Male, Black and Sexual Minorities Are Increasingly at Risk of Attempting Suicide According to Research Presented at the Society of Behavioral Medicine

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Study finds significant racial and sexual differences for trends in high school students’ thinking, planning and attempting suicides from 1999 to 2019.

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Male, Black and sexual minorities are increasingly at risk of attempting suicide – whether or not they’ve previously exhibited suicidal ideation or formulated a suicide plan -- new research suggests.

Male, Black and sexual minorities are increasingly at risk of attempting suicide – whether or not they’ve previously exhibited suicidal ideation or formulated a suicide plan -- new research suggests.

The research is being presented Thursday at the Society of Behavioral Medicine’s 42nd Annual Meeting & Scientific Sessions.

The researcher examined the 1999-2019 National Youth Risk Behavior Survey, a national school-based survey conducted biannually by the U.S. Centers for Disease Control and Prevention. The results revealed significant disparities in trends based upon sex, racial/ethnic identity, and sexual orientation in distinct suicidal profiles over the past 28 years.

“Our data suggest that the trends in suicidal subgroups of high school students in the U.S. are different,” the authors write. “Male, Black and sexual minorities are more likely to be in the group with suicide attempt only, without concurrently thinking or planning suicide.”

“This has the potential of guiding suicide prevention programs targeting the most at-risk racial/ethnic and sex subpopulations,” said corresponding author Yunyu Xiao, Ph.D., M.Phil., an assistant professor of social work at the Indiana University School of Social Work.

Suicide is the second leading cause of death for adolescents aged 10 to 18 in the United States. In 2019 alone, more than 2,144 adolescents completed suicide. Recent studies have begun understanding the different risks to an adolescent who only thinks of suicide and those who take action to attempt suicide. However, little is known about disparities in the trends of distinct suicidal profiles, constructed by various combinations of suicidal ideation, plan and attempts, over time.

More targeted and tailored suicide prevention programs are urgently needed to address the racial/ethnic and sex differences in suicidal behaviors among adolescents over time.

Dr. Xiao derived a nationally representative sample of 186,680 students in grades 9-12 (48.9% female; 51.1% male) from a biannual, school-based survey titled National Youth Risk Behavior Survey. The researcher then categorized five suicidal profiles using self-reported suicidal behaviors in the past 12 months, including suicidal ideation, a suicide plan and suicide attempts. The trend analysis includes a series of logistic regression using survey years to identify linear and quadratic trends in the suicidal profiles, controlling for grade levels. The study further explores the differences in the trends across sex, race/ethnicity, and sexual orientation.

“The prevalence of the attempt-only group has increased by 500%, compared to non-suicidal students, but there were downward trends for other subgroups,” the authors write, and “more attention shall be focused on male, racial/ethnic, sexual minorities and intersectionality.”

Dr. Xiao cautioned that all the measures of suicidal behaviors were self-reported and may be associated with recall and social desirability bias. For example, adolescents may underreport their suicidal ideation and plans in the past year due to the fear of stigma.

“There’s still a lot to learn about the potential social determinants of health factors associated with the disparities in trends of suicidal subgroups,” said Dr. Xiao. “While there is a current push for policy action and legislation regarding investment in suicide prevention, we still don’t fully understand the impact of structural racism, housing segregation, social networks, neighborhood effect, cultural interpretation and substance use.”

Dr. Xiao said the next phase of research would examine the risk and protective factors associated with different suicidal subgroups.

Additionally, the new study adds to the pool of knowledge about the effectiveness of opioids and may help parents, school social workers and public health practitioners gain a better understanding of their pain with and without opioids.

Such information is imperative to better identify adolescents at the greatest risk of acting on suicidal ideation and tailored interventions to disrupt this risk trajectory.
“Our findings, coupled with existing evidence on the long-term effectiveness of opioid therapy to reduce pain intensity, have significant clinical implications for the ways in which opioid discontinuation processes and conversations take place between patients and clinicians,” the authors write.

The research team will present the findings on Tuesday, April 13, 2021, at 5 P.M. EST during a paper session at the SBM Annual Meeting, being held virtually. Dr. Yunyu Xiao is an SBM member.

About Indiana University School of Social Work

Committed to diversity, equity, and inclusion, the IU School of Social Work is nationally and internationally recognized for educating leaders of tomorrow through community-engaged practice, research and partnerships to positively impact individuals and society. As the primary provider of Indiana’s social work workforce since 1911, the School enrolls over 1,600 students annually through its PhD, MSW, BSW and Labor Studies programs across the state. Headquartered at Indiana University-Purdue University Indianapolis (IUPUI), Indiana’s premier urban public research university, the School is part of IU’s academic health sciences campus, including the nation’s largest medical school.

About SBM

The Society of Behavioral Medicine (SBM) is a 2,400-member organization of scientific researchers, clinicians and educators. They study interactions among behavior, biology and the environment and translate findings into interventions that improve the health and well-being of individuals, families and communities (


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