This AFSP Young Investigator Innovation Grant proposal aims to examine the role of racial and ethnic discrimination in risk for suicidal behaviors in racially and ethnically minoritized adolescents. We propose to test the overall hypothesis that disrupted stress responses contribute to increased suicide risk in minoritized youth is due in part to discrimination.
We will recruit Black and Latinx adolescents ages 13-19 years from an outpatient psychiatry clinic in a low-resourced community in The Bronx, NY: a high-risk group (N=40) with a history of suicide attempts (SA+); and a low-risk group (N=40) with no history of suicide attempts (SA-) matched by age, sex, race/ethnicity, and psychiatric disorders. Stress response will be indexed 1) Behaviorally by (1a) emotional reactivity via performance on an emotion-based behavioral task (Affective Go/No-Go); and (1b) emotional dysregulation by mood state subsequent to the recall task of a personal encounter with racism (autobiographical emotional memory task); and 2) Biologically through salivary cortisol and cytokine measurements. All will have detailed diagnostic semi-structured interviews and dimensional assessments of symptoms including anxiety, depression, PTSD, and suicidality.
Aim 1. Examine the association between racial/ethnic discrimination, emotional reactivity and dysregulation in adolescent suicidal behaviors. Hypothesis 1. (1a) Compared to adolescents with SA-, adolescents with SA+ will exhibit: Increased discrimination, greater emotional reactivity as evidenced by bias toward negative emotional cues during the Affective Go/No-Go task, and greater emotional dysregulation as evidenced by greater negative affect during the recall task. (1b) Alterations of emotional reactivity and dysregulation will mediate the relation between discrimination and SA.
Aim 2. Examine the relation between racial/ethnic discrimination and biological stress response in adolescent suicidal behaviors. Hypothesis 2. (2a) Compared to adolescents with SA-, adolescents with SA+ will exhibit: Blunted cortisol patterns and increased pro-inflammatory cytokine output (IL-1β, IL-6, IL-8, TNFα). (2b) Alterations of cortisol and cytokine secretions will mediate the relation between discrimination and SA.
Exploratory Aim 3. This exploratory aim will test the moderation effect of racial/ethnic identity in the relation between discrimination and risk for suicidal behaviors. Hypothesis 3. Higher levels of racial/ethnic identity will attenuate the association between discrimination and (3a) biological markers of stress response (cortisol and cytokine secretions); (3b) emotion reactivity and dysregulation; and (3c) severity of psychiatric symptoms (depression, anxiety, PTSD, and suicidal ideation).
Findings from this study will support the identified parameters as potential mechanisms underlying the association between discrimination and suicide risk in minoritized youth. This information is critical to develop more culturally responsive youth suicide prevention strategies by improving identification of minoritized youth at greatest risk for suicidal behaviors. This research will also highlight the need to account for race-based stressors in routine suicide risk assessments, and as a novel target of intervention to reduce suicide risk in psychiatrically vulnerable Black and Latinx adolescents. Overall, this research will reduce racial and ethnic disparities in youth suicidal behaviors to better serve the mental health needs of minoritized youth at elevated risk for suicide.
