Reducing suicidal ideation in African American adolescents: A randomized controlled clinical trial.

OBJECTIVE: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design. METHOD: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention. RESULTS: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition. CONCLUSION: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal patterns and predictors of suicidal ideation in African American adolescents.

Suicide rates among African American adolescents have increased dramatically. Suicidal ideation is associated with both suicide attempts and completions, thus understanding ideation patterns and predictors in African American adolescents is critical to informing prevention efforts. This study recruited 160 African American ninth grade students. Participants were those students randomized to the control condition of a randomized controlled preventive intervention. Of the 160 participants, 99 completed all assessment points and were included in latent transition analyses. We assessed participants four times: baseline then again at 6-, 12-, and 18-month postbaseline. Constructs of interest for this study included suicidal ideation, depression, hopelessness, and community violence exposure. A 2-class model (i.e., low ideation [LI] and high ideation [HI]) characterized ideation at each time point. A total of 86%-90% of participants were in the LI class in any given time point and 27.3% of participants were in the HI class at least once. Participants in the LI class tended to stay in that class, whereas those in the HI class often transitioned to the LI group. Depression and hopelessness, but not exposure to community violence, predicted HI class membership. Findings suggest that (a) most African American adolescents may experience suicide ideation at some point in time, (b) a concerning proportion of African American adolescents may experience high ideation, (c) high ideation is often time-limited, and (d) depression and hopelessness predict high ideation.

Social Support Coping for African American Adolescents: Effect of a Culturally Grounded Randomized Controlled Trial Intervention.

The effect of the Adapted-Coping with Stress (A-CWS) intervention on social support coping was examined, using a randomized controlled trial design. The participants were 410 ninth-grade students (ages 14 to 16 years and mostly African American) living in low-resourced neighborhoods. Participants were randomly assigned 1:1 to either the A-CWS intervention or a standard care control condition. All participants were assessed at their schools before implementation of the intervention, at intervention completion, and again at 6- and 12-month post-intervention. Engagement in social support coping was examined in both intention-to-treat and treatment-as-received samples (i.e., intervention participants who attended at least 12 A-CWS treatment sessions and participants in the standard care control condition), using latent growth models. In intention-to-treat analyses, no significant treatment effects were identified. In treatment-as-received analyses, results revealed a significant association between social support coping and treatment condition; levels of social support coping decreased over time in the control condition, but they remained relatively stable in the treatment condition. The results indicate adequate intervention adherence and efficacy of the A-CWS to sustain social support coping within a sample of youth at high risk for stress exposure and associated disorders.Clinical Trial Registration: clinicaltrials.gov identifier: NCT0395445.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience.

Historically, suicide rates for African American adolescents have been low, relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology.

African American adolescent suicidal ideation and behavior: The role of racism and prevention.

Suicide is one of the most devastating, yet preventable, health disparities for African American adolescents. African American adolescent suicidal ideation and behavior may have different manifestations and risk factors relative to those of adolescents from other ethnic backgrounds that impact prevention efforts. For example, in addition to more common manifestations of suicidal ideation and behavior, African American youth may engage in violent or high-risk behaviors, use more lethal means, or report ideation at lower depression levels. The Adapted-Coping with Stress Course (A-CWS), an adaptation of Gregory Clarke and colleagues' Coping with Stress Course, was developed to address the cultural nuances of African American adolescents. The A-CWS is a 15-session cognitive-behavioral, group-based preventive intervention that aims to enhance adaptive coping skills and reduce suicidal ideation, by incorporating strategies that counter stressors associated with systemic racism that burden African American adolescents. This study evaluated the feasibility and acceptability of the A-CWS intervention, using a sample of predominantly African American ninth-grade students. Results indicated that the adolescents were very favorable and receptive to the A-CWS intervention and that the intervention could be conducted feasibly. The A-CWS intervention serves as a model to advance culturally-grounded, evidence-based preventive intervention, for an underserved sector of adolescents.

