Introduction: Suicide is a leading cause of death among Black Americans. Nationally representative studies indicate that the longstanding difference in suicide rates between White and Black Americans is shrinking, as more Black Americans take their own lives. Suicide risk and protective factors are modulated by race, place, and time. Bio-ecological models are rarely used in suicidology but may be well suited to assess recent changes in Black American suicide because they describe the dynamic individual, contextual, and historical factors that affect health outcomes.
Aims: The proposed study will 1) explore differences between Black and White Marylanders who died by suicide between 2003 and 2019, 2) identify differences in risk and protective factors within the Black community by comparing Black Marylanders who died by suicide with Black Marylanders who died by accident or undetermined causes between 2003 and 2019, and 3) assess changes in suicide rates and characteristics among Black Marylanders between 2003 and 2020, with a focus on the spring 2020 period of crisis related to COVID-19 and racial injustice protests.
Methods: The proposed study will include 61,380 individuals (to date) who died in Maryland between 2003 and 2020 and were assessed by the Office of the Chief Medical Examiner of Maryland (OCME). The OCME investigates all unexpected deaths in the state, including all suicide and injury deaths. The sample includes subjects who died by suicide (n = 9461, 15.4%), in accidents (n = 32,844, 53.5%), and by undetermined causes (n = 19,075, 31.1%). We will exclude individuals who died by homicide or in homicide-suicides due to ethical and legal limitations on OCME data sharing policies. We will exclude individuals who died of natural causes because the scope of OCME jurisdiction prevents random sampling from this population.
The OCME database will provide individual-level variables including decedents’ demographic characteristics, manner and cause of death, psychiatric and medical history, and toxicology reports. We will harmonize these data with publicly available, common data elements (e.g., the PhenX toolkit) which will provide location-based markers of community protective factors (e.g., neighborhood social cohesion), current disadvantage (e.g., poor healthcare accessibility), and historical disadvantage (e.g., segregation). For Aim 3, we will use Google Trends and Google Health API to identify periods of increased regional focus on COVID-19 and racial injustice.
Expected outcomes: Preliminary analyses showed that suicide rates were elevated in Black Marylanders compared to historical norms and compared to White Marylanders during the early months of the COVID-19 crisis. In the proposed analyses, we expect to see differences between Black and White suicide decedents, between Black suicide decedents and Black decedents who died by other causes, and among Black suicide decedents over time. The proposed study will provide pilot data for a psychological autopsy study of Black suicide decedents that would support deeper, intersectional assessments. This study will explore the bio-ecological context of suicide in Black Marylanders, creating a theoretical scaffold for ecological momentary assessment research and culturally affirming assessment and treatment development.
