How NIMH’s Disparities Research Priorities Inform Suicide Prevention Efforts

July ushered in not only long days and balmy temperatures but an important observance: Minority Mental Health Awareness Month. As that month comes to a close, it is an opportune time to reflect on NIMH's commitment to research on mental health disparities and health equity.

At the forefront of these efforts are the Office of Disparities Research and Workforce Diversity (ODWD) and the Disparities Team. Together with colleagues across NIMH, we're championing equity in mental health research and addressing the unique needs of underrepresented and underserved communities in research and the scientific workforce. We hope you join us in celebrating and supporting this vital work this month and beyond.

In ODWD, we're taking bold steps across five strategic priority areas to help address striking disparities in the prevalence, course, and outcomes of mental illnesses in the United States. One area where ODWD is making significant investments is suicide prevention. By investing in large-scale research efforts, NIMH has improved suicide risk screening, assessment, and intervention, helping to save lives.

This Director's Message focuses on three groups that are disproportionately affected by disparities in suicide rates or increases in those rates: racial and ethnic minority groups, people living in rural areas, and sexual and gender minority groups. We highlight three of the many ways NIMH is supporting research to advance suicide prevention efforts in these communities:

• Identifying biological, environmental, and structural factors contributing to suicide deaths in minoritized populations
• Improving the quality of and access to treatments for suicidal thoughts and behaviors
• Increasing capacity for health equity research and informing next steps

From 2018-2021, suicide rates significantly increased for non-Hispanic American Indian and Alaska Native and non-Hispanic Black people, while those rates declined for non-Hispanic White people. Graph shows age-adjusted rates of suicide for race and ethnicity groups in 2021. Adapted from data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Data Visualization Tool, by the National Centers for Injury Prevention and Control, Centers for Disease Control and Prevention (https://www.cdc.gov/injury/wisqars/index.html). Learn more on the NIMH Suicide Statistics page.

Identifying biological, environmental, and structural factors contributing to suicide deaths in minoritized populations (ODWD strategic priority areas 2 and 3)

Suicide is a significant public health problem in the United States and globally. Suicidal behavior is complex, and there is no single cause. Researchers are committed to understanding the range of factors that contribute to suicidal behaviors to address groups at increased risk.

There have been steep increases in rates of suicide attempts among Black youth for decades. However, leading theories of suicide were mainly developed from studies with non-Black, non-youth participants. This is because, for decades, research studies lacked diverse samples and overlooked groups experiencing the greatest health disparities.

But that is now changing, due in no small part to research supported by NIMH. One study comes from the University of Houston, where researchers are using a community-engaged research approach called Cultural Consensus Modeling to understand the culturally relevant risk factors for suicide among Black youth. Cultural Consensus Modeling incorporates experiences of racial discrimination into the study design and actively involves Black preteens and teens with a history of suicidal thoughts and behaviors in identifying new treatments.

The use of overly broad racial and ethnic categories has also been a concern in suicide prevention efforts because it can obscure disparities in mental illness risk and trajectories. For example, Asian American, Native Hawaiian, and Pacific Islander people are often looked at as a single group in health disparities studies. However, the population is racially and ethnically diverse. Even though suicide is the leading cause of death amon Asian American, Native Hawaiian, and Pacific Islander adolescents, patterns of suicidal thoughts and behaviors vary within and across these groups. For instance, the National Latino and Asian American Study showed differences in the lifetime prevalence of suicidal behaviors (ideation, planning, and attempts) among Asian Americans of Chinese, Vietnamese, Filipino, and other ethnicities.

In an NIMH-funded study, researchers at the Public Health Institute are examining school-based stressors (poor academic performance and race-related bullying), substance use, and sleep among eight different Asian American, Native Hawaiian, and Pacific Islander groups to better understand the risk factors for suicide in each group. This information will help guide new preventive interventions that address contributors to suicide risk among adolescents in those groups and their specific treatment needs.

Another way to strengthen disparities research is by considering the intersectionality of multiple marginalized and minoritized identities. As highlighted in the NIH Strategic Plan to Advance Research on the Health and Well-Being of Sexual and Gender Minorities, people in sexual and gender minority groups, such as LGBTQI+ individuals, are at significantly higher risk for suicide attempts. This risk can be compounded in rural areas of the United States, where the rate of suicide deaths is nearly twice as high as in large metropolitan areas.

