The missing piece to the puzzle of black youth suicide

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REMARK

“Do you think racism plays a role in all of this? I asked my black teenage patient in her hospital room. She had avoided eye contact with me, but when I asked that question, she suddenly looked at me, her carob brown eyes widening in surprise. She nodded slowly, then faster, and began to speak more openly. She was admitted for attempted suicide and had dropped hints since she started describing her depression to me. She felt isolated, did not fit in and was punished more than her peers at her prep school.

When you tell enough patients about racism, you recognize when you are being tested. She was testing me to see if it was safe to discuss an experience that was downplayed by those who aren’t targeted, and sometimes by those who are. The taboo experience of our conversation that day was not, in fact, his suicide attempt, it was racism.

I presented my assessment to the attending physician, citing racism as central to my patient’s major depressive disorder and suicide attempt. The attendant interrupted me. “Nah. Racism is not the issue here. I was wondering if the participant was aware of the damaging impact predominantly white spaces can have on black people, a concept called the white space.1 I wondered if the participant was aware that black girls are more likely to be criminalized in schools for the same behaviors as their white counterparts.2 More importantly, I wondered how many other black patients whose primary drivers of attempted suicide – the isolation and abuse they suffered due to racism – had been rejected and silenced by this patient. . As for me, I stopped discussing the racism that future patients conveyed to me with the presenter, even though racism was a crucial component in the formulation and treatment of my patient. I stopped talking to this doctor about racism because, as my patient had done with me, I had tested her and she was not safe.

Race and suicide

Medical education teaches us that suicide is less of a problem among black youth, yet the suicide rate among black youth is increasing to a low. faster pace than in any other racial / ethnic identity.3 A recent study, published last month, documented this significant increase in suicide among black youth, especially black youth between the ages of 15 and 17, and black girls.4 Yet some suicide risk assessments continue to include white race as a risk factor for suicide, an additional point in the algorithm that can shape care. Experiences of racism are absent from this risk assessment, but race-related stress impacts the development of black youth.5 Not surprisingly, suicide prediction models, which are accurate for white populations, have been shown to be insensitive for black populations.6 A growing number of studies document the deleterious impact of racism on the mental health of black youth, including depression, but it is largely omitted from the account when discussing black youth suicide. CA shouldn’t be. Racism is the missing piece in the puzzle of black youth suicide.

Black girls in particular, like my patient, face unique challenges that contribute to their depressive symptoms. The racism that black girls experience is known as misogynist, an anti-black racist misogyny that is distinct from the racism experienced by black boys and the sexism experienced by non-black women.7 Black girls are more likely to be viewed as older, more sexually mature, and less in need of comfort than white girls, a racist phenomenon known as adultification.8 Society’s expectation that black girls should be strong, also known as strong black woman archetypal, is detrimental to the mental health and well-being of black girls who may have emotional difficulties.9

See racism in research and the clinic

Although racism affects the physical and mental health of black youth and is a factor in health inequalities,ten psychiatrists are not systematically trained to identify and mitigate racism. Experiences of racism may have a dose-dependent relationship with depressive symptoms. Black teens can experience racism multiple times in a single day, with more racist experiences correlating with greater depressive symptoms.11 Yet there is a dearth of research specifically targeting the mental health of black youth. In fact, race is rarely mentioned in psychological research, and when it does, the research is written and edited by predominantly white scholars.12

If psychiatrists are to elucidate the cause of the increase in suicide among black youth, they must conduct more studies that target black youth and their experiences of racism. Clinically, psychiatrists need to stop treating racism like an unrecognized elephant in the room and start helping black teens deal with or confront it. Their life may depend on it.

Concluding thoughts

Black youth are less likely than white youth to access and stay in the mental health system.13 And of course, socioeconomic status plays a role in this regard, although one cannot fully examine the socioeconomics of black youth without first examining white supremacy and the intentional economic oppression of black Americans. . However, the lack of access to care due to economic resources is not everything. Socioeconomics may be the non-taboo reason, a reason that can be attributed to the patient’s factors, not the psychiatrist’s factors.

Perhaps black children lack access to mental health because psychiatrists, largely non-Black, fail to establish a therapeutic alliance with them. Perhaps studies cannot understand why suicide among black youth is increasing because the research does not specifically target black youth and their experiences of anti-black racism. And maybe the psychiatrists black children encounter, like my former assistant, downplay and silence their experiences of racism, which is even more traumatic. As one of my black patients once told me, when I asked her why she had quit therapy, “I will never go back to therapy.” I don’t want to expose my guts to another stone-faced, condescending therapist who looks like Judge Judy.

Dr Calhoun is an adult / child psychiatry resident at the Yale Child Study Center / Yale School of Medicine. She is also a Public Voices member of the OpEd project at Yale University.

The references

1. Anderson E. White space. Sociology of race and ethnicity. 2015; 1 (1): 10-21.

2. Morris M. Pushout: the criminalization of black girls in schools. The new press; 2016.

3. Coleman BW. Sound the Alarm: The Black Youth Suicide Crisis in America. Emergency Task Force on Black Youth Suicide and Mental Health: A Report to the Congressional Black Caucus Congress. 2021. Accessed October 6, 2021. https://watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf.

4. Sheftall AH, Vakil F, Ruch DA, et al. Suicide of Black Youth: Investigation of Current Trends and Triggering Circumstances. J Am Acad Child Psychiatry. 2021: S0890-8567 (21) 01365-4.

5. Jones SCT, Anderson RE, Gaskin-Wasson AL, et al. From “Cradle to Coffin”: Managing the Stress of Racism Across the Lifespan of Black Americans. Am J Orthopsychiatry. 2020; 90 (2): 267-282.

6. Coley RY, Johnson E, Simon GE et al. Racial / ethnic disparities in the performance of suicide death prediction models after mental health visits. JAMA Psychiatry. 2021; 78 (7): 726-734.

7. Bailey M, Trudy. On the misogynist: quotation, erasure and plagiarism. Feminist Media Studies. 2018; 18: 762-768.

8. Epstein R, Blake JJ, González T. Research confirms that black girls feel the sting of adultification bias identified in an earlier Georgetown Law study. Georgetown Law: Center on Poverty and Inequality. May 15, 2019. Accessed October 6, 2021. https://www.law.georgetown.edu/news/research-confirms-that-black-girls-feel-the-sting-of-adultification-bias-identified-in-earlier-georgetown-law-study/

9. Geyton T, Johnson N, Ross K. “I’m fine”: examining the internalization of the strong black woman archetype. Journal of Human Behavior in the Social Environment. 2020.

10. Trent M, Dooley DG, Dougé J; Community Paediatrics Council; Adolescent Commission. The impact of racism on the health of children and adolescents. Pediatrics. 2019; 144 (2): e20191765.

11. English D, Lambert SF, Tynes BM, et al. Daily multidimensional racial discrimination among black American teens. J Appl Dev Psychol. 2020; 66: 101068.

12. Roberts SO, Bareket-Shavit C, Dollins FA, et al. Racial inequality in psychological research: trends of the past and recommendations for the future. Perspect Psychol Sci. 2020; 15 (6): 1295-1309.

13. Alegria M, Vallas M, Pumariega AJ. Racial and Ethnic Disparities in Pediatric Mental Health. Child Adolescent Psychiatr Clin N Am. 2010; 19 (4): 759-774.


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