Why effective suicide-risk assessment might look different for Black children

Black adolescents have been found to have higher rates of suicide compared to their white counterparts. So how might effective suicide-risk assessment need to look different for this cohort? There are specific considerations physicians should have when screening, treating and de-escalating crises for the Black children they treat, said Dr. Olabode Akintan, child and adolescent psychiatrist, in a presentation at the Black Physicians’ Association of Ontario’s mental health professional development day in May. “It’s important for you to come from a place of humility and be willing to learn about a person,” said Dr. Akintan. That’s because there are multiple risk factors, in addition to those potentially true of any child—mental health disorders, substance abuse, family history of suicide—that put Black youth at risk of suicide. Racial discrimination, socioeconomic disparities and cultural factors can often be overlooked when assessing a Black children specifically. Many of these culturally specific risk factors can be met with protective factors, like promoting a strong cultural identity and a connection to their community, that can help mitigate the risk of suicide among Black youth, he said. When it comes to a connection to their community, Dr. Akintan says it’s important for physicians to remember that ‘family’ to a Black child may not fit a preconceived conception of a nuclear household.“You have to ask the child what their definition of family is. It could be a grandmother, aunt or cousins that care for the child. And you have to speak with who will support them,” Dr. Akintan said. Trauma, a risk factor for suicide in youth in the general population, can also result from different life experiences for a Black child versus their white counterpart, according to Dr. Akintan, who stressed the importance of maintaining trauma-informed perspective.For physicians, that trauma-informed perspective means considering that racism is traumatizing. Dr. Akintan also says physicians should consider the impact of past traumas on a patient’s current mental health and suicide ideation and to recognize the disparities in experience of facing authority. “When you work with Black youth, there are going to be times when even if they see you, they might not believe you. When they walk in, they may be apprehensive about you already and that you may not know their story,” said Dr. Akintan, “You have to lean in and show them that you’re willing to learn.” Crisis de-escalation strategies“In some cultures, terms like ‘depression’ and ‘suicidal’ are not terms that would fit in a person’s vocabulary, or that a patient of a certain culture might use to self-describe, so physicians should be aware of that,” said Dr. Akintan. It’s important to remember that some patients may not be able to describe what they’re experiencing in psychiatric terms, but are presenting somatic symptoms—like abdominal pain—that accompany common psychiatric markers like insomnia, or a change in mood.“Your patient may meet the criteria for depression, they just won’t call it that,” he said.This could also make it difficult when interviewing a child, he said, since “there may be no documented family history of mental illness, because it is not culturally acceptable”. With patients who come from cultures that don’t accept the reality of mental illness, he said he often refrains from using psychiatric language. “I’ve treated many patients that have abdominal pain that’s preventing them from going to school with Prozac, the anti-depressive. When it comes to follow-up visits, my question may not be, ‘how’s your depression or anxiety’, but ‘how’s your stomach feeling’,” said Dr. Akintan. Cultural competence is essential in suicide risk assessment, he emphasized, and also in crisis de-escalation strategies.Collaborate with your patient and use clinical judgement, he said, along with the standard screening tools—the Pateint Health Questionnaire for Adolescents (PHQ-A), the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Ask Sucide-Screening Questions (ASQ)—when treating Black patients. “Use the screening tools to inform you, not to lead you,” he said. Globally, an estimated 1.1 million adolescents die each year, according to the World Health Organization. After accidents, suicide is the second leading cause of death for people aged 15 to 24. In 2018, suicide was the leading cause of death for children aged 10 to 14. Suicide rates among Black youth in the U.S. have grown at an alarming rate. From 2000 to 2020, Black youth aged 10 to 19 experienced a 78% increase in suicide rates, and from 2018 to 2021, suicide rates among Black youth aged 10 to 24 increased 37%, the largest increase in suicides among any other ethnic group.

Why effective suicide-risk assessment might look different for Black children

Register for free access or login.

Related Topics