To address these overlapping concerns, NIMH-supported research at Emory University and Johns Hopkins University will follow 2,000 rural sexual and gender minority adults over time to measure their exposure to stigma, discrimination, and trauma and look for associations with depression and suicidal ideation. This study is the first comprehensive investigation of stressors experienced by rural sexual and gender minority people and the links between those stressors and mental health outcomes.

Improving the quality of and access to treatments for suicidal thoughts and behaviors (ODWD strategic priority areas 4 and 5)

Minoritized communities face systemic barriers to engaging and staying in treatment for mental health conditions. These disparities in engagement naturally lead to disparities in outcomes, such as the risk for suicidal thoughts or behaviors. To address these gaps, NIMH-funded researchers at Yale University are testing a community-informed approach called Strategic Treatment Assessment with Youth, or STAY . STAY is a culturally responsive, measurement-based approach to delivering mental health care for racial and ethnic minoritized youth at high risk for depression or suicidal thoughts or behaviors. Using feedback from youth and their families about their treatment concerns, STAY aims to help minoritized youth remain in treatment and reduce negative mental health outcomes. The approach is a powerful example of how best to adapt clinic-based care to meet the needs of minoritized populations.

Farther along the continuum of services and intervention research, NIMH-supported studies are addressing the stark disparities in suicide outcomes for American Indian and Alaska Native communities, where suicide is the second leading cause of death for people aged 10-34. For example, researchers at Johns Hopkins University have partnered with the Apache Tribe and Navajo Nation to investigate barriers to implementing a community-based suicide surveillance and case management intervention grounded in local cultural beliefs and context. In partnership with the Apache Tribe and Navajo Nation, the researchers will use the predictive analytics NATIVE-RISE program to enhance suicide risk identification in these groups. This is a strong example of how community-engaged research can meet the needs of people at high risk for suicide and build trust in ways that the research status quo cannot.

In 2017, NIMH, along with the National Institute on Minority Health and Health Disparities, established the Collaborative Hubs to Reduce the Burden of Suicide Among American Indian and Alaska Native Youth to identify effective, culturally relevant preventive interventions that can increase resilience and reduce the burden of suicide in American Indian and Alaska Native communities. Because each community has different strengths, challenges, and cultural practices and approaches, researchers at each hub are committed to forming strong community and tribal partnerships to achieve the project goals.

States with Collaborative Hubs to Reduce the Burden of Suicide among American Indian and Alaska Native Youth. Courtesy of NIMH.

Increasing capacity for health equity research and informing next steps (ODWD strategic priority area 1)

In NIMH's priority areas for mental health disparities research, building capacity for health equity research is a new and top priority. This enhanced focus on capacity building will ensure that institutions can tackle the complex systems leading to mental health inequities.

ODWD has also identified several critical next steps that researchers within and outside NIMH can take to help meet these priorities and advance disparities research.

• Invest in the next generation of mental health researchers, such as predoctoral and postdoctoral scholars and early stage investigators, using novel methods to address disparities.
• Increase support for studies using community-engaged and multilevel approaches that build in resources for community co-design, investigate interacting factors that underlie and exacerbate disparities, and translate and test services and interventions tailored to local needs. These efforts will bolster trust in the community and help better meet their needs.
• Create networks of mental health disparities researchers to seed collaborations for large cohort studies capable of comparing distinct subgroups that experience mental health disparities.
• Use insights from collaborative research efforts to identify best practices for the field (such as standard demographic data to collect) and novel approaches for data collection and analysis among minoritized groups.
• Move from understanding the causes of disparities to implementing policies and preventive interventions that achieve mental health equity. For maximal impact, the knowledge gathered from this cutting-edge research cannot exist in a vacuum and must have a real-world impact.

The studies and efforts highlighted above are only a few of the many ways NIMH works every day to better understand and help reduce suicide risk in minoritized populations. As it has done for the past 75 years, NIMH will continue to prioritize research on suicide prevention and many other facets of minority mental health.

Learn more about how the U.S. Department of Health and Human Services (HHS) honored National Minority Health Month 2024 at https://www.hhs.gov/national-minority-health-month/index.html

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