2Department of Psychology, DePaul University, Chicago, IL 60614
Keywords: Suicide; Suicidality; African American Adolescents; Protective Factors; Resiliency
Historically, rates of suicide among African American adolescents have been relatively low when compared to those of European American adolescents [46]. However, overall rates of African American suicide have been on the rise since 1965 [32,52]. More recent reports from the CDC indicate rates of suicidality among African American adolescents have been nearing and/ or surpassing those of European American adolescents. For example, according to the CDC’s 2013 Youth Risk Behavior Surveillance Survey (YRBSS), African American youth in grades 9-12 were significantly more likely to report suicide attempts within the 12 months prior to the survey than their European American counterparts [7].
African American youth live in poverty at twice the rate of European American youth. With nearly 40% of African American adolescents living in poverty, this vulnerable population is more likely to live in under-resourced neighborhoods and be exposed to more community violence [56,46]. In a predominantly African American (92%) sample of urban youth, 90% witnessed violence or were victimized in the year prior to data collection, and 77% were exposed to more than one instance of community violence. Other factors related to poverty, such as hopelessness, increased substance use, residential mobility, family dysfunction, and mental health problems (e.g., depression) are also associated with suicidality [10,16,19,20,28,29,51]. Mood disorders, such as depression and dysthymia among African Americans have been identified as some of the psychiatric risk factors most often predictive of suicidal behaviors [31,53,25]. Further, African American adolescents face barriers to mental health treatment, such as lack of insurance and access to high-quality services, and cost of medical expenses and transportation [51]. As such, they are significantly less likely to receive treatment for mental health problems than European American adolescents [43]. African American adolescents, subjected to the treatment barriers and contextual stressors of living in disadvantaged, urban communities, are twice as likely to experience suicidal ideation, and four times as likely to attempt suicide as their European American counterparts [13]. Results from the Mobile Youth Survey, a large, multi-cohort, longitudinal study, indicated that an alarming 36% of extremely impoverished African American adolescents would attempt suicide by the age of 19 [15]. With African American adolescents grossly overrepresented in underresourced, urban communities, they are at high risk for suicidality related to their disadvantaged environment, and in great need of culturally-relevant sources of protection.
Reviews of the existing literature on African American suicidality have tended to focus more heavily on risk factors and general African American populations. One published study reviewed literature that examined ethnocultural risk factors of youth suicidality (with a partial focus on African American youth); while another examined suicide prevention and treatment across ethnic groups, with a minor emphasis on risk factors and mention of only one protective factor for African American youth [9,21]. Chu and colleagues conducted an extensive review of suicide literature pertaining to four cultural minority groups, including African Americans; however, reported only minimal findings on African American adolescent suicidality protective factors [8]. Gould and colleagues conducted a literature review of youth suicide risk factors and prevention interventions; however, they did mention one protective factor for African American youth suicidality [23]. Three literature reviews examined risk and protective factors of suicidality among African Americans in general, with no specification of age, location, or socioeconomic status [32,57,63]. Another review paper addressed risk and protective factors of suicidality among African American youth, adults, and elderly. Protective factors were more generalized (i.e., not tailored to youth) and there was no specific mention of socioeconomic status of the samples in the reviewed studies [18]. Crosby and Molock conducted a review of the history of suicide research in African American communities, which included predominantly risk factor literature, with some focus on protective factors for adolescent suicide [11]. Balis and Postolache conducted a literature review of risk and protective factors across five ethnic groups of adolescents, including African Americans [1]. However, much of the literature reviewed by Balis and Postolache pertained to older or age-unspecified African American populations. Another literature review focused on risk and, to a lesser extent, protective factors for adolescent suicide, and gender differences, across four ethnic groups, including African Americans [37]. Joe reviewed literature on national suicide trends of African American youth, with an emphasis on explanatory hypotheses and practice implications, and, to a much lesser extent, risk and protective factors for African American youth suicide [30]. To date, no known literature reviews have been published that have a primary focus on sociocultural protective factors associated with African American youth suicidality. Nor have any review papers been identified that attempt to emphasize low-income, urban, African American adolescents, a sub-group of African Americans who are particularly at risk for suicidality. There is a gap in the research literature that needs to be filled in order to inform future policies, programs, prevention interventions, and treatment.
