Psychological and socio-ecological correlates of 12-month suicide behavior among junior high school students in the greater Accra region of Ghana.

AIM: In Ghana, we know little about the epidemiology of suicide ideation, plan and attempts among junior high school (JHS) students in Ghana including the years preceding high school. This study explores the onset, characteristics, and recent patterns of 12-month suicide behavior among Ghanaian junior high school (JHS) students. MATERIALS AND METHODS: Paper-based surveys were administered to a sample (n = 800) of junior high school students in the Greater Accra region of Ghana. Self-reported measures on suicide ideation, plan and attempt as well as several psychological and psychosocial factors related to mental health, substance use, poverty, sexual behavior, interpersonal relationships, and family structure were employed. Bi-variate, multivariate and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25). RESULTS: This study found that 1 out of 5 adolescents have experienced suicide ideation in the last 12 months. Girls had significantly higher 12-month (χ2 = 3.5, p < 0.05) suicide ideation rates than boys. More importantly, the study found stress significantly increasing the odds of suicide behaviors in the last 12 months (ß = 1.14; CI = 1.05-1.24, p < 0.05) and parental support significantly reducing the odds of suicide behaviors in the last 12 months (ß = 0.86; CI = 0.81-0.91, p < 0.05). Additionally, we found significant associations between sexual intercourse, dating, hunger, substance use, suicide stigma and suicide behaviors. CONCLUSION: This finding highlights a potential emerging suicide crisis among preteens which warrants attention. Additional studies are needed to observe these increasing trends and identify risk, protective and precipitating factors to help prevent suicide among these children.

The Capacity-to-Serve Model as a Data-Driven Process for Provider Capacity Management in Outpatient Community Mental Health.

Despite increasing mental health provider supply shortages, research on capacity planning and management in the field of outpatient community mental healthcare is limited. There is an immediate need for strategies to plan and manage the capacity of existing mental healthcare providers to ensure a balance between demand and resources. To address this need, research on capacity planning and management in healthcare and mental healthcare settings is reviewed. Next, the Capacity-to-Serve Model is introduced and defined as a data-driven process for quantifying and reporting real-time standardized estimates of mental health provider availability based on qualifications, monitoring of outcome targets, and use of the Capacity-to-Serve Ratio and Realizing Capacity Measure. Finally, implications for using the model as an innovative solution for capacity management to meet demand in mental health are addressed. A case example is provided to demonstrate the application of the model. Ultimately, the Capacity-to-Serve Model can standardize capacity reporting of existing provider organizations and networks, both small and large, to support increased access to and supply of mental health services.

Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study.

BACKGROUND: Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. OBJECTIVE: This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. METHODS: We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion. RESULTS: In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. CONCLUSIONS: Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31241.

Correlates of Suicide Among Middle and High School Students in Ghana.

PURPOSE: We know little about the epidemiology of suicide among middle school students in Ghana, including the years preceding high school. This study explores the onset, characteristics, and recent patterns of suicide among Ghanaian middle and high school students. METHODS: This study used the World Health Organization Global School-based Student Health Survey (GSHS, 2012), which has self-reported measures on suicide ideation, plan, and attempt of middle and high school students in Ghana. Correlation and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25). RESULTS: The study found prevalence of suicidal behaviors among the population as follows: ideation (19%), plan (22%), and attempt (25%). Suicide ideation significantly increased the risk for suicide plan (odds ratio [OR] = 9.14; 95% confidence interval [CI] = 7.57-11.02) and attempt (OR = 11.89; 95% CI = 9.82-14.38), whereas suicide plan significantly increased the odds of suicide attempt (OR = 12.64; 95% CI = 10.50-15.19). There was a higher prevalence of suicide ideation, plan, and attempts among middle school students than high school students although only suicide attempt differences were significant (28.4% > 22.3%; χ2 = 17.1, p < .001). DISCUSSION: The onset of suicide among Ghanaian students occurs at younger ages than previously thought, and there were increasing trends in suicide behaviors as age increases. This finding highlights a potential suicide crisis among preteens, which warrants attention. Additional studies are needed to observe these increasing trends, identify risk, protective, and precipitating factors to help prevent suicide among these children.

