Racial/ethnic differences in risk of suicidal ideation and suicide attempts in a nationally representative sample of US adolescents

Background: Suicidal ideation (SI) and suicide attempts (SA) are risk factors for suicide which peak during adolescence; however, evidence focused on differences in SI and SA risk among racial/ethnic minority youth is limited despite increasing suicide rates among several racial/ethnic minority groups. Methods: We analyzed a representative sample of adolescents aged 12-17 with prior depressive symptoms (n = 32,617) from the cross-sectional National Surveys on Drug Use and Health (2008-2019). Survey-weighted adjusted logistic regressions estimated the association of race/ethnicity with self-reported lifetime SI and SA, controlling for sociodemographics, lifetime substance use, lifetime major depressive episode, and self-rated health. Results: Compared to white adolescents, Black and Hispanic adolescents had a 2.5 % (p = 0.04) and 4.2 % (p < 0.001) lower likelihood of reporting SI. However, among participants reporting SI, Black and Hispanic adolescents had a 3.2 % (p = 0.03) and 3.1 % (p = 0.03) higher likelihood of reporting SA than white adolescents. Multiracial adolescents were 5.9 % (p = 0.03) more likely to report SA than white adolescents. Limitations: Although racial/ethnic minority groups are less likely to self-report mental health symptoms, we could only assess SI/SA among adolescents self-reporting prior depressive symptoms, and we could only assess SA among adolescents self-reporting SI due to survey methods. Conclusions: Variation in the racial/ethnic distribution of suicidality supports theories conceptualizing separate pathways for SI and SA. This underscores the need for greater attention to racial/ethnic differences in suiciderelated research, surveillance, and prevention efforts, including ensuring that mental health risk assessments directly evaluate SA in addition to SI in order to better identify high-risk racial/ethnic minority youth.