Edited by: Benjamin Miller, Stanford University, United States
Reviewed by: Erica D. Diminich, Stony Brook Medicine, United States
This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Despite a steady decrease in suicide rates in the United States, the rate among Black males has increased in recent decades. Moreover, suicide is now positioned as the third leading cause of death in this population, signaling a public health crisis. Enhancing the ability for future suicide prevention scholars to fully characterize and intervene on suicide risk factors is an emerging health equity priority, yet there is little empirical evidence to robustly investigate the alarming trends in Black male suicide. We present fundamental areas of expansion in suicide prevention research focused on establishing culturally responsive strategies to achieve mental health equity. Notably, we identify gaps in existing research and offer future recommendation to reduce suicide death among Black males. Our perspective aims to present important and innovative solutions for ensuring the inclusion of Black males in need of suicide prevention and intervention efforts.
The Centers for Disease Control (CDC) report that suicide is now the third leading cause of death for Black male adolescents and young adults. The crisis of suicide among Black Americans is inherently gendered, with Black boys and men accounting for the vast majority (81%) of completed suicides in this population (
This crisis has recently garnered growing national recognition as a public health priority facing Black males, as evidenced by the recent efforts by the National Institutes of Health and the 2018 report from the Emergency Task Force on Black Youth Suicide and Mental Health (
Given that the life expectancy for Black males is among the lowest of all racial and ethnic and gender groups (
Much of the extant research investigating suicidality has been conducted among persons of European descent, thus masking the unique population-level risk factors that are present for this population (
In order to fully contextualize pathways to suicide prevention for Black males, researchers much first contend with the detrimental role of racism. Racism is a multilevel construct that encompasses all aspects of society and results in the diminished availability of resources to support wellbeing. This marked disadvantage has an influence on health outcomes, with racialized populations consistently demonstrating shorter lifespans and poorer physical and mental health than their advantaged counterparts (
Despite recent advancements in the study and measurement of structural racism in the lives of Black Americans (
A recent review, conducted by Kiara Alvarez et al., highlighted the need for a multi-sector approach in suicide prevention and identified settings in which structural racism may permeate and exacerbate mental wellbeing, including outpatient mental health settings, schools, and crisis response interventions (e.g., the intersection of law enforcement, emergency services, and inpatient psychiatric settings) (
Lack of uniformity of these data sources also obscure reliable information on the social determinants that precede mental health challenges. Outside of research participation, the health and safety of Black males who elect to participate in studies focused on their mental wellbeing is of paramount importance. In considering this population and the frequent racialized threats that encompass their lived experiences, the nature of mental health crisis support itself must be re-examined to provide inclusive safety considerations for Black males at high risk of suicide. Indeed for Black males, the intersection of the criminal justice system and police involvement has resulted in a disproportionate amount of state-sanctioned violence and racialized trauma (
The current landscape of suicide prevention research is primed for novel approaches to ensure that Black males live to their fullest potential. Accordingly, by noting evidentiary gaps, we can prioritize areas of targeted opportunity for future initiatives to support Black males in crisis. Although the need for innovative solutions to curtail Black male suicide is clear (
The current shortage of scholars in the field focused on Black male suicide may also yield limited research on the topic itself. Notably, Black researchers who may be more inclined to address such topics are less likely to receive funding from federally funded organizations (
The paucity of available literature on Black male suicide prevention also demonstrates the need for more research to establish conclusive linkages that catalyze suicidal thoughts and behaviors in this vulnerable population. As evidenced by the Congressional Black Caucus' recent Emergency Task Force Report (
The healthcare sector is a vital institution for characterizing and treating emerging psychiatric distress and subsequent suicidal thoughts and behaviors. Yet, Black males often lose contact with health care services following the utilization of emergency services for suicide (
Enhancing brief interventions that leverage smartphones to support Black males in real-time may also support the therapeutic alliance with the healthcare setting. Research suggests that Black Americans are the most active mobile phone users in the United States, adopting and using smartphones at much higher rates than other racial and ethnic groups. Additionally, 67% of Black Americans have used their phone in the past year to seek health information, compared to 58% of White respondents (
A critical extension of current literature requires a within-group focus on the unique risk factors that influence suicide risk among Black males (
Our recent data on suicide increases among Black Americans have largely positioned Black males as a homogenous group. This sampling decision across studies has the potential to omit the diverse African diasporic communities that are present in the United States. By expanding study samples to account for heterogeneity in the Black male suicide experience (
With the recent national implementation of the 988 Suicide and Crisis Lifeline, there are more opportunities to reach Black males in crisis and connect them to timely care. Thus, it is imperative that these initiatives also prioritize enhancing the diversity of the counseling workforce to better serve the emergent needs of Black males that may rely on this resource. Moreover, the occupational composition of such crisis teams should be carefully considered to ensure that resulting responses do not further place Black males at risk of criminal justice involvement or state-sanctioned violence by police officers.
In many instances of mental health crises there is an emergent, but ultimately unmet, need that occurs when armed police encounter Black males. The potential harm of such interactions outweighs the benefit when considering mental health crisis support care for Black males. Safety planning interventions offer a promising approach to identify resources for psychiatric crisis before it occurs (
Finally, community stakeholders are critical in ensuring the mental wellbeing of Black males at risk of suicide. To this end, placing community leaders in the driver's seat of suicide prevention efforts is a natural next step in enhancing trust in prevention efforts and reducing cultural stigma related to mental health help-seeking for Black males. These engaged efforts will center the needs of Black males and move beyond comparative models in the development of future suicide prevention interventions. Guided by participatory practices that ensure a co-learning structure between researchers and community, these partnerships will have a more sustainable approach for identifying and dismantling pathways in which structural racism limits opportunities for Black males to thrive. Targeting areas where Black males live, work, and play, such as gyms, churches, barbershops, and outdoor activity spaces may bolster trust to participate in suicide prevention efforts. Consequentially, eliciting the direct perspectives of Black males at risk for suicide using qualitative and engaged approaches may be critical early step in understanding targeted areas of improvement and reducing mistrust in research participation.
Community-based involvement would require an intentional approach to maintain successful partnerships over time and maintain contact with research participants beyond the duration of the study. In previous studies, these approaches have included directed follow-up communication
Our perspective highlights key gaps in our understanding of Black male suicide and offers preliminary recommendations to engage stakeholders in action-oriented advancement in the field of suicide prevention. Consistent with ongoing efforts that highlight the alarming rates of suicide in the Black community (
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
LA conceptualized and wrote the first draft. RT contributed to critical revision and writing of the final manuscript. All authors contributed to and approved the final manuscript.
LA was supported by a grant (K01MH127310) from the National Institutes on Mental Health and the American Foundation on Suicide Prevention (YIG-0-001-19). RT was supported by grants from NIH K02AG059140 and U54MD000214.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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