Citation |
Sample |
Age/Grade in School |
Protective Factors |
Gender Differences |
Bearman & Moody, 2004 |
Add Health U.S. representative (N = 13,465; 61% Caucasian, 25% Other (i.e., Native American, Asian, Hispanic, mixed-race/ethnicity), 14% African American) |
Ages 11-21; Grades 7-12 |
Dense school social network linking adolescents together (F – SI; M – SA); Transitive relationships (F – SI); High self-esteem (M/F – SI, F – SA) |
Yes |
Borowsky, Ireland, & Resnick, 2001 |
Add Health U.S. representative |
Grades 7-12 |
Parent-Family Connectedness; Emotional Well-Being (F); Academic Achievement/Grade Point Average (M) |
Yes |
Burr, Hartman, & Matteson, 1999 |
African American males (range of SES backgrounds, from those “living below the official poverty line” to those with “upper white-class occupations”) |
Ages 15-24 (comparison group, “all black males” 15 and over) |
Increased socioeconomic status (i.e., income/occupation) |
Not assessed |
Davidson, Wingate, Slish, & Rasmussen, 2010 |
African American college students (N = 115; 78 female, 37 male) |
Ages 18-31 (MAge = 20.37 years); College freshmen through seniors |
Hope |
Not indicated |
Gangwisch, et al., 2010 |
Add Health U.S. representative (N = 15,659) |
Ages 12-21; Grades 7-12 |
Earlier parental set bedtime (i.e., 10:00 p.m. or earlier) |
Not indicated |
Greening & Stoppelbein, 2002 |
Caucasian (72%) and African American (28%) adolescents (N = 1,098; 53% female, 47% male) |
Ages 14-18 |
Orthodoxy; Family support; Ascribing to an adaptive attributional style |
No |
Harris & Molock, 2000
|
African American adolescents from “middle to upper-middle socioeconomic backgrounds” (N = 188; 67% female, 32.4% male) |
Ages 17-22; College freshmen and sophomores
|
Family cohesion; Family support
|
Not indicated
|
Haynie, South, & Bose, 2006 |
Add Health U.S. representative (N = 9,594; 68% Caucasian, 16% African American, 17% other race; 52.4% female, 47.6% male; 8% received public assistance) |
Ages 11-20; Grades 7-12 |
Living in current residence for more than two years (F); High quality relationships with parents (F); Older age (F); Having popular friends (i.e., adolescent’s friends received many friendship nominations; F); School attachment (F) |
Yes |
Joe, Baser, Neighbors, Caldwell, & Jackson, 2009 |
National Survey of American Life nationwide sample of African American (69.2%) and Caribbean Black (30.8%) adolescents (N = 1,170; 52% female, 48% male) |
Ages 13-17 (MAge = 15 years, SD = 1.42)
|
Living in southern or western regions of the U.S. (compared to northeastern regions)
|
Not indicated
|
Kidd, et al., 2006 |
Add Health U.S. representative (N = 9,142; 70.1% Caucasian, 20.1% African American, 12% Hispanic, 6.6% “other,” 4.5% Asian, 3.7% Native American; 52% female, 48% male) |
Grades 7-11 |
Parent-family connectedness; Peer connectedness (M with history of attempts); School connectedness (M with history of attempts) |
Yes |
Kimbrough, Molock, & Walton, 1996 |
African American college students from “middle- or upper-class socioeconomic status”(N = 157; 71.1% female, 28.9% male) |
Ages 17-46 (MAge = 19.9 years); College freshmen (64.3%), sophomores (17.3%, juniors (12.2%), and seniors (6.1%) |
Perceived social support (i.e., family, platonic friends, and boyfriend/girlfriends) |
Not indicated |
Maimon, Browning, & Brooks-Gunn, 2010 |
Urban adolescents (N = 990; 7 categories of racial/ethnic composition; high, medium, and low SES; 50% female, 50% male) |
Ages 11-16 (MAgeW1 = 14 years, MAgeW2 = 15.5 years) |
Family attachment and support; Collective efficacy interacts positively with family attachment and support to reduce likelihood of SA; Longer durations of time living in one residency (SA) |
Not assessed |
Marion & Range, 2003 |
African American female college students from rural (73.3%) and urban (26.7%) southeastern universities (N = 300) |
MAge = 22.09 years, SD = 5.07 |
Family social support; Collaborative religious problem solving (i.e., “God and I work together as partners” to solve a problem); Negative attitude |
Not applicable |
Matlin, Molock, & Tebes, 2011
|
“Middle class” African American adolescents (N = 212; 62.7% females, 37.3% males) |
Ages 13-19; Grades 9-10
|
Family support; Peer support; Community connectedness
|
Not indicated
|
McKeown, et al., 1998 |
Suburban South Carolina middle and high school students (N = 359; weighted |
Ages ≤12 (28.6%), 13 (37.8%, 14 (28.6%), ≥ 15 (5.0%) |
Family cohesion |
No |
Perkins & Hartless, 2002 |
