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

摘要 从1991年到2017年，黑人青年的自杀企图增加了73%。黑人青年<13是 自杀的可能性是白色同龄人的两倍理论模型（如人际心理模型） 自杀理论; IPTS）和他们所告知的干预措施在很大程度上利用了非黑人，非青年，样本， 限制了他们对黑人青年的关注。我们的团队，其中包括两个黑人早期职业研究人员将是 第一，利用严格的，多方法，人种学的方法，即文化共识建模 (CCM)，直接说出11-17岁黑人青年自杀想法和行为的原因， 黑人青年自己创造的文化模式。然后，我们将评估文化模式， 他们与来自IPTS的更传统的自杀预测因子（感知负担， 挫折的幸福感，获得的能力），以及与社会不公正有关的变量，特别是 种族歧视在集成IPTS和交叉性的概念框架的指导下，我们的中心 假设是，衍生的文化模型将指出重新定义IPTS变量的重要性， 种族歧视的透镜。CCM方法本质上是迭代的，初始研究阶段提供信息 随后的阶段，验证和进一步测试衍生的文化模型。目标1将招募50名处于危险中的黑人 青年（50%女性），根据过去的自杀意念或行为和中度至重度抑郁症确定 成绩.利用“自由列表”CCM方法，将要求青年人确定风险因素（常见的 原因）自杀的想法和行为之间的同龄黑人青年。我们假设黑人青年 产生与IPTS有关的自杀动机以及与种族歧视有关的动机。目标2将 招募100名有风险的黑人青年（50%为女性）作为新样本，他们将对因素的文化相关性进行评级 在目标1中产生的5点李克特量表上。我们假设不止一种文化共识模型 如果群体中存在预期的异质性（亚文化），则会出现群体（集群）。目标3将利用一个子集 的参与者（N=25; 50%女性）完成目标2，以代表Aim中确定的每个文化模型 1.将进行定性访谈，以收集关于每种文化模式的深入信息。通知 目标1-3的结果，目标4将招募一个新的样本， 200 面临风险的黑人青年（50%为女性）， IPTS和种族歧视的措施，以测试假设（1）文化模式将映射到 自杀想法和行为的原因;（2）文化模式将与个体差异保持一致， IPTS和种族歧视，以及（3）与种族歧视相一致的模型将最强烈地预测 自杀严重程度，指出通过种族透镜重新定义IPTS变量的重要性 歧视这项拟议的工作是对研究自杀风险因素的紧急呼吁的回应。 黑人青年的行为，并将首次提供经验性的治疗目标， IPTS和其他自杀预防计划的相关治疗适应。

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.