The Moderating Role of Race/Ethnicity in Suicide Risk and Family Connectedness in Youth Presenting to the Emergency Department

Abstract

Objective

Significant racial disparities exist in youth suicide rates. Research has identified family connectedness as a strong protective factor against suicide. However, the role of family in youth mental health can vary based on cultural factors that may differ across race and/or ethnicity. This study aimed to evaluate how race/ethnicity moderates the association between suicide risk and family connectedness.

Method

This secondary analysis of Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study 1 included youth ages 12 to 17 years. Data were obtained for race/ethnicity, family connectedness (combined score of 2 items, range 2 [low] to 10 [high]), and the Ask Suicide-Screening Questions (ASQ) tool. Binary logistic regression assessed the association between family connectedness and positive ASQ screen, with race/ethnicity as a moderator.

Results

Data for 5,514 participants (50.9% female, 45.8% non-Hispanic White, mean [SD] age = 15.0 [1.7] years) were analyzed. Of all participants, 23.5% (1,293/5,514) screened positive for suicide risk. Overall, participants reported high family connectedness (mean [SD] = 8.2 [1.74]). Multiracial participants had the lowest average family connectedness (7.93) and the highest screen positive rate (28.34% [70/247]). For a 1-unit increase in family connectedness, the odds of screening positive were significantly lower for Black/African American participants (odds ratio 0.54, 95% CI 0.49-0.59) compared to White participants (odds ratio 0.46, 95% CI 0.43-0.49) (difference: z = −3.17, p = .001).

Conclusion

The protective effect of family connectedness for suicide risk may vary by race/ethnicity. In this study, family connectedness was less protective against suicide risk for Black/African American youth compared to White youth. Findings highlight the importance of cultural considerations in family-based interventions for suicide prevention.

Plain language summary

There are significant racial disparities in youth suicide rates, with family connectedness as one of the strongest protective factors against suicide. This study evaluated how race/ethnicity moderates the relation between suicide risk and family connectedness using data from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study which included youth aged 12-17 years. Family connectedness may be less protective against suicide risk for Black/African American youth compared to White youth. In addition, multiracial youth were at higher risk with the lowest average family connectedness and the highest screen positive rate for suicide risk. These results highlight the importance of cultural considerations in family-based interventions for suicide prevention.