African American (26.1%) and European American (73.9%) adolescent residents of Michigan (N = 14,922; 53% female, 46.7% male; 45.5% rural, 41.6% urban, 12.9% suburban) |
Ages 12-17; Predominantly grades 7, 9, and 11 |
Family support (F – SI, M/F -SA); Older age (M/F – SI); School climate (M – SI, M/F -SA) |
Yes |
Resnick, et al., 1997 |
Add Health U.S. representative (N = 11,572 [W1]; Caucasian, African American, Hispanic, Asian/Pacific Islander, Native American, “other” mixed race/ethnicity) |
Grades 7-12 |
Parent-family connectedness; School connectedness |
Not indicated |
Walker & Bishop, 2005
|
African American college students (N = 459; 64% African American, 35% Caucasian; 65% female, 33.5% male) |
Ages 18-41 (MAge = 20.88 years)
|
Intrinsic religiosity; Social support
|
Not indicated
|
Wang, Lightsey, Pietruszka, Uruk, & Wells, 2007 |
College students (N = 416; 48% Caucasian, 45% African American, 7% Hispanic/Latino, American Indian/Alaskan Native, Asian American, other, or biracial; 73% female, 27% male) |
MAge = 19.77 years, SD = 4.6; College freshmen (81%) |
Reasons for living; Avoidance-oriented coping (indirect effect on SI/SA via positive relationship with reasons for living); Purpose in life (indirect effect on SI/SA via inverse relationship with depression) |
Not indicated |
Wang, Lightsey, Tran, & Bonaparte, 2013 |
African American college student (N = 341; 73% female, 27% male) |
MAge = 21.56 years, SD = 5.70; College freshmen (36.4%) and sophomores (22.3%) made up largest proportion of students |
Reasons for living (F); Life satisfaction (M ) |
Yes |
Wang, Nyutu, & Tran, 2012 |
African American college students (N = 361; 72% female, 28% male) |
MAge = 21.6 years, SD = 5.8 |
Reasons for living; Avoidance-oriented coping |
Not indicated |
SI = suicidal ideation; SA = suicide attempt
Citation |
Sample |
Age/Grade in School |
Protective Factors |
Gender Differences |
Farrell, Bolland, & Cockerham, 2014 |
Mobile Youth Survey “Extremely impoverished” African American adolescents (N = 7,299; MSex = 49.1% female) |
Ages 9.75 -19.25 (MAge = 12.1 years) |
Peer support; Younger age |
No |
Fitzpatrick, Piko, & Miller, 2008 |
Urban African American adolescents (N = 1,526; 50.2% female) |
Grades 5-6 (40.1%), 7-8 (26.4%), 9-12 (33.5%) |
Self-esteem; Perceived spiritual community membership |
Not indicated |
Gutierrez, Muehlenkamp, Konick, & Osman, 2005 |
Urban adolescents (N = 337; 51.9% Caucasian, 24.6% African American, 7.1% Latino/a, 3.6% Asian, 12.8% unidentified; 199 females, 138 males) |
Ages 13-19; Grades |
Reasons for living |
Not assessed |
O’Donnell, O’Donnell, Wardlaw, & Stueve, 2004
|
Urban adolescents (N = 879; 68.6% African American, 16.5% Hispanic/Latino, 8.1% other, 6.8% African American and Hispanic; 57.9% female, 42.1% male) |
Ages 16-17; Grade 11
|
Family closeness; Having lived in the same neighborhood for >5 years; Religiosity
|
No
|
O’Donnell, Stueve, Wardlaw, & O’Donnell, 2003 |
Urban adolescents (N = 879; 68.6% African American, 16.5% Hispanic/Latino, 8.1% other, 6.8% African American and Hispanic; 57.9% female, 42.1% |
Ages 16-17; Grade 11 |
Perceived support ( F – SI); Family network availability; Accessing a formal network |
Yes |
SI = suicidal ideation
For African American adolescents from a variety of socioeconomic backgrounds and regions, the familial protective component of Durkheim’s theory was supported by the overall results of the present study. However, of the five studies that reported on the protective nature of familial factors for low-income, African American adolescents only two identified familial factors as significant protective factors for suicidality [15,16,24,46,47]. Familial factors reported as non-protective against suicidality among urban African American youth were parental involvement, supervision, support, warmth, family alliance [15,16,24]. Of the eight studies that identified familial protective factors for African American youth with various socioeconomic backgrounds, three found non-significant familial protective factors (i.e., parental social capital, monitoring, education, family structure); although, each study also identified alternative significant protective familial factors [28,42,48]. Family structure (i.e., composition) did not impact suicidality for African American youth of any socioeconomic background. Overall, familial factors were less protective for urban, low-income adolescents than for youth of various socioeconomic backgrounds.