Expanding Collective Efficacy Theory to Reduce Violence Among African American Adolescents.

Community violence is a complex phenomenon, and many theories have been put forth to explain the causes of community violence and disparities in community violence across neighborhoods. One notable theory, collective efficacy theory (CET), posits that collective efficacy (i.e., a neighborhood's social cohesion and informal social control) mediates the association between concentrated disadvantage and community violence. As CET theorizes an inverse feedback loop between collective efficacy and community violence, collective efficacy could mitigate the link between neighborhood disadvantage and community violence. The current study examines the reciprocal association between collective efficacy and community violence exposure using data from 604 low-resourced, urban African American ninth-grade students from a large Midwestern city. Data were collected at 6-month intervals over 2 years. Significant cross-sectional associations were found between each of the collective efficacy constructs (social cohesion and informal social control) and community violence exposure, although no significant longitudinal cross-lagged associations were found. There were positive cross-sectional associations between (a) collective efficacy and community violence exposure and (b) informal social control and community violence exposure; however, the association between social cohesion and community violence exposure was negative. Associations between overall collective efficacy, as well as its subscales, and community violence exposure were consistent with hypothesized directions for social cohesion, but not for collective efficacy or informal social control. Findings support the use of collective efficacy as two constructs, rather than a single construct as proposed by Sampson et al. Implications for expanding original assumptions of CET are discussed.

Suicidality Protective Factors for African American Adolescents: A Systematic Review of the Research Literature.

Overall rates of African American adolescent suicide have been increasing for the past 50 years; however, the research literature examining factors related to suicide for these vulnerable youth is sparse. The shortage of research literature on suicidality protective factors is particularly significant. Little is known about the impact of protective factors on African American youth, especially within subgroups (e.g., gender and socioeconomic status). Approximately 40% of African American youth live in poverty, exposing them to contextual stressors that place them at increased risk for suicidality. Females are significantly more likely to have suicidal ideation and make attempts, whereas males surpass females in their rates of completions. To better understand suicidality protective factors, we conducted a systematic review of the research literature on protective factors for African American adolescents, with a focus on gender differences and urban, low-income youth. This review yielded 26 articles that met inclusion criteria and identified protective factors in the following categories: familial, religiosity-based, relational/social, personal, and socioecological. Gender differences and protective factors for urban, low-income youth are discussed, regarding their role in the prevention of suicidality. This review highlights a need for further research to identify and clarify suicidality protective factors for African American adolescents.

Culturally Grounded Stress Reduction and Suicide Prevention for African American Adolescents.

Suicide is an often-overlooked manifestation of violence among African American youth that has become more prevalent in the last two decades. This article reports on the process used to culturally adapt a cognitive-behavioral coping with stress prevention intervention for African American adolescents. We implemented this adapted school-based suicide prevention intervention with 758 African American 9th, 10th and 11th grade students at four high schools in a large Midwestern city. The findings presented are preliminary. The adolescents in this sample endorsed high levels of suicide risk, with females endorsing significantly more suicide risk than males. Those receiving the prevention intervention evidenced an 86% relative suicide risk reduction, compared to the standard care control participants. The presented model of adaptation and resulting culturally-grounded suicide prevention intervention significantly reduced suicide risk among African American adolescents. Clinical, research and policy implications are discussed.

Housing and abstinence self-efficacy in formerly incarcerated individuals.

To avoid recidivism, formerly-incarcerated individuals must successfully navigate barriers to re-entry, including finding adequate housing and avoiding substance use. This study examined the role that time in diverse housing situations affect abstinence self-efficacy in formerly-incarcerated individuals. Formerly-incarcerated individuals were surveyed about previous housing situations and abstinence self-efficacy after release from prison or inpatient substance use treatment. Models were estimated with both days spent in different housing situations in the past 180 and past 30 days. More time spent in recovery situations was associated with increased abstinence self-efficacy, while more time spent in precarious situations was associated with decreased abstinence self-efficacy.

