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. Author manuscript; available in PMC: 2024 Apr 29.
Published in final edited form as: J Black Psychol. 2023 Aug 31;49(3):404–429. doi: 10.1177/00957984211061920

Associations Between Family Factors, Social Integration, and Suicidal Ideation Across the Life Course of an Urban African American Cohort

Munjireen S Sifat 1, Charlene Kuo 1, Jee Hun Yoo 1, Sharifah Holder 1, Kerry M Green 1
PMCID: PMC11056940  NIHMSID: NIHMS1987626  PMID: 38686022

Abstract

Suicide is a problem on the rise but not studied extensively among African Americans. It is critical to identify risk factors for suicidal ideation to reduce risk. This study examines whether family and social factors over the life course predict suicidal ideation among African American adults in midlife. We conducted multiple logistic regression analyses on data from a longitudinal cohort of African Americans first assessed in childhood to identify associations with suicidal ideation in midlife (ages 33–42). Findings suggested living without one’s mother in childhood (vs. living with mother alone; aOR = 3.69, p = .017) and parental rule-setting in adolescence (aOR = 0.79, p = .047) were associated with suicidal ideation. Having a lifetime drug disorder (aOR = 2.19, p = .046) or major depression by young adulthood (aOR = 3.58, p < .001) was also associated with an increased risk of suicidal ideation. Findings highlight the importance of intervention for children in mother-absent homes for improving mental health outcomes. Family interventions that promote parental rule-setting and addressing drug problems and depressive symptoms early in the life course offer an area for intervention to reduce suicide over the long term.

Keywords: suicide, family systems, mental health, child development, substance abuse

Suicide is a major contributor to the decreasing life expectancy of Americans generally (Xu et al., 2018), and African Americans in particular (Curtin & Hedegaard, 2019). Suicide has become the second leading cause of death for African American adolescents, with rates of suicide increased by 60% for males and 82% for females from 2001 to 2017 (Price & Khubchandani, 2019). Among African American adults (ages 25–64), rates of suicide deaths increased by 17.7% from 2008 to 2016 (Woolf et al., 2018). National data have shown an increase in suicide deaths in all age groups over the last 20 years (Curtin & Hedegaard, 2019), with rates exceptionally high during middle age (19.58/100,000, ages 45–64) compared to all ages (14.48/100,000; (Centers for Disease Control and Prevention [CDC], National Center for Health Statistics, 2020). In 2017, for ages 35–44, suicide was the fifth leading cause of death in Black men and 9th in Black women (Heron, 2019).

Even more prevalent than death by suicide are suicidal attempts and suicidal ideation. For every death by suicide, it is estimated that there are approximately 25 suicide attempts (Brickman & Mintz, 2003; Walker & Flowers, 2011). In 2017 alone, 68,528 African American males and 94,760 African American females made suicide attempts severe enough that they had to be treated by health professionals (Price & Khubchandani, 2019). Studies have suggested a sequential and robust relationship between suicidal ideation, suicidal attempt, and death by suicide (Bebbington et al., 2010; Compton et al., 2005; Tejedor et al., 1999). For example, most suicide deaths occur among those with a prior history of suicidal ideation or attempts (Compton et al., 2005; Tejedor et al., 1999). In a national psychiatric morbidity study conducted in Britain, Bebbington et al. (2010) found a hierarchical relationship between elements of suicidality in the following manner: exhaustion with life, suicidal ideation, and attempted suicide. The strong link between suicidal ideation, suicide attempts, and death highlights the need to identify modifiable factors, such as social integration and family support, that, when addressed, can interrupt this pathway, and reverse the alarming trends in suicide.

Much of the research about suicide prevention in the United States has overlooked racial minority populations (Odafe et al., 2016), highlighting the need to identify and address risk and protective factors specific to the African American population (Compton et al., 2005; Shervington, 2000). Although there is evidence suggesting that African Americans have a different developmental trajectory to suicide than Whites (Crosby & Molock, 2006; Robinson et al., 2016; Walker et al., 2006), this issue has not been studied extensively. African Americans, on average, face greater risk factors for suicide than Caucasians across the life course. Such risk factors include social and contextual factors, such as community deprivation and stigma (Crosby & Molock, 2006; Jones-Eversley et al., 2020; Singh & Siahpush, 2014). On average, African Americans are more frequently exposed to violence, and traumatic stress (Droege et al., 2017; Morrison & Downey, 2000), yet are less likely to seek mental health treatment for depression or suicidal ideation than Caucasians (Balis & Postolache, 2008; Wang et al., 2016). The focus on modifiable risk factors specific to African Americans is necessary to improve prevention programming efforts. Two important risk factors for suicidal ideation that need further examination are the lack of social support and lack of social integration (Miller et al., 2015, 2017).