Investigating the Role of Suicidality and Ethnic Identity among Black Adolescents: A Latent Profile Analysis.

OBJECTIVE: Suicide among Black adolescent youth has steadily increased in recent years, yet few studies describe how facets of social identity shape suicidal thoughts and behaviors (STBs) during this critical stage of development. Ethnic identity represents an underexplored, yet important element of social identity among Black youth that may contribute to differential associations with STBs. This study examined the association between ethnic identity and self-reported suicidal ideation, planning, and attempts. METHODS: Data were drawn from 1,170 African American (n = 810) and Caribbean Black (n = 368) adolescents aged 13-17 (Mean age = 15) that participated in the National Survey of American Life Adolescent supplement study. RESULTS: Using latent profile analyses, three patterns of ethnic identity were identified: Undifferentiated, Low Ethnic Identification, and Alienated. Caribbean Black adolescents were more likely to be in the Low Ethnic Identification class relative to the Undifferentiated class. Adolescents in the Undifferentiated group reported higher proportions of suicidal ideation, planning, and attempts compared to the remaining latent profile groups. CONCLUSION: Findings demonstrate that ethnic identity is an important aspect of social identity that can influence STBs among Black adolescents. Considering increased suicide attempts and death rates among Black youth, findings underscore the importance of examining culturally relevant developmental processes that may shape suicidal beliefs and behaviors.

Development, construct validity, and measurement invariance of the Modified Classes of Racism Frequency of Racial Experiences Measure (M-CRFRE) to capture direct and indirect exposure to perceived racism-based police use of force for Black emerging adults.

OBJECTIVES: To utilize focus groups, cognitive interviews, content expert panel, and computer-assisted surveys to develop and pilot survey items assessing exposure to perceived racism-based police violence to enhance the Classes of Racism Frequency of Racial Experiences (CRFRE). METHOD: Focus groups and cognitive interviews were conducted with Black emerging adults (n = 44) in St. Louis, Missouri. Utilizing a grounded theory approach, a thematic analysis of the focus group and cognitive interview transcripts was conducted to identify key items to be added to the CRFRE. Three content experts assessed the face and content validity of survey items. Computer-assisted surveys were conducted to pilot the modified CRFRE with a sample of Black emerging adults (n = 300). Confirmatory factor analyses and structural paths were used to examine the construct validity of the modified CRFRE. RESULTS: Participant's qualitative data and suggestions from content experts resulted in the development of 16 additional survey items regarding exposure to perceived racism-based police violence across three domains (victim, witness in person, and seen in media). The modified CRFRE measure showed construct validity, internal reliability, and measurement invariance between men and women. CONCLUSIONS: This study advances our epidemiological methodology for quantifying exposure to perceived racism-based police violence. Future research is necessary to assess the prevalence of exposure to perceived racism-based police violence and associated mental and behavioral outcomes for Black emerging adults in the U.S. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Examination of Suicidal Behavior among Black College Students with Exposure to Police Violence.

There is limited research about suicidal behaviors among Black emerging adults (peak age of suicide risk) who report exposure to police violence. The current study applies an integrated approach to examine individual, immediate environment, and community-based risk and protective factors of suicide among Black college students who reported previous exposure to police violence. A purposive sample of Black college students (N = 300) was analyzed using bivariate analyses and binary logistic regression. Outcome variables investigated were lifetime suicidal ideation and suicide attempt. Twenty-eight percent of participants reported lifetime suicidal ideation and 14 percent reported lifetime attempts. Female students were significantly more likely to report lifetime suicidal ideation and recent symptoms of anxiety and to engage in emotional social support than male peers. Logistic regression results demonstrated that higher income and greater depression symptoms were associated with lower reporting of lifetime suicidal ideation. Reporting of more grit, the trait of perseverance and passion for long-term goals, was associated with a lower reporting of both lifetime suicidal ideation and suicide attempt. Findings have implications for how social workers in higher education are encouraged to address suicidal behavior among Black students, including the cultivation of grit.

Male Caregivers and Engagement in a Family Strengthening Program for Child Disruptive Behavior Disorders.