Although several religious-based factors were identified as protective, particularly those of a more intrinsic nature, there were a number of religious-based factors that were not protective against suicidality. Only one study assessed, but did not find support for, religious-based protective factors among African American youth from low-income, urban backgrounds [16]. More specifically, church membership, religious importance, and prayer frequency did not protect urban African American adolescents from suicidality. Among African American adolescents from a variety of socioeconomic backgrounds, church attendance, religious importance, religiosity, self-directing religious problemsolving (i.e., actively tried to solve one’s own problems without God’s help), deferring religious problem-solving (i.e., let God provide solutions to problems, rather than coming up with solutions for oneself), and extrinsic religiosity (i.e., social and personal benefits of religious practice/behavior) were not found to be protective against suicidality [2,4,4048,58]. Overall, for African American adolescents, religious-based factors of a more extrinsic nature were not identified as protective against suicidality, and no religious-based factors were protective for urban youth.
Several relational/social factors were identified as protective against African American adolescent suicidality; however, mixed and non-significant results were also identified for some relational/social factors. Among youth of various socioeconomic backgrounds and low-income, urban African American youth there were mixed findings for peer support as a protective factor for suicidality [41,40,15,46]. School attachment, identified as protective for African American adolescents of various socioeconomic backgrounds was not a significant protective factor for urban African American youth suicidality [28,34,50,46]. Similarly, school bonding (i.e., frequency an adolescent talked to a teacher about a problem) was not protective for urban adolescents’ suicidality [16]. Other factors that were not protective for African American adolescents of various socioeconomic backgrounds were network centrality (i.e., direct links to others in one’s friendship network; only assessed for females), perceived supportive college community, having friends, popularity, and involvement in extracurricular activities [28,35,48]. For urban African American youth in particular, school settings (e.g., attachment to and teacher support) were not protective against suicidality, whereas they did provide protection for African American youth of various socioeconomic backgrounds. Overall, there were several relational/social factors that were protective against African American adolescent suicidality; however, a number of mixed findings suggest that there may be characteristics unique to the different samples that may account for the differing results.
While a variety of personal factors were identified as protective for African American adolescent suicidality, a range of personal factors were also identified as not being protective against suicidality. Although three studies identified reasons for living as protective against suicidality, Marion and Range found that reasons for living were not protective for female suicidal ideation (only females were assessed) [40]. Academic achievement/GPA was protective against suicide attempt for males, whereas school engagement (i.e., paying attention, getting homework completed) was not protective against suicide attempt [28]. Various coping styles were also non-significant protective factors for suicidality, including task-oriented coping (i.e., active attempts at problem-solving) and emotion-focused coping (i.e., reacting emotionally to stressful situations) [61]. “John Henry” style coping (i.e., actively managing psychosocial stressors through positive orientation toward the future and hard work) was not protective for urban African American youth suicidal ideation [46]. O’Donnell and colleagues also did not find evidence to support ethnic identity formation as a protective factor for suicidal ideation [46]. There were mixed results for academic-related factors, and the more active coping strategies (e.g., problem-focused, “John Henry” style for urban youth) were not effective at protecting African American youth from suicidality. Overall, African American youth gained more protection from suicidality through avoiding problems rather than dealing with problems and contextual circumstances directly.
Two studies identified factors that were not protective against suicidality. Harris and Molock found that communalism (having strong communal values) actually increased suicidal ideation among African American adolescents [26]. Farrell and colleagues found that neither living in one’s residence for more than one year, nor contextual safety (perceived safety of one’s social environment) were protective factors for urban African American youth suicide attempt [15]. Studies from this review provided mixed results for support of socioecological factors as protective against African American adolescent suicidality. Durkheim’s social integration theory describes shared, communal values as being a component of social integration that helps to strengthen societal bonds [14]. Communal values, however, were not found to be protective of suicidality among African American adolescents; rather, strong communal values promoted suicidal ideation. Socioecological factors (i.e., residential stability and perception of a safe environment) were not found to be protective for urban African American youth.