Theoretical Approach

Durkheim’s (1951) theory of social integration helps explain suicidal behaviors. Durkheim (1951) indicates that one’s sense of belonging to a community provides meaning and purpose in life to prevent depression and suicidal thoughts. Social integration can happen through roles, such as marriage or employment, voluntary activities, or bonds to friends or family. Social integration has been shown to protect against physical and mental health problems (Cohen, 2004). For example, a study of urban African American mothers found that those who continuously engaged in their community had lower anxiety and depression (Fothergill et al., 2011). In an earlier analysis of predictors of suicidal ideation using the Woodlawn dataset used in the current study, Juon and Ensminger (1997) examined if social integration in childhood, adolescence, and young adulthood related to suicidal behaviors at age 32. Examining residential mobility, school bonds, family involvement, marital status, employment, and church attendance, they found that high-risk family structure at age 6 and being unmarried predicted suicidal behaviors in young adults. The present study extends these findings by examining suicidal ideation in midlife (age 42) and including additional life course family factors.

Related to Durkheim’s (1951) notion of social integration is attachment theory (Ainsworth & Bowlby, 1991; Bowlby, 1988) in which early maternal attachment is thought to promote later social integration. Attachment theory arose to understand the impact of maternal loss or deprivation on a child’s later personality development and sense of security. The basis of attachment theory is that family factors play a critical role in a child’s mental health (Ainsworth & Bowlby, 1991). Attachment to the family has been measured by focusing on a child’s bonding with parents and family communication (Bowlby, 1988). Parental bonding comprises broadly of parental care (including affection and warmth) and parental over-protection, which includes control (Raudino et al., 2013). Positive parenting factors are expected to enhance children’s self-worth, emotional regulation, and social integration, thereby enhancing developmental assets that increase the child’s resilience (Bretherton, 1992; Chen et al., 2019), whereas negative parenting factors, such as being unsupportive or neglectful, inhibit a child’s emotional regulation, social competency, and neurological functioning, all of which are associated with poor health later in life (Elstad, 2005; Felitti et al., 1998).

Empirical Findings

Empirical evidence further has supported the conclusion that family and social factors contribute to the development of mental health problems and suicidality at various points in the life course (Chang et al., 2017; Opara et al., 2020), including in African American families (Droege et al., 2017; Odafe et al., 2016). Odafe et al. (2017) examined the role of social support as a moderator between the association of race-related stress and hopelessness in a sample of African American adults (N = 243). Social support was negatively associated with hopelessness. They also found that self-esteem and social support buffered the role of race-related stress on self-reported hopelessness, a common risk factor for suicide ideation. Matlin et al. (2011) surveyed 212 adolescent African Americans to examine family and social factors associated with depression and suicide. They found that increased social support from family and peer groups was associated with decreased suicidality (Matlin et al., 2011). Social integration factors, such as peer support and community connectedness, were associated with depressive symptoms and suicidality (Matlin et al., 2011).

The National Survey of American Life (NSAL) is a cross-sectional survey that has been used to assess associations with suicidal ideation among African Americans. Over 3500 African American adults were surveyed, and of them, 4% reported a lifetime suicide attempt (Chatters et al., 2011). Chatters et al. (2011) found that perceived emotional support from others was associated with lower odds of suicidal ideation and attempts. Chatters et al. (2017) also found that frequency of contact with a church and family members and emotional support from family was inversely associated with depressive symptoms, while negative church and family interactions were positively associated with depressive symptoms. Lincoln et al. (2012) also used the NSAL dataset to examine both positive and negative family factors associated with suicidal behavior. They found that higher levels of negative interactions with family members (family members make too many demands, criticize, and try to take advantage of you) were associated with higher risks of suicidal ideation and attempt. In contrast, those who reported higher levels of emotional support from their family (family makes you feel loved and cared for, listens to you talk about your private problems and concerns, and express interest in your well-being) had decreased risk of suicide attempt and ideation (Lincoln et al., 2012). Hollingsworth et al. (2016) found that African Americans in their sample who have a high sense of thwarted belongingness, defined as “feelings of social disconnection and the feeling that one does not belong to a group of people, and includes feelings that care is not being reciprocated from others” are more likely to experience suicidal ideation (p. 176). The authors emphasize the need to focus on protective factors to build resiliency in African American youth.

