Suicide is the second leading cause of death among U.S. adolescents and young adults aged 10 to 34. Racial/ethnic disparities in suicidal behaviors among youth and young adults in the US have emerged in recent years. Structural social determinants of health (SSDoH) are critical to understanding the impact of structural racism on suicide risks as they reflect systematic stressors that burden minorities. Yet, the longitudinal effects (and mechanisms) of the multidimensional structural social determinants on the disparities in suicidal trajectories (i.e., changes in suicidal ideation/attempts over the life course) are less clear. Few studies have examined disparity-related mediation pathways through stress (e.g., depression) and networks (e.g., parental closeness) to suicidal trajectories by race/ethnicity.
We propose to leverage a cohort study of a nationally representative sample of 9421 respondents from Waves I-V National Longitudinal Study of Adolescent to Adult Health (1994-2018), with substantial diversity in race, and neighborhood and socioeconomic status, recruited in 7-12th grade across the U.S. and followed up five times through young adulthood (ages ~42) with over 80% response rates per wave, to innovatively study where, why, and to whom intra-neighborhood differences in SSDoH influence the incidence and persistence of suicidal ideation and suicide attempts. We will link SSDoH data of neighborhood physical, healthcare, social, education, and economic contexts to each participant's residential and school neighborhoods. We will also innovatively assess confounding via individual-level factors known or hypothesized to influence suicidal behaviors, including social networks, mental illness, and access/quality of healthcare, and then construct SSDoH typologies that will directly inform policy. Our central hypothesis is that living in high-risk SSDoH increases suicidal behaviors concurrently and longitudinally, particularly in racial/ethnic minorities. We will produce findings of direct relevance to public health, city planning, and design decisions around temperature-reducing, healthcare-producing, and social cohesion-promoting interventions, greening, tree planting, and building construction. Our aims are:
Aim 1: Intensively characterize SSDoH and their associations with suicidal trajectories of >9,000 longitudinally followed adolescents till their young adulthood.
Aim 2: Apply novel latent variable techniques to physical and social environment data to identify SSDoH typologies related to suicidal trajectories that are relevant to city planners.
Aim 3: Identify mediators (e.g., social networks, depressive symptoms) and moderators (e.g., health care access) of the impact of SSDoH and suicidal trajectories to advance future research and inform policies.
The emerging concerns on social risks underscores that investment in research on the multidimensional SSDoH on suicide risks is critical, timely, and can produce real-world changes with population-level benefits. We will produce innovative findings with direct health policy implications and clear and downstream interventions that improve health. We have previously conducted large-scale longitudinal studies and have collaborated with policymakers to leverage our science in improving health for local communities, making us well-situated to complete the proposed project.
Findings of our study will support an NIMH R01 application to further identify place-based suicide prevention. Focusing on SSDoH over the life course provides a unique and timely opportunity to unravel the impact of structural racism that systematically burdens racial/ethnic minorities.
