Cultural Consensus Modeling to Identify Culturally Relevant Risk Factors for Suicide among Black Youth

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ABSTRACT Between 1991 and 2017 there was a 73% increase in suicide attempts among Black youth. Black youth <13 are twice as likely to die by suicide compared to White peers. Theoretical models (e.g. Interpersonal-Psychological Theory of Suicide; IPTS) and the interventions they inform have largely utilized non-Black, non-youth, samples, limiting their relevance for Black youth. Our team, which include two Black early career researchers will be the first to make use of a rigorous, multi-method, ethnographic approach, namely Cultural Consensus Modeling (CCM), to give direct voice to the reasons for suicidal thoughts and behaviors in Black youth, ages 11-17, in the form of cultural models generated by Black youth themselves. We will then evaluate cultural models for their association with more traditional suicide predictors derived from IPTS (perceived burdensomeness, thwarted belongingness, acquired capability), in addition to variables related to social injustice, in particular racial discrimination. Guided by a conceptual framework that integrates IPTS and Intersectionality, our central hypothesis is that derived cultural models will point to the importance of redefining IPTS variables through the lens of racial discrimination. The CCM methodology is iterative in nature with initial study phases informing subsequent phases, verifying and further testing derived cultural models. Aim 1 will recruit 50 at-risk Black youth (50% female), as determined by past suicidal ideation or behaviors and moderate-severe depression scores. Making use of “free listing” CCM methodology, youth will be asked to identify risk factors (common reasons) for suicidal thoughts and behaviors among peer Black youth. We hypothesize that Black youth will generate IPTS-related motivations for suicide as well as motivations related to racial discrimination. Aim 2 will recruit a new sample of 100 at-risk Black youth (50% female) who will rate the culture-relevance of factors generated in Aim 1 on a 5-point likert scale. We hypothesize that more than one cultural consensus model (clusters) will emerge given expected heterogeneity (sub-cultures) in the population. Aim 3 will utilize a subset of participants (N=25; 50% female) who completed Aim 2 to represent each identified cultural model from Aim 1. Qualitative interviews will be conducted to gather in-depth information on each cultural model. Informed by the results of Aims 1-3, Aim 4 will recruit a new sample of 200 at-risk Black youth (50% female), alongside measures of IPTS and racial discrimination to test the hypotheses that (1) cultural models will map well onto own reasons for suicidal thoughts and behaviors; (2) cultural models will align with individual differences in IPTS and racial discrimination, and that (3) models that align with racial discrimination will most strongly predict suicide severity, pointing to the importance of redefining IPTS variables through the lens of racial discrimination. The proposed work responds to urgent calls for research on the risk factors for suicidal behaviors in Black youth and will, for the first time, provide empirically derived treatment targets for culturally relevant treatment adaptation of IPTS and other suicide prevention programs.