Awareness and interest in involving male caregivers in child mental health treatment has grown, especially for youth with disruptive behavior disorders like oppositional defiant disorder (ODD). The purpose of this study was to examine the relationship between male caregiver involvement and treatment engagement for child ODD. Children (n = 122) ages 7-11 and their caregivers participated in the 4 Rs 2 Ss Strengthening Families Program for child-onset ODD. Families were compared based on male caregiver presence. Families with a male caregiver were significantly more resourced with respect to income, educational status, and food security. Additionally, they were over three times less likely to drop out of the program than those without a male caregiver. The presence of a male caregiver was associated with increased resources and higher rates of engagement in services than single, female-headed families. Future research is needed to discern the underlying mechanisms of this association.

An Assessment of the Role of Parental Incarceration and Substance Misuse in Suicidal Planning of African American Youth and Young Adults.

Suicide rates among youth are increasing, and African American youth are becoming the most likely group to die by suicide in the USA. We utilized ecodevelopmental theory to investigate the relationship between parental incarceration and substance misuse and their association with suicidal planning in a sample of African American youth and young adults. Participants consisted of 190 African American youth and young adults living in public housing in a mid-Atlantic city in the USA who completed a youth health-risk behavior measure, and parental incarceration and substance misuse measures. Findings indicate males were significantly more likely than females to have devised a plan to die by suicide, especially if their mothers were incarcerated or their fathers had an alcohol problem. The findings of this study suggest several implications for health prevention and intervention efforts to reduce suicide-related risks among African American youth and young adults, including strategies that promote family-centered, evidence-based interventions that are culturally tailored to provide further insight into the best practices in suicide prevention.

Assessing the Real-time Influence of Racism-Related Stress and Suicidality Among Black Men: Protocol for an Ecological Momentary Assessment Study.

BACKGROUND: Suicide is the third leading cause of death among Black adults aged 18-35 years. Although men represent a majority of suicide deaths among Black adults, less is known regarding the extent to which unique cultural stressors, such as racism-related stress (eg, racial discrimination), are salient in exacerbating suicide risk among Black men. Moreover, few studies examine the daily influence of racism-related stressors on suicide outcomes using real-time smartphone-based approaches. Smartphone-based mobile health approaches using ecological momentary assessments (EMA) provide an opportunity to assess and characterize racism-related stressors as a culturally sensitive suicide risk factor among Black young adult men. OBJECTIVE: The goal of this study is to describe a protocol development process that aims to capture real-time racism-related stressors and suicide outcomes using a smartphone-based EMA platform (MetricWire). METHODS: Guided by the Interpersonal Theory of Suicide (ITS), we developed a brief EMA protocol using a multiphased approach. First, we conducted a literature review to identify brief measures previously used in EMA studies, with special emphasis on studies including Black participants. The identified measures were then shortened to items with the highest construct validity (eg, factor loadings) and revised to reflect momentary or daily frequency. Feasibility and acceptability of the study protocol will be assessed using self-report survey and qualitative responses. To protect participants from harm, a three-tier safety protocol was developed to identify participants with moderate, elevated, and acute risk based on EMA survey response to trigger outreach by the study coordinator. RESULTS: The final EMA protocol, which will be completed over a 7-day period, is comprised of 15 questions administered 4 times per day and a daily questionnaire of 22 items related to sleep-related impairment and disruption, as well as racism-related stress. Study recruitment is currently underway. We anticipate the study will be completed in February 2023. Dissemination will be conducted through peer-reviewed publications and conference presentations. CONCLUSIONS: This protocol will address gaps in our understanding of Black men's suicide outcomes in the social contexts that they regularly navigate and will clarify the temporal role of racism-related stressors that influence suicidal outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31241.

Analyzing mass incarceration.

With almost 2 million people in confinement, the United States locks up more people per capita than any other nation. Understanding the reasons and then forging a path to reduce mass incarceration in America will require better research and analyses of the government policies and spending that sustain the US carceral system.

Trends of Suicidal Behaviors Among High School Students in the United States: 1991-2017.