Evidence has also indicated that family factors may not operate only at one point in time. Instead, early family factors may have long-term effects on mental health outcomes, including suicidal ideation (Chen et al., 2019; Raudino et al., 2013). For example, a longitudinal study in New Zealand found that the quality of parent–child relations in childhood affected psychosocial functioning in early adulthood (Raudino et al., 2013). Similarly, family affection and parental warmth (both considered parental bonding indicators) in childhood have been associated with increased flourishing, decreased drug use, and lower depression rates in midlife (Chen et al., 2019). Family support, including parental care, protection, and attachment, in adolescence has been found to have an inverse relationship with suicidal ideation and attempt at age 30 (Lizardi & Klein, 2005; Raudino et al., 2013).

Current Study

There is an accumulation of evidence that positive family factors are protective against suicidal ideation, but few longitudinal studies have focused on African Americans, limiting understanding how family factors throughout the life course influence mental health outcomes through midlife. Given the rise of suicide rates among African Americans (Brickman & Mintz, 2003), it is of critical importance to identify factors early in the life course that can serve as targets of prevention programs. This study examines whether family (based on attachment theory) and social integration (based on Durkheim’s (1951) theory) factors in earlier life stages are protective of suicidal ideation in midlife among an urban African American cohort. We focused on (a) family structure in childhood; (b) family attachment, family affection, family involvement, and parental control in adolescence; and (c) social roles and bonds in young adulthood. The overall research question is, “What family factors and indicators of social integration over the life course impact African Americans’ risk of suicidal ideation in midlife?”

Our hypotheses are as follows.

  • Hypothesis 1: Children who grow up in families absent a maternal figure would have an increased risk of suicidal ideation in midlife compared to those who grow up in other family types.

  • Hypothesis 2: Adolescents with higher family involvement would have a decreased risk of suicidal ideation in midlife.

  • Hypothesis 3: Adolescents with higher family affection would have a decreased risk of suicidal ideation in midlife.

  • Hypothesis 4: Adolescents who experienced greater parental rule-setting would have a decreased risk of suicidal ideation in midlife.

  • Hypothesis 5: Young adults with a greater number of social roles would have a decreased risk of suicidal ideation in midlife.

  • Hypothesis 6: Young adults with a greater number of social bonds would have a decreased risk of suicidal ideation in midlife.

  • Hypothesis 7: Young adults with a higher level of family support in young adulthood would have a decreased risk of suicidal ideation in midlife.

Method

Participants and Procedures

This study is based on data from the Woodlawn Study, a community cohort study of urban African Americans who were first assessed in first grade in 1966 (N = 1242). Woodlawn is one of Chicago’s 76 community areas. At the time, 99% of the community’s residents were African American but had a mix of socioeconomic backgrounds due to residential segregation (Council for Community Services in Metropolitan Chicago, 1975). In the original study, all first graders in any of Woodlawn’s public or private schools were invited to participate in the study; only 13 families declined, reducing selection bias. The initial population had 606 boys and 636 girls.

The baseline assessments were conducted by interviewing mothers and teachers regarding the first-grade students. Follow-up assessments were conducted when the participants reached adolescence (age 16, 1976–1977), interviewing both mothers (n = 939) and youth (n = 705). This second assessment was followed by interviews in young adulthood (n = 952, age 32, 1992–1993) and in the latest wave of midlife (n = 832, age 42, 2002–2003). By age 50, 11% of participants had passed away, as confirmed by National Death Index data. Extensive attrition analyses are documented in past literature (Crum et al., 2006; Doherty et al., 2008). The total sample size for this paper is n = 825. Eighty-eight percent of the first graders attended public school while 12% attended parochial school. Over half of cohort members’ mothers completed high school (58%). On average, participants lived in households with five other individuals. The analytic sample was nearly even in gender (55.0% female) and childhood poverty index (52.2% below federal poverty line).

