Prospective Risk and Protective Factors for Suicide Attempts Among Black Adolescents Seeking Emergency Department Services

<h2>ABSTRACT</h2><h3>Objective</h3> Suicide rates among Black youth have been rising at an alarming rate, with a 54% increase between 2018-2022. Using a large sample of Black youth who visited the Emergency Department (ED), we investigated sociodemographic, suicide-related, clinical, and interpersonal risk and protective factors of lifetime (cross-sectional) and 6-month (prospective) suicide attempt. <h3>Method</h3> Data from 1,719 Black youth (Female = 1,046 [61%], Mean age=14.98 years [SD = 1.66]) came from the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) Study One cohort recruited from 13 nation-wide pediatric EDs (Pediatric Emergency Care Applied Research Network [PECARN]). Among 784 youth selected for follow-up interviews based on level of suicide risk, 616 (78.6%) participated in 3- and/or 6-month follow-ups. Univariable logistic regression models examined cross-sectional and longitudinal relationships between sociodemographic, suicide-related, and other clinical and interpersonal risk / protective factors and suicide attempt. A multivariable logistic regression model predicting follow-up suicide attempt was examined. <h3>Results</h3> Cross-sectional and follow-up univariable models found gender identity, sexual minority status, suicidal ideation / behavior, non-suicidal self-injury, hopelessness, depression, agitation, anxiety, sexual abuse history, level of impairment, connectedness (family, peer, school), and impulsivity predicted suicide attempt. The final multivariable model included lifetime suicidal behavior, baseline suicidal ideation in the past week, impulsivity, and all forms of connectedness (AUC = 0.91, 95% CI: 0.87-0.95) as predictors of suicide attempt, although impulsivity and social / school connectedness were non-significant predictors that were retained for improved fit indices. <h3>Conclusion</h3> Our findings highlight the importance of suicide-related factors, hopelessness, functional impairment, sexual and gender minorities, and connectedness at baseline in predicting future suicide attempts in Black youth. Future work should incorporate race-related risk and protective factors.