OBJECTIVES: To determine if racial and ethnic subgroups of adolescents are at high risk for engagement in suicidal behaviors. METHODS: Using the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, we conducted logistic regression analyses to examine trends by different racial and ethnic groups, with each suicide indicator serving as a dichotomous outcome. Participants included 198 540 high school students. RESULTS: Across all sex and race and ethnic groups, there were significant linear decreases in self-reported suicidal ideation and suicide plans from 1991 to 2017. Female adolescents (odds ratio [OR], 0.98; P < .001) had significant decreases in attempts over time. Black adolescents had positive linear trends for suicide attempts among both boys (OR, 1.04; P < .001) and girls (OR, 1.02; P = .003). Black adolescent boys (OR, 1.04; P = .048) had a significant linear increase in injury by attempt. CONCLUSIONS: The results suggest that, over time, black youth have experienced an increase in suicide attempts, which is troubling because attempts are the most prominent risk factor associated with suicide death. For black boys, a significant increase in injury by attempt occurred, which suggests that black boys may be engaging in increasingly lethal means when attempting suicide. Examining trends of suicidal thoughts and behaviors over time by sex and race and ethnicity allow us to determine where to focus prevention and intervention efforts. Future research should examine the underlying reasons for these changes observed in US high school students.

A Review of Treatments for Young Black Males Experiencing Depression.

The objective was to qualitatively examine the treatment effects of depression interventions on young, Black males (YBM) across treatment providers and settings via a review. Randomized controlled trials (RCTs) seeking to ameliorate depressive symptomology in Black males ages 12-29 were eligible for inclusion. After review of 627 abstracts and 212 full-text articles, 12 studies were selected. These RCTs were organized into five categories based on the intervention method. We isolated only one study that targeted YBM exclusively. Additionally, only two treatment effect sizes for YBM were available from the data. While remaining RCTs did involve Black youth, disaggregated data based on race and gender were not reported. Overall, the lack of research specific to YBM prevented any strong conclusions about the treatment effects on depression for this population. Small sample size along with poor representation of YBM were trends in the selected studies that also posed an issue. Therefore, our review produced qualitative findings but failed to isolate any true effect size for YBM being treated for depression. Until more conclusive evidence exists, alternative strategies may need to be employed in order to find appropriate interventions for depressed YBM seeking mental health treatment.

What Works for Adolescent Black Males at Risk of Suicide: A Review.

We reviewed the controlled studies that report outcome findings for Black adolescent males 24 years of age and younger at risk of suicide. Our review identified 48 articles published from 2000 to 2015, 33 that met our initial criteria for full-text articles review, resulting in 6 that met all inclusion criteria. We sought to understand what works for Black males experiencing suicide ideation or engaging in suicidal behaviors (e.g., attempts). We identified crossover effects for multisystemic therapy for reducing the risk for suicide ideation and attempts. Attachment-based family therapy was salient for use as a component of clinical practice for Black males being treated for suicide ideation. While remaining randomized control trials did involve Black youth, dis-aggregated data based on ethnicity and gender were not reported. Overall, the located studies are too few to provide unequivocal guidance for practice.

Police Use of Force by Ethnicity, Sex, and Socioeconomic Class.

OBJECTIVE: Disparities in police responses to Black and White people have received significant research and public attention in recent years. This study examines self-reported accounts of exposure to and perceptions of police use of force among Black and White ethnic groups by sex and income level. METHOD: Using bivariate and multivariate approaches, we analyzed data from the Bureau of Justice Statistics 2011 Police-Public Contact Survey, a measure administered to a nationally representative sample of U.S. residents. Participants were asked a series of questions about their most recent contact with police during a 12-month period. Our analyses were limited to Black (n = 59; mean age 28.8 years) and White (n = 366; mean age 34.6 years) participants whose most recent involuntary contact with police included a street stop. RESULTS: For Black residents, being male and having an income under $20,000 significantly increased the risk for exposure to police use of force during a street stop. For White residents, being male, having an income under $20,000, or being age 35 or older significantly increased the risk for exposure to police use of force during a street stop. CONCLUSIONS: Future research will benefit from additional attention to the cumulative impact of police use of force and how experience with police use of force shapes U.S. residents' understanding of and expectations for procedural justice.

Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis.