Measures

This study draws on measures from all waves of the study: childhood (age 6), adolescence (age 16), young adulthood (age 32), and midlife (age 42).

Outcome Variable

Participants were considered to have midlife suicidal ideation (age 42) if they answered “yes” to either of the following verbatim questions from the Composite International Diagnostic Interview (CIDI) module for depression “have you thought about committing suicide,” or, “have you ever made a suicide plan” (Wittchen & Kessler, 1994). All participants were asked these questions regardless if they were screened into the depression module. The final binary outcome of suicidal ideation was operationalized as either “yes” (1) the respondent made a suicide plan or had thought about suicide, or “no” (0) if they did not experience either of those.

Predictors

Childhood.

We created the family structure construct based on household rosters at the age six assessment with four categories: (a) mother without another adult in the household (mother alone = 0), (b) both a mother and father in the home (= 1), (c) a mother and another adult other than the father in the home (= 2), and (d) home in which the mother was absent (= 3, see Kellam et al., 1977). Poverty status was dichotomized based on the mother reported household income falling below the poverty line at the first data collection point in 1966 (0 = not below the poverty level, 1 = at or below the poverty level). Gender was dichotomized into female (= 0) or male (= 1).

Adolescence.

All measures in adolescence were developed by Kellam et al. (1977), a number of measures were developed specifically for the Woodlawn project, and as such we are unable to provide reliability and validity statistics from other studies unless otherwise noted. Family affection was an average of adolescents’ ratings of their family on five items which asked how often the family (a) acts loving and warm to one another, (b) hugs and kisses, (c) understands each other’s moods, (d) brings gifts, and (e) says nice things to one another. This item has demonstrated convergent and divergent validity with family involvement and family communication (see Doherty et al., 2008). Ratings were on a 6-point scale, with 1 being less than every few months to 6 being several times a week (α = .75).

Family involvement was measured by averaging answers to five questions about spending time with the family, such as going out with the family for entertainment, playing sports or other recreation with the family, doing things around the house with the family, working on homework with family members, and going to community activities with the family. This measure has demonstrated convergent and divergent validity with family communication and family affection (Doherty et al., 2008), convergent validity with school involvement (Fothergill et al., 2016) and predictive validity with suicidal behaviors (Juon & Ensminger, 1997).

Parental rule-setting was measured by averaging three items that asked about the rules that parents set for their children regarding alcohol, cigarettes, and drugs (α = .63). Principal components analysis finds the three measures load onto a single factor (see Doherty et al., 2008). This measure has demonstrated predictive validity regarding future substance use (Doherty et al., 2008). The response to each of these questions ranged from left up to the child (1) to forbidden (6).

Adolescent depressive symptoms were six self-report items measuring symptom frequency (1 = never, 6 = very much). Items included how often adolescents feel sad, feel hopeless, cry and do not know why, feel ashamed of myself, feel guilty, and think people would be better off without them (α = .69). Psychometric examination of this measure of depressive symptoms showed high convergent validity with psychopathology and discriminant validity with self-esteem (Petersen & Kellam, 1977).

Young Adulthood.

In young adulthood, constructs were created to evaluate the participant’s number of social roles and the extent of social bonding. Social roles were examined by creating a count of the number of social roles. To do so, we summed whether one was employed, was a parent, or was married, resulting in a 0–3 count variable (0 = no social roles, 1 = having one of the three social role, 2 =have two out of the three social roles 3 = having all three social roles). This measure shows predictive validity to future social roles and has previously been shown to predict substance use trajectories (Ensminger et al., 2016).

Social bonds were measured by examining whether participants were involved in either secular (i.e., church participation) or non-secular organizations (i.e., belonged to a social non-religious organization). A sum was created of the number of types of social bonds participants had (0 = no social bonds, 1 = one secular or non-secular social bond, 2 = both secular and non-secular social bonds). The measure has concurrent validity with the measure of social roles (r = .28, p < .001), and predictive validity of social roles at midlife (r = .38, p < .001). Religious and non-religious social organizational participation have been shown previously to predict substance use (Ensminger et al., 2016).

