Understanding the Role of Mental Healthcare Access and Availability for Suicide Risk among Adolescents & Young Adults

PROJECT SUMMARY Black adolescents and young adults (AYA) face profound and increasing suicide rates. Evidence suggests that differences in individual risk factors (e.g., mood disorders, substance use) do not account for these trends. Longitudinal research is needed to highlight whether mental healthcare access and availability may be driving increases in Black AYA suicide risk, including suicidal thoughts and behaviors (STBs), and to translate these findings into public health interventions for U.S. American AYA. We propose to build from an existing infrastructure supporting our U.S. national U-award study, to enroll a cohort of 1,000 Black AYA from ages 16 to 24 in the U.S. and Puerto Rico. We will use a combined approach to recruitment (e.g., digital recruitment techniques, community partner networks) that is adaptive to known shifts in digital technology and capitalizes on community-, school-, and internet-based networks maintained by our collaborators. Participants will complete a web-based survey at enrollment and annually thereafter for two years that assesses STBs, established microsystemic suicide precursors (interpersonal risk factors [thwarted belongingness, perceived burdensomeness], local suicide prevention resources [access to psychotherapy, health services]), STB correlates (e.g., stress, anxiety, substance use), and key sociodemographic (e.g., age) and contextual variables. Concordant with study enrollment, our multidisciplinary team of researchers, care providers, and public health experts will develop novel metrics to quantify mental healthcare access and availability for Black adolescents and young adults (Aim 1). We will subsequently utilize these metrics and the longitudinal follow-up data to test whether there are direct associations from mental healthcare access and availability for Black adolescents and young adults to later STBs (Aim 2). We will also use these data to test indirect associations from mental healthcare access and availability for Black adolescents and young adults to STBs through increased interpersonal suicide risk factors (thwarted belongingness, perceived burdensomeness; Aim 3a) and decreased access to local suicide prevention resources (psychotherapy; AYA health services Aim 3b). The proposed study will provide evidence to develop and disseminate recommendations to reduce suicide among all U.S. American AYA by identifying risk and prevention factors among one of the groups at highest risk for suicide: Black AYA.