It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, January 19, 2020
Black kids and suicide: Why are rates so high, and so ignored?
Black youth may be less likely to share their thoughts of loneliness or depression than other youth, which could be a reason for higher rates of death by suicide among black youth. Credit: Motortion Films/Shutterstock.com
Also, the 2015 Centers for Disease Control and Prevention's biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.
Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.
For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers' interviews with African American pastors concluded that suicide is a "white thing" and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a "white thing" but it is a myth that black people do not die by suicide.
Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.
More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as "hidden ideators" who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.
Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children's lives are lost—lives that could be saved.
Unique needs in African American mental health
Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.
In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.
When there are cultural differences, therapists must be willing to "think outside of the box" to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.
In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.
Caring adults are a child's first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help. The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.
When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.
Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.
For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.
Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she "get over it" is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.
No clear evidence of increase in adolescent suicide after '13 Reasons Why'
by Annenberg Public Policy Center of the University of Pennsylvania
Suicide rates per 100,000 in youth ages 15-19 in the United States, 1981-2017. Credit: Centers for Disease Control and Prevention
Contrary to the findings of a 2019 study that associated the release of the Netflix series "13 Reasons Why" with an increase in monthly suicide rates among adolescent boys, a reanalysis of the data by the Annenberg Public Policy Center finds no evidence of contagion. The reanalysis, published today in PLOS ONE, found that after controlling for the dramatic increase in adolescent suicide in recent years, the show's release had no clear effect.
The reanalysis found that the increase in the suicide rate for boys observed in the original study by Bridge and colleagues for three months after the series' release was no longer evident after controlling for the ongoing trend in adolescent suicide. In addition, the increase seen during the first month of the release began the month prior to the release, making it difficult to attribute the rise to the show. The reanalysis found no effects in the subsequent months of that year.
"Our reanalysis casts considerable doubt on the show having an effect on boys," said author Dan Romer, Ph.D., research director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania. The paper, "Reanalysis of the Bridge et al. study of suicide following release of 13 Reasons Why," was published January 15, 2020, in PLOS ONE.
The original time-series analysis of suicide rates by Bridge et al. found an additional 195 suicide deaths among boys ages 10 to 17 during the nine months following the series' release, on March 31, 2017, but did not find a similar result among adolescent girls. Romer said he questioned that finding for two reasons: "First, contagion would be expected to be stronger for girls than boys because this show focuses on the suicide of a high school girl. Second, the prior analysis didn't take into account strong secular trends in suicide, especially in boys from 2016-2017."
APPC's reanalysis did find a modest rise in the suicide rate among adolescent girls during the first month following the release of "13 Reasons Why," but it was not statistically reliable.
Rising suicide rates for adolescents
Suicide rates for both adolescent males and females have been rising since 2008 and the rise in 2017 was particularly strong. The rate for young males ages 15 to 19 increased by 21 percent between 2016 and 2017. Suicide among female adolescents ages 15 to 19 increased by 7 percent.
There has been disagreement about the causes of the recent rise in adolescent and young adult suicide. Some researchers have suggested that the rise is due to increased use of social media. But a recently published analysis by Romer suggested that the trend may be attributable in part to lingering economic stress from the 2008 financial crisis in combination with increased pressure on teens from their parents to succeed academically.
'13 Reasons Why' and suicide contagion
When the first season of the Netflix show appeared in 2017, it created widespread concern that its graphic portrayal of a teenage girl's suicide would lead to imitation among vulnerable young people, especially adolescent girls. This concern prompted researchers to see whether there was evidence of contagion in U.S. suicide rates following the show's release.
The first such study, by Bridge et al., found evidence of a jump in suicides among boys ages 10 to 17 in the three months following the show's release, but no effect for girls. Romer said that analysis relied on a forecasting method to project the likely trend in suicide for 2017. But that forecast failed to anticipate the actual trend.
A second study by different researchers (Niederkrotenthaler et al.) in JAMA Psychiatry had a similar problem, Romer said. That study found an effect in boys and girls 10 to 19 years old in the three months following the series' release. But it similarly failed to control for the secular trend in suicide, again making it difficult to separate the effects of the show from the trend.
Potential for harm
APPC's analysis does not rule out the possibility that the show had an adverse effect, especially on girls. A previous study by Romer and colleagues that examined the effects of the second season of "13 Reasons Why" found that viewing the show had both beneficial and detrimental effects on young adult viewers. The small increase observed in girls in this current reanalysis of the first season data may have been the net result of these opposing effects, Romer said.
In mid-2019, over two years after the release, Netflix edited a graphic suicide scene from the Season 1 finale and asserted that the show encouraged young people "to start conversations about difficult issues such as depression and suicide and get help—often for the first time."
"Despite that, it does not appear that the show reversed or slowed the ongoing increase in adolescent suicide," Romer noted. "Even if the series also had a positive effect for some viewers, the producers should recognize the potential for harm to vulnerable audience members. It should be possible to produce a show that highlights the challenges that young people face without also producing suicide contagion."
Romer thanked Jeffrey Bridge for providing the data that were not available in his paper, which is in press in the Journal of the American Academy of Child & Adolescent Psychiatry.
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