Family support in young adulthood was measured based on the number of different methods of support participants received from their families. Participants were asked whether they could turn to a family member if they (a) are sick, (b) need money, (c) are making an important decision, (d) are sad, and (e) had a fight with their friends. Responses were summed and resulted in a 0–5 continuous variable, with 0 meaning they could not turn to family members for any type of support and 5 meaning they were able to receive all these types of support from their family members (α = .78). This measure has predictive validity for family social support 10 years after the time of young adulthood measurement (r = .34, p < .001). This measure has previously been shown to be correlated with marital and employment status (Ensminger et al., 2009).

Young adult major depressive disorder was assessed using a module from the CIDI (Kessler et al., 1993), which followed criteria set by the DSM III-R criteria (American Psychiatric Association, 1987) for lifetime depression (0 = no depression, 1 = met criteria for lifetime depression). As reported by Kessler et al. (1998), the CIDI module for depression has good inter-rater reliability and test–retest reliability and good agreement with clinical diagnoses of major depressive disorder. The positive predictive value of CIDI was 0.65 for major depression. A kappa of .53 was computed when examining the validity between CIDI and SCID (Structured Clinical Interview for DSM-III-R; Spitzer et al., 1992).

Meeting lifetime criteria for a drug use disorder by young adulthood was also assessed using a module from the CIDI (Kessler et al., 1994, 0 = did not meet criteria for a drug use disorder, 1 = met criteria for a drug use disorder), which was based on DSM III-R criteria (American Psychiatric Association, 1987). This measure has been previously validated against clinical assessments and other instruments (Kessler et al., 1998) and shows excellent reliability (Cottler et al., 1991). For example, the positive predictive value of CIDI was 0.87 drug abuse, and the Kappa calculated between CIDI and SCID scores was between .39–.59 (Kessler et al., 1998).

Analytic Strategy

We expected all scales to be approximately normally distributed. We first described the sample in terms of variables of interest, providing means and percentages. Next, we calculated skewness and kurtosis. Following this, we examined a correlation matrix of study variables. We also analyzed the bivariate association of each variable with suicidal ideation using logistic regression. Next, using unadjusted logistic regression, we examined predictors of midlife suicidal ideation (yes/no) to provide estimates of the odds of suicidal ideation in midlife. We included all statistically significant variables across the four life stages from these unadjusted regression analyses, at a cutoff of p ≤ .20 (Hosmer & Lemeshow, 1989) in an adjusted logistic regression, to examine the cross-life stage model. This method minimized the number of variables included in a model, making the model more parsimonious (Hosmer & Lemeshow, 1989). Gender, poverty status, and family structure were included regardless of statistical significance to account for the influence of confounding variables, as previous scholars have recommended when examining predictors of suicidal ideation (Chatters et al., 2017; Juon & Ensminger, 1997). By adjusting for confounding variables, this model provided risk estimates. A priori alpha level was set at .05 and effect was reported using R2, which was provided for the adjusted logistic regression model to show the total variance explained. The estimated a priori effect size for this was .253–.314, as found in previous R2 reporting for the outcome of suicidal behavior in this cohort (Juon et al., 1997).

Results

Data Management

Analyses were conducted using the statistical package STATA (StataCorp, 2017). Missing data were accounted for using multiple imputations to address missingness on predictor variables; 40 datasets were imputed to maximize power and decrease bias. The total sample size for all analyses was 825, only using data from participants who responded to the outcome variable (7 participants interviewed at age 42 were missing the outcome variable). All skewness and kurtosis for predictor variables were in the acceptable range (Doane & Seward, 2011); there were no outliers. Scale reliability for predictor variables ranged from .63 to .78, as shown in Table 2. The analytic sample was nearly even in gender (55.0% female) and childhood poverty index (52.2% below federal poverty line). Of those with suicidal ideation, 60.9% were female, and among those without suicidal ideation, 54.8% were female, this was not a statistically significant difference (p = .330) based on bivariate logistic regression. During adolescence, participants rated their families to be moderately affectionate (M = 3.54, SD = 1.28, range = 0–6) and involved in their lives (M = 3.36, SD = 1.26, range = 1–6), meaning that families displayed affection to or were involved in the life of the participants between every 2 weeks to once a month, on average. Parents were somewhat restrictive in rule-setting regarding substance use (M = 4.11, SD = 1.44, range = 1–6), as a response of 6 indicated that participants were absolutely forbidden to partake in substance use and an answer of 1 indicated there were parental rules regarding this topic. Adolescents reported low levels of depressive symptoms (M = 1.97, SD = 0.94, range = 1–6).

Table 2.

