhaps in a way that white Americans don’t learn to the same degree or from a young and formative age.”

    Single parenthood is another possible explanation. Black women are more likely to be single parents than white women, and they have the lowest suicide rates across any race/gender group. (Suicide is less common among women than men in general.)

    “For single parents, being the sole financial, instrumental and/or emotional support provider for children can deter suicide, even in times of extreme distress,” Professor Mouzon said. Another way single parenthood may reduce suicide risk is through the coalescing of extended family and community support for the care of the child. It’s possible this support, once in place, also confers mental health benefits that reduce suicide risk for the mother.

    Experts say some reasons for the relatively low suicide rate among Latinos — who also tend to be poorer and face discrimination — are close social and family networks, which can build and maintain resilience, as well as moral objection to suicide based on religion. A study published in 2014 in the Journal of Clinical Psychiatry suggested that immigrant families can lose some of that protection when they assimilate and lose ties to Latino culture.

    Though it’s impossible to predict who will attempt or complete suicide, the broad risk factors that contribute to suicide in all racial and ethnic groups are widely documented. They include mental health challenges and psychiatric disorders, exposure to suicide by others, being bullied, substance use, loneliness and social isolation, and exposure to stressful life events.

    In the last two decades, there has been a sharp rise in so-called deaths of despair — suicides, drug overdoses or alcohol abuse — among middle-aged white Americans without a college degree. In their research on the subject, the Princeton economists Anne Case and Angus Deaton pointed to, among other factors, loss of community and loss of status.

    Over all, the C.D.C. report found higher suicide rates in rural America than in medium/small and large metropolitan counties. Most gun deaths in America are suicides, not murders, and white men are more likely to own a gun. The C.D.C. report said rates of suicide by gun in rural counties were “almost two times that of rates in larger metropolitan counties.”

    Among Asian-Americans, one study suggests that collectivist cultures among immigrants that promote care for others could be a protective factor. Another points to close family relationships. But what holds for one group may not for another. Aparna Kalbag, a mental health research psychologist and advocate, works with South Asian-Americans. “Their relatively higher education also plays a role,” she said. “It influences how they perceive and react to mental health symptoms. They view them as something they can change, and they have the resources to do so.”

    This is not the case with other, lower-income groups whose access to mental health care is more circumscribed.

    Suicide rates are highest among Native American and Alaska Native populations: 21.8 per 100,000 people.

    One study found that American Indian youth in southeastern Montana are more likely than white youth to report feeling sad or hopeless — one predictor of suicide risk. Greater alcohol and drug use among Native American populations is also associated with higher suicide rates. Another study documented high rates of psychological distress among Indigenous populations.

    According to scholars of suicide in Indigenous populations, these are all byproducts of colonization.

    “Colonization is not only in the past,” said Desi Rodriguez-Lonebear, an assistant professor at U.C.L.A. and a citizen of the Northern Cheyenne Nation. “It’s an ongoing system, a series of structures that continue to disenfranchise, erase and traumatize Indigenous peoples.”

    One of the most obvious and tangible effects of colonization on those populations is their forced segregation into reservations and the intergenerational trauma that ensued from severing ancestral relationships to their lands, cultures, languages and ways of life. “The psychological, social, and economic harms this causes cannot be overstated,” Professor Rodriguez-Lonebear said.

    Explanations for variation in suicide rates across racial and ethnic groups point to ways to reduce it. “Whether through family, church or another community, emotional and social support is key to suicide prevention,” said Lillian Polanco-Roman, an assistant professor of psychology at The New School. “Beyond that support, these groups can also serve as bridges to mental health services.”

    If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources

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