Identification of Environmental and Lifestyle Factors that Contribute to Black Youth Suicide Attempt Risk in Four Large Samples

Suicide is the second leading cause of death in youth. Recent trends in adolescent suicidal behaviors reveal race disparities marked by a steep rise among Black youth. The reasons for which are unclear. Environmental and lifestyle factors and other social determinants of health (i.e., exposures) are key contributors to youth suicide attempt risk. This project will study how race differences in exposures contribute to the heightened Black youth suicide risk. We propose to use four large datasets with a combined sample size of over 16,000 Black youth (from a total of N>50,000 youth) and apply data-driven approaches to identify key exposures associated with suicide attempt risk. We will study how environmental and lifestyle factors (e.g., trauma, discrimination, poverty, substance use) associate differently with Black youth suicide attempt risk. The datasets represent the diverse US population and are derived from different settings, including a research study of 21 sites across the US, electronic health records of a tertiary pediatric hospital, and two nationally representative youth surveys. All datasets include granular characterization of environmental and lifestyle factors and suicide attempts, and two have longitudinal data that will allow probing developmental effects. Analyses will be conducted in each dataset but also in harmonized and fused datasets to increase generalizability and impact of findings. The large sample size enables us to focus on suicide attempts as the outcome, increasing this project’s impact on suicide prevention. Specific aims include (Aim 1) identification of exposures that are differentially associated with Black youth suicide attempt risk using Exposome Wide Association Study (ExWAS) in cross-sectional data and (Aim 2) machine learning models that allow ranking of predictors based on their importance for suicide attempt risk prediction across races in longitudinal data. Our team combines expertise in adolescent psychiatry, suicide research, exposome, and racial disparities. Our strong collaborative record and experience working with large datasets, including those used in this proposal, will allow for the most comprehensive assessment of the risk and protective factors of Black youth suicide attempts yet conducted. Our long-term objective is to mitigate Black youth suicide risk through science that impacts clinical care and policy. Our proposal aligns with AFSP’s priority on diversity in “suicide research related to underrepresented communities, health and mental health disparities”. By the end of this project, the expected findings will have (i) clinical impact, by identifying specific factors that improve individual risk assessments of Black youth; and (ii) research impact, by pointing to exposures that are uniquely associated with Black youth suicide risk and can be tested as targets for intervention for Black youth suicide prevention.