Correlation Matrix and Descriptive Statistics of Variables.

1 2 3 4 5 6 7 8 9 10 11
1. Female versus Malea, b — <.01 .04 −.01 −.17** −.06 .02 −.02 −.04 .18** −.07
2. Poverty statusa, c — .09 .10* −.08* .08 −.04* −.04 −.05 −.07 .13**
3. Family affectiond,e — .58** −.02 − 1 −.01 .11 .11* <.01 .06
4. Family involvementd,f — .09 −.03 .03 .17* .12* .03 <.01
5. Parental rule-settingd,g — −.03 .16** .10* .08 −.07** .05
6. Depressive symptomsd, h — − 13** −.15* −.06 −.04 .10
7. Social rolesi,j — .27** .19** −.11** −.09**
8. Social bondingi,k — .13** −.09** .02
9. Family social supporti,l — <.01 <.01
10. Drug use disorderi,m — .16**
11. Major depressioni,n —
Range 0–1 0–1 1–6 1–6 1–6 1–6 0–3 0–2 0–5 0–1 0–1
M (SD) — — 3.54 (1.28) 3.36 (1.26) 4.11 (1.44) 1.97 (0.94) 1.70 (0.86) 1.23 (0.79) 4.14 (1.41) — —
Skew (SE) — — −0.255 (0.111) −0.013 (0.109) −0.389 (0.108) 1.339 (0.110) 0.112 (0.091) −0.426 (0.091) −1.619 (0.091) — —
Kurtosis (SE) — — −0.822 (0.221) −0.941 (0.217) −0.650 (0.216) 2.096 (0.220) −0.899 (0.181) −1.256 (0.182) 1.715 (0.182) — —
Reliability (α) — — .75 .69 .63 .69 — — .78 — —
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Note. N = 825.

a

Assessed in childhood (1st grade),

b

0 = Female, 1 = Male,

c

0 = not below the poverty level, 1 = at or below the poverty level,

d

Assessed in adolescence (age 16),

e

0–6 scale, higher number meaning more family affection,

f

1–6 scale with 1 = less than every few months and 6 = several times a week,

g

1–6 scale 1 = most lenient parental rules 6 = most strict parental rules,

h

1–6 scale, higher number meaning more depressive symptomology,

i

Assessed in young adulthood (age 32),

j

0 = no social roles, 3 = social roles,

k

0 = no social bonds, 1 = secular or non-secular social bond, 2 = both secular and non-secular social bonds,

l

0–5 scale with higher numbers meaning more family support,

m

, 0 = no drug disorder, 1 = met criteria for drug disorder,

n

0 = no depression, 1 = met criteria for lifetime depression.

*

p < .05,

**

p < .01, p-values are based on non-imputed data.

In young adulthood, participants, on average, assumed nearly two out of the three social roles (M = 1.70, SD = 0.86) and were involved in at least one organization (M = 1.23, SD = 0.79). Family social support was high (M = 4.14, SD = 1.41, range = 0–5), meaning that participants could turn to a family member for four out of five reasons (i.e., if they were sick, needed money, etc.,); 10.2% and 16.3% of the participants met the criteria for lifetime drug disorder and major depressive disorder, respectively.

As shown in Table 1, we report participant characteristics as well as whether these characteristics differed significantly between those who had suicidal ideation in midlife with those who did not have ideation. p-Values are based on unadjusted logistic regression. None of these participant characteristics, including poverty level and gender, differed by history of suicidal ideation in midlife (all p’s > .05). Most participating families reported being either mother-alone (36.6%) or mother-and-father (42.9%) families, while fewer reported having a mother and another adult other than the father (15.2%) or having the mother absent (5.3%). The primary caregivers in mother absent families were grandmothers (45.2%), non-relatives (27.3%), fathers only (13.1%), and aunts (11.9%). In midlife, 38.3% of the sample has either a GED or a high school diploma, 27.2% went to some college or had an associated degree, 23.4% did not have a high school diploma, and 11.1% had a bachelor’s degree or higher. Sixty-nine individuals (8.4%) reported having suicidal ideation during midlife.

Table 1.

Sample Characteristics by Suicidal Ideation, N = 825.