Reducing Stress and Preventing Anxiety in African American Adolescents: A Culturally- Grounded Approach.

Evidenced-based and culturally adapted stress-reduction interventions for urban African American adolescents who are at risk for anxiety and other problems related to stress are needed. This study presents intervention components and preliminary outcome findings of a culturally adapted stress-reduction intervention for urban African American adolescents. Preliminary findings support the efficacy of the intervention to reduce anxiety and enhance general cognitive competencies, such as coping strategies, self-efficacy, and positive thinking, among participants, in comparison to controls. Clinical implications of the stress-reduction intervention for the prevention of psychopathology, particularly among African American adolescents, are discussed.

The role of socially prescribed perfectionism in the link between perceived racial discrimination and African American adolescents' depressive symptoms.

Research examining the social origins of perfectionism has focused on negative evaluative experiences in the family, with less attention to negative social evaluations in other contexts and situations relevant for African American adolescents. The experience of racial discrimination is common for African American youth, and may trigger maladaptive perfectionistic beliefs if the youth perceive that they do not meet others' standards (socially prescribed perfectionism) or internalize discriminatory messages. Thus, the present study examined longitudinal associations among racial discrimination, socially prescribed perfectionism, and depressive symptoms among a community sample of urban and predominantly low income African American adolescents (n = 492; 46.7 % female). In each of grades 7, 8 and 9, participants reported their experiences with racial discrimination, perfectionistic beliefs, and depressive symptoms. Analyses revealed that experiences with racial discrimination in grade 7 were associated with socially prescribed perfectionism in grade 8 which, in turn, was linked with depressive symptoms in grade 9. Results suggest that prospective associations between the experience of racial discrimination and depressive symptoms are due, in part, to increased socially prescribed perfectionism. Implications for interventions targeting depression in African American are discussed.

Burgeoning directions for the prevention of youth violence. Introduction.

Despite focused efforts toward the prevention of youth violence within the United States, it continues to adversely affect the lives of children and families within our communities and society at large. The articles in this issue address risk and protective factors that affect violence among urban youth to inform prevention and treatment. Pathways to youth violence are complex and may begin early. Prevention efforts in school, family, and community settings that address risk and protective factors within a socially, culturally, and ecologically valid context early in human development are crucial. While challenges remain for the prevention of youth violence, research suggests opportunities to improve our efforts. Federal agency initiatives in partnership with communities are currently underway to increase the knowledge base and advance prevention of youth violence among diverse populations.

Pathways to aggression and violence among African American adolescent males: the influence of normative beliefs, neighborhood, and depressive symptomatology.

Youth violence continues to present a serious public health challenge in the United States, particularly so for African American adolescent males. The present study utilized a multilevel approach to predict aggression within a community sample of low-income, urban African American adolescent males (n = 80). Participants' self-report data on normative beliefs about aggression, exposure to community violence, and depressive symptoms were used in multiple regression equations to predict (a) self-reported interpersonal aggression and (b) self-reported aggressive response style when angered. Results of this study indicate that all three of the independent variables contributed significantly to the prediction of interpersonal aggression and aggressive response style when angered. The findings are important for increasing our understanding of pathways to various types of youth aggression and guiding the development of evidence-based approaches to violence prevention among African American adolescent males.

12-step participation among dually-diagnosed individuals: a review of individual and contextual factors.

The frequent co-occurrence of substance abuse disorders along with psychiatric disorders creates a number of complexities and needs in terms of long-term treatment for individuals. 12-step groups might provide unique mechanisms by which dually-diagnosed individuals can maintain their abstinence and improve their psychological functioning. This paper reviews the literature on outpatient community 12-step participation among dually-diagnosed individuals, and also focuses on individual factors that may interact with treatment: homelessness, legal status, and ethnicity. A total of 59 articles was included in the review, with an emphasis on these individual factors and findings regarding mechanisms of action. Overall, findings from the studies reviewed suggest a general benefit of 12-step participation across these individual factors and some potential for dual-focus 12-step programs for dually-diagnosed individuals via social support and self-efficacy. However, methodological limitations and lack of research in the area of ethnicity limited some of the conclusions that can be made. Suggestions for further research are discussed.