Disproportionately lower educational achievement, coupled with higher grade retention, suspensions, expulsions, and lower school bonding make educational success among Black adolescents a major public health concern. Mental health is a key developmental factor related to educational outcomes among adolescents; however, traditional models of mental health focus on absence of dysfunction as a way to conceptualize mental health. The dual-factor model of mental health incorporates indicators of both subjective wellbeing and psychopathology, supporting more recent research that both are needed to comprehensively assess mental health. This study applied the dual-factor model to measure mental health using the National Survey of American Life-Adolescent Supplement (NSAL-A), a representative cross-sectional survey. The sample included 1170 Black adolescents (52% female; mean age 15). Latent class analysis was conducted with positive indicators of subjective wellbeing (emotional, psychological, and social) as well as measures of psychopathology. Four mental health groups were identified, based on having high or low subjective wellbeing and high or low psychopathology. Accordingly, associations between mental health groups and educational outcomes were investigated. Significant associations were observed in school bonding, suspensions, and grade retention, with the positive mental health group (high subjective wellbeing, low psychopathology) experiencing more beneficial outcomes. The results support a strong association between school bonding and better mental health and have implications for a more comprehensive view of mental health in interventions targeting improved educational experiences and mental health among Black adolescents.

Treating Mental Illness Among Diabetic Black Male Adolescents: A Review.

OBJECTIVE: To examine randomized controlled trials (RCTs) for treatment evidence for Black male adolescents suffering from comorbid mental illness and diabetes mellitus. METHOD: A review of the studies published in English-language journals was conducted. RESULTS: We found no RCT focused on Black males with diabetes mellitus Type 2 (DMT2). However, we found RCT inclusive of Black male adolescents with diabetes mellitus Type 1 (DMT1). Multisystemic therapy appears to be the best supported overall treatment for DMT1 management and psychosocial functioning followed by an enhanced form of behavioral family systems therapy for diabetics. Metformin was the only treatment in this review noted for use within DMT2. Metformin and a nursing-based telephone case management intervention realized utility as secondary services. CONCLUSIONS: There are gaps present for what effectively treats comorbid mental illness and DMT2 in Black male adolescents. For comorbid mental illness and DMT1, there are gaps in additional efficacious treatments, effectiveness across conditions, and effect duration beyond 24 months.

Prevalence of suicide ideation and attempts among Black Americans in later life.

This article provides the first national estimates of the prevalence and correlates of nonfatal suicidal behavior among older Black Americans. There is a lack of national data on suicide ideation and attempts across ethnic classifications of Blacks in a nationally representative sample. Data are a subsample from the National Survey of American Life (NSAL), a national U.S. adult household probability sample of 5,191 Black Americans. The WHO Composite International Diagnostic Interview (CIDI) was used to assess older Blacks for nonfatal suicidal behavior and 14 DSM-IV disorders. Bivariate and multivariate logistic regression analyses were employed to delineate patterns and correlates of nonfatal suicidal behavior. The estimated lifetime prevalence of suicidal ideation and attempts among older Blacks in the United States was 6.1% and 2.1%, respectively. On an average it took 2.5 and 5.7 years respectively to go from ideation to attempts or from planning to attempts. Surprisingly, among older Black adults, men reported attempting suicide and seriously consider taking their own lives more than women. Older Blacks at higher risk for suicide attempts were middle aged, had poorer health, were anxious, and had multiple DSM-IV disorders. The results also show that approximately 1 in 4 attempters and 2 in 5 ideators have never sought treatment for their emotional or psychological problems. Preventative care, particularly screening in primary care settings, should consider these findings when treating older Black Americans for psychiatric-related risk.

Social Integration and the Mental Health of Black Adolescents.

The influence of family, school, and religious social contexts on the mental health of Black adolescents has been understudied. This study used Durkheim's social integration theory to examine these associations in a nationally representative sample of 1,170 Black adolescents, ages 13-17. Mental health was represented by positive and negative psychosocial well-being indicators. Results showed that adolescents' integration into family and school were related to better mental health. In addition, commitment to religious involvement positively influenced mental health. Although the direct effect of religious involvement was inversely related to mental health, mediation analyses revealed a positive influence through religious commitment. Findings suggest a greater emphasis on all three social contexts when designing strategies to improve the mental health of Black adolescents.

Suicide, negative interaction and emotional support among black Americans.

OBJECTIVES: This study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults. METHOD: Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older. RESULTS: Multivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans. DISCUSSION: Negative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.