Overall, identified protective factors for suicidality coincided with factors that may promote social integration, through which one may obtain support, guidance, and protection from suicide. Durkheim noted that familial, relational/social, and religious ties were the mechanisms through which one achieved social integration [14]. Personal factors may contribute to the initiation and preservation of some of the afore-mentioned relational bonds, which may impact the feasibility of social integration. Socioecological factors play a role in social integration theory as well, given that they may present challenges and barriers, such as an unemployed or underemployed individual needing to move away from one’s family and community in order to find work, possibly deterring one’s integration into society.
The most strongly supported factors protective against African American adolescent suicidality were familial, relational/social, and personal factors, followed by the lesser-studied religiosity based and socioecological factors. Feeling connected to supportive and accessible family members, being a part of a cohesive family, and having high quality relationships with parents represent the types of familial factors that protect against suicidality for African American youth from a variety of socioeconomic backgrounds.
African American Christian churches have long been suggested to provide protection against suicidality for African Americans [18,44]. Overall, religiosity-based factors of an intrinsic nature (based on the adoption of a religious-based framework to provide meaning in one’s life), rather than extrinsic religiosity (i.e., emphasis on the benefits of religious practices/behavior) were protective against African American adolescent suicidality [58]. Religious coping that involved a collaborative problemsolving approach, in which the individual works with God to solve problems in one’s life, also was protective against suicidality. Perhaps not surprisingly, more extreme types of coping, in which the individual either loses all agency in the problem-solving process (i.e., deferring problem-solving), or does not involve God at all in the process (i.e., self-directive problem-solving) were not protective against suicidality for African American youth [58]. Although church membership is a route to social integration, according to Durkheim, it received mixed results as a protective factor [14]. However, church membership has been found to be protective against suicidality for African American men [4]. It may be that church membership becomes more desirable with age; although, more research is necessary to investigate this relationship.
Several significant protective relational/social factors emerged from this review. Tightly-knit friendship networks, supportive social networks, school attachment, and community connectedness represent some of the factors protective against suicidality for African American youth suicidality from a variety of socioeconomic backgrounds. Having these social bonds may be indicative of social integration, which Durkheim purported is protective against suicide [14]. Study results support Durkheim’s theory of social integration. Peer support had mixed results, which may suggest that peer networks may not be the best and most stable sources of support for African American youth suicidality. Further investigation is warranted.
Numerous personal factors or characteristics unique to the adolescents, such as self-esteem, emotional well-being, academic achievement, etc., were protective against suicidality. Having some of these personal competencies may be associated with better mental health and may contribute to more positive outlooks. It makes sense that someone who has high self-esteem, a high grade point average, and who has many reasons for living may be less at risk for suicidality than individuals who do not have those personal factors. Contextual factors of different environments may make it more or less likely for youth to have positive personal competencies.
Socioecological factors, including higher socioeconomic status, decreased residential mobility, residing in southern or western regions, and collective efficacy were protective against youth suicidality. These factors are directly associated with one’s environment. Durkheim noted that socioeconomic status may impact one’s ability to socially integrate into society, such that lower socioeconomic status may present more challenges to social integration [14]. Residential mobility may be a consequence of one’s socioeconomic status and may be disruptive to the social relationships that bring about social integration [28]. Thus, increased socioeconomic status and decreased residential mobility may facilitate social integration and provide protection against suicidality. Collective efficacy (i.e., community members’ mutual trust and willingness to act on behalf of the common good), a goal and byproduct of Durkheim’s notion of social integration, may help to promote a sense of cohesion and belongingness that provides some protection against suicide attempt [39]. Interestingly, communalism (i.e., having strong communal values) was found to increase suicidality. Promoting the common good was a pervasive component of collective efficacy; however, the content underlying the communal values was not mentioned. Perhaps the content of the communal values may have been more adversely impactful than the shared nature of the values was beneficial.
The present study identified multiple protective factors for African American adolescent suicidality. Protective factors were categorized into several categories (i.e., familial, religiositybased, relational/social, personal, and socioecological) that, overall, provide support for Durkheim’s social integration theory of suicide protection. There is a dearth of current literature on the topic of African American youth suicide. More research needs to be completed in order to understand current contextual and protective factors for these youth. Additionally, there is a need to examine ways in which to promote protective factors for African American adolescents.
