Understanding the Role of Structural Oppression for Suicide Risk among Black Sexual and Gender Minority Adolescents and Young Adults

PROJECT SUMMARY/ABSTRACT Black sexual and gender minority (SGM) adolescents and young adults (AYA) face profound and increasing suicide inequities. Evidence indicates differences in individual risk factors (e.g., mood disorders, substance use) do not account for these suicide inequities. As such, there is a need to move beyond models of individual- level causes of population-level inequities to identify and intervene upon the socio-structural drivers of suicide among Black SGM AYA. Specifically, longitudinal research is needed to highlight sources of structural racism, anti-SGM stigma, mental health stigma, and their intersections that affect suicidal thoughts and behaviors (STBs) among Black SGM AYA, and to translate these findings into public health policy intervention. We are submitting this application in response to RFA-MH-22-140 Understanding Suicide Risk and Protective Factors among Black Youth (R01). We propose to build from an existing infrastructure supporting our U.S. national U- award study (UG3AI169655), to enroll a national cohort of 1,000 Black SGM from ages 16 to 24, which would be one of the largest Black SGM AYA national cohorts of its kind. We will use a combined approach to recruitment (e.g., digital recruitment techniques, school-based recruitment) that capitalizes on community-, school-, and internet-based networks maintained by our community collaborators. Participants will complete a web-based survey annually for three years that assesses STBs, microsystemic suicide precursors (interpersonal risk factors [thwarted belongingness, perceived burdensomeness], suicide prevention resources [access to psychotherapy, access to community-based SGM support]), STB correlates (e.g., interpersonal stigma, anxiety, substance use), and key sociodemographic and contextual variables. In tandem with study enrollment, our multidisciplinary team of oppression and suicide researchers, psychological care providers, policy experts, and community-based collaborators will develop a database of novel quantitative structural oppression metrics (e.g., state-level policy and social climate indicators), including developmentally-specific forms of structural racism, anti-SGM stigma, mental health stigma, and their intersections that target Black SGM AYA (Aim 1). We will subsequently utilize these metrics and the longitudinal follow-up data to test whether there are direct associations from structural oppression to later STBs (Aim 2). We will also use these data to test indirect associations from structural oppression to STBs through increased interpersonal suicide risk factors (thwarted belongingness, perceived burdensomeness; Aim 3a) and decreased access to suicide prevention resources (psychotherapy, SGM AYA social services; Aim 3b). Developing and testing a socio- structural model of suicide risk meets the calls of the 2019 Congressional Black Caucus Taskforce “Ring the Alarm” report and has strong potential to move the field beyond individual-level models of risk to support the structural change that will help to reduce population-level Black SGM AYA suicide inequities.