Depressive symptoms, gender, and sexual risk behavior among African-American adolescents: implications for prevention and intervention.

African-American youths are disproportionately affected by deleterious outcomes associated with risky sexual activity. Arguably, females are at greater risk for these adverse outcomes due to physiological and emotional risk factors, such as depression. The current study examines the relationship between depressive symptomology and sexual risk behavior within a sample of 1,970 inner-city, economically disadvantaged African-American adolescents in grades nine and eleven. The findings of this study support a relationship between sexual risk behavior and depressive symptomology for the sample, such that as depressive symptomology increases so does sexual risk behavior. Furthermore, an interaction for gender was found, with depressive symptomology being a stronger predictor of sexual risk behavior for African-American females as compared to African-American males. Implications of these findings for the design of prevention programs specifically tailored to African-American adolescent women are discussed.

Psychological distress for African-American adolescent males: exposure to community violence and social support as factors.

This study examined exposure to community violence and depressive and post-traumatic stress disorder (PTSD) symptoms within a non-random sample of low-income, African-American male adolescents. The moderating effect of social support on these relationships was also examined. Seventy-seven African-American adolescent males were recruited from an inner-city, Midwestern high school and surveyed on exposure to violence, depression, post-traumatic stress, and social support. Regression analyses revealed that exposure to violence was significantly associated with both depressive and PTSD symptoms. However, social support was not found to moderate the relationship between exposure to community violence and psychological distress. Implications for intervention are discussed.

Reducing Substance Use Among African American Adolescents: Effectiveness of School-Based Health Centers.

This paper explores the impact of school-based heath centers (SBHCs) on the substance use behaviors of low-income, inner-city African American adolescents. Researchers surveyed 2,114 9th- and 11th-grade students from seven inner-city public high schools (three with SBHCs and four without SBHCs). Of the initial 2,114 students, 598 SBHC students and 598 non-SBHC students were successfully matched using ethnicity, grade, gender, and propensity scores. The results of separate grade × gender × SBHC ANOVAs indicated significant grade × SBHC interactions (i.e., such that substance use decreased in SBHC schools while increasing in non-SBHC schools) for cigarettes (p = .05) and marijuana (p< .001), but not for alcohol. These findings show that the SBHC intervention model is promising toward the prevention and reduction of substance use among high-risk African American adolescents and highlight the importance of accessible, holistic, and culturally appropriate health care.

Identity development in adolescents living with HIV.

The purpose of this project was to qualitatively explore how identity formation may be affected by the presence of HIV disease. Eight HIV-infected adolescents (three males, five females), aged 17-21, participated in a semi-structured interview that combined measures of identity development with open-ended, qualitative questions aimed at eliciting the adolescents' personal stories and experiences of living with HIV. All participants fell into either Diffusion or Achievement identity statuses, which in turn impacted their response to having HIV. The impact that HIV had on the participants' values and future goals varied across the sample. Findings are discussed in terms of clinical intervention implications, contextual variables, and the need for larger, more comprehensive research efforts.

Risk Behavior in Adolescence: Methodological Challenges in School-Based Research.

Presents the first phase of a school-based project which aims to begin the identification of factors associated with risk and resiliency in urban African-American youth, as well as evaluate the role of school-based adolescent health centers for this population. A cross-sectional moderated risk design is employed. Methodological challenges are identified and strategies for resolution are discussed. Methodological challenges pertinent to school and community entry, characteristics of the school setting, obtaining informed consent, the use of incentives, confidentiality assurance, and the relevance of instrumentation for the study population are addressed.