Family closeness and family network availability were the only familial factors identified as protective for urban African American youth suicidality [46,47]. Parental involvement, supervision, support, warmth, and family alliance were not protective against urban youth suicidality [15,16,24]. Low-income African American youth living in under-resourced areas are at greater risk of family dysfunction and breakdown suggesting that positive familial factors such as parental involvement, support, warmth, etc. may be less readily available when families are unstable and faced with a multitude of contextual stressors [10,36]. Financial strain may require that some parents work more and stay home less, potentially prohibiting them from being more involved with their children or supervising them.
Only one study assessed the protective impact of religiosity-based factors [16]. Perceived spiritual community membership was the only factor identified as protective against suicide for urban African American adolescents. Religious importance and prayer frequency were not found to be protective. Spiritual community membership may provide social support and social integration for urban African American youth; however, given that only one study assessed religiosity-based protective factors for this population, more research is needed to further explore this relationship.
Low-income African American youth, like African American youth from different socioeconomic backgrounds, reported that general social support was protective against suicide attempt. However, school bonding and attachment were not found to be protective among low-income youth. Under-resourced schools in low-income neighborhoods may not have been able to provide the same positive, protective environment as schools in higher-income areas.
Personal factors, such as self-esteem and reasons for living may be impacted by contextual factors of one’s environment. Youth living in under-resourced, low-income areas are at increased risk of having fewer positive personal competencies than youth living in higher-income areas. Self-esteem and reasons for living were protective against suicidality for low-income African American adolescents; however, many of the personal factors identified as protective for youth from various socioeconomic backgrounds were not assessed among low-income adolescent populations. Future research may be able to identify additional personal factors that may be protective for low-income African American adolescents.
Residential mobility and contextual safety (i.e., perceived safety of one’s environment) were the only socioecological factors assessed for low-income African American youth [15]. Results provided mixed support for decreased residential mobility as protective against suicidality, while contextual safety was not found to be protective for low-income African American suicidality. Clearly, more research is needed to understand whether socioecological factors may provide some protection against lowincome African American suicidality.
Overall, there is a large dearth of information on protective factors for low-income African American adolescent suicidality. The five identified studies provide some information about possible protective factors, but more research must be completed to have a more informed understanding of factors that mitigate suicidality for this vulnerable population. Further, given the lack of resources available to these youth, future research may wish to focus effort on identifying what resources are needed to help promote suicidality protective factors.
Other study limitations involve multiple articles reporting on datasets from the same study. Six studies utilized data from the longitudinal, multi-wave National Longitudinal Study of Adolescent Health (i.e., Add Health study) [2,3,17,28,34,50]. The study was initiated in 1994 and assessed health status, risk behaviors, and social contexts of adolescents from 132 middle and high schools, their parents, friends, schools, and neighborhoods [28]. None of the six studies utilized exactly the same subsamples of Add Health U.S. representative adolescents; although, it was not always clearly indicated from which year/wave data was being used. Similarly, two of the articles that assessed protective factors for urban African American youth utilized data from the same dataset [46,47]. In the case of the studies by O’Donnell and colleagues, it meant that only four different samples of urban African American youth were assessed for factors pertaining to suicidality [46,47]. This highlights the need for more suicidality protective factor research among urban African American youth. Additionally, although it is common for the same dataset to be used in more than one study, it may limit the generalizability of findings.
Different assessment measures of key constructs represent additional study limitations. Although many of the reviewed studies assessed the same constructs, in some cases, they employed different measures to assess these constructs. For example, studies utilizing the Add Health data assessed both suicidal ideation and suicide attempts with single items. Suicidal ideation and number of suicide attempts within the past year were reported [28]. Joe and colleagues assessed suicidality through the World Health Organization Composite International Diagnostic Interview (CIDI) [33]. The CIDI assessed suicidal ideation, plan, and attempt within the past year and lifetime. Fitzpatrick and colleagues measured only suicide attempt by a single, dichotomous-response item: “Have you ever tried to kill yourself?” Still other studies utilized different composite measures to assess suicidality [16]. Given that the assessment measures often define the construct, utilizing a variety of measures/items may lead to a variety of operational definitions for various constructs. For example, suicidal thoughts and behaviors may refer to ideation and attempts for some studies, or suicidal ideation, plans, and attempts for others.
The present study identified numerous protective factors; however, there is only a modest amount of literature available that assessed protective factors for African American youth suicidality. Further, there is a dearth of literature involving current data. More research is needed, particularly among low-income, urban African American adolescents, to identify factors that protect against suicidality, in order to inform future prevention/intervention programs, policies, and treatment for these vulnerable youth.
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