Total % Among Those with Suicidal Ideation Among Those without Suicidal Ideation p-value
Childhood
Female gender (%) 55.30% 60.90% 54.80% .330
Family structure (%)
 Mother alone 36.60% 31.90% 37.00% Reference
 Mother father 42.90% 43.50% 42.90% .547
 Mother, other adult 15.20% 14.50% 15.20% .798
 Mother absent 5.30% 10.10% 4.90% .060
 Below federal poverty line (%) 52.23% 52.31% 52.22% .988
Adolescence
 Family affection (1–6) 3.54 (1.28) 3.23 (1.28) 3.57 (1.27) .107
 Family involvement (1–6) 3.36 (1.26) 3.08 (1.22) 3.38 (1.35) .172
 Parental rule-setting (1–6) 4.11 (1.44) 3.67 (1.62) 4.15 (1.42) .027
 Depressive symptoms (1–6) 1.97 (0.94) 2.30 (0.93) 1.93 (0.93) .008
Young adulthood
 Social roles (0–3) 1.70 (0.86) 1.46 (0.74) 1.72 (0.86) .025
 Social bonding (0–2) 1.23 (0.79) 1.09 (0.79) 1.24 (0.79) .161
 Family social support (0–5) 4.14 (1.41) 3.64 (1.57) 4.19 (1.38) .003
 Drug use disorder (%) 10.16% 17.24% 9.45% .002
 Major depressive disorder (%) 16.32% 40.82% 13.88% <.001
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Note. p-values are based on bivariate logistic regression with suicidal ideation as the outcome as chi-square statistics are not available with imputed data.

Results showed higher mean levels of depressive symptoms (2.30 vs. 1.93, p = .008) and lower mean levels parental rule-setting (3.67 vs. 4.15, p = .027) among participants with suicidal ideation compared to those without ideation. Those with suicidal ideation had, on average, fewer social roles (1.72 vs. 1.46, p = .025) and family social support (4.19 vs. 3.64, p = .003), but higher levels of drug use disorder (17.2% vs. 9.5%, p = .002) and major depressive disorder (40.8% vs. 13.9%, p < .001).

Correlation Matrix

The correlation matrix for the study variables is shown in Table 2. Family factors were significantly intercorrelated within a time period. For example, adolescent family affection was significantly correlated with adolescent family involvement (r = .58, p < .001). Statistically significant correlations were observed across time for family factors. Specifically, adult family social support was significantly correlated with adolescent family affection (r = .11, p = .015) and adolescent family involvement (r = .12, p = .027), and parental rule-setting during adolescence was significantly associated with social roles (r = .16, p = .001) and social bonding (r = .10, p = .032) during young adulthood. Depressive symptoms during adolescence were significantly correlated with adolescent family affection (r = −.11, p = .006), adult social roles (r = −.13, p = .001) and adult social bonding (r = −.15, p = .031), whereas major depressive disorder during young adulthood was significantly associated with poverty status (r = .13, p = .003), and adult drug use disorder (r = .16, p < .001). Diagnosable levels of drug use disorder during young adulthood were significantly correlated with gender (female as the comparison group; r = .18, p < .001), adult social roles (r = −.11, p < .001), and adult major depressive disorder (r = .16, p < .001).

  • Hypothesis 1. The unadjusted logistic regression analyses for all 12 predictors of midlife suicidal ideation are presented in Table 3. No childhood factors were statistically significantly associated with suicidal ideation in midlife at in the unadjusted logistic regression analyses though mother absent family approached significance (p = .060) with those in mother absent families having over 2.4 times the risk of suicidal ideation in midlife compared to those in mother alone families.

  • Hypotheses 2–4. In adolescence, the unadjusted logistic model findings showed that parental rule-setting and adolescents’ depressive symptoms were significantly associated with suicidal ideation in midlife, such that adolescents who had lower parental rule-setting (OR = 0.78, p = .027) and higher depressive symptoms (OR = 1.53, p = .008) had a greater risk of suicidal ideation in midlife.

  • Hypotheses 5–7. In young adulthood, the unadjusted model showed that social roles, family social support, and participants’ lifetime diagnosis of drug and major depressive disorders were significantly associated with suicidal ideation in midlife. Those who had greater social roles (OR = 0.69, p = .025) and more family social support (OR = 0.77, p = .003) had decreased risk of suicidal ideation. Those who met the criteria for a drug disorder or for major depressive disorder in young adulthood had an increased risk of suicidal ideation in midlife (OR = 2.75, p