Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States

Abstract

Context: Lack of data on the lifetime prevalence and age at onset of suicide ideation, plans, and attempts among blacks in the United States limits the creation and evaluation of interventions to reduce suicide among black Americans.

Objective: To examine the prevalence and correlates of suicide ideation, planning, and attempts across 2 ethnic classifications of blacks in a nationally representative sample.

Design, setting, and participants: Data are from the National Survey of American Life, a national household probability sample of 5181 black respondents aged 18 years and older, conducted between February 2001 and June 2003, using a slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Bivariate and survival analyses were used to delineate patterns and correlates of nonfatal suicidal behavior.

Main outcome measures: Self-reports of lifetime suicide ideation, planning, and attempts.

Results: Survey respondents, categorized as African Americans and Caribbean Americans, reported lifetime prevalence of 11.7% for suicide ideation and 4.1% for attempts. Among the respondents who reported ideation, 34.6% transitioned to making a plan and only 21% made an unplanned attempt. Among 4 ethnic-sex groups, the 7.5% lifetime prevalence for attempts among Caribbean black men was the highest among black Americans. The greatest risk of progressing to suicide planning or attempt among ideators occurred within the first year after ideation onset. Blacks at higher risk for suicide attempts were in younger birth cohorts, less educated, Midwest residents, and had 1 or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders.

Conclusions: This study documents the burden of nonfatal suicidality among US blacks, notably Caribbean black men, and individuals making planned attempts. Advancing research on the transition from suicide planning to attempt is vital to the efficacy of health care professionals' ability to screen blacks at risk for suicide.

Figure 1. Age of Onset of Lifetime Suicide Ideation, Plan, and Attempt Among Blacks (n=5002)

The smoothed hazard functions describe the ways in which the onset risks of the 3 suicidal behaviors change with time. For all behaviors, the highest risk occurs from the teenage years to the mid-twenties. From the mid-twenties, the risks generally decline gradually with the exception of a slight increase from the mid-forties to mid-fifties. Notice that the risk of attempting suicide is slightly higher than the risk of making a suicide plan until approximately age 19 years, when the 2 hazard curves cross. This suggests that nonplanned, impulsive attempts are more likely than planned attempts up to this point in young adulthood.

Figure 2. Conditional, Cumulative Speed of Onset From Ideation to Suicide Plan, Impulsive and Planned Attempt Onset (n=542)

The x-axis represents time in years from the first onset of suicidal ideation. The y-axis represents the event-free survival probability. For example, among ideators with a suicide plan, the probability of not attempting suicide decreases to less than 50% in the first 2 years after ideation onset. The probability of remaining attempt-free continues to decrease gradually until 35 years after ideation onset. At this point, only approximately 25% of individuals who made a suicide plan have not made an attempt, while 75% have attempted. Contrast this with the ideators who did not make suicide plans. After a sharp decrease in the first year after ideation onset, the respondents’ probability of remaining attempt-free stabilizes at about 80%.

Figure 3. Age of Onset of Lifetime Suicide Attempt Among Blacks by Ethnicity and Sex (n=5002)

These smoothed hazard functions describe the ways in which the risk of first suicide attempt changes with time for the 4 sex-by-ethnicity groups. As in Figure 1, the greatest risk generally occurs during the teenage years to the mid-twenties. African American men are at notably lower risk of making an attempt than the other 3 groups until their mid-20s and actually become the group most at risk after approximately age 34 years. Caribbean black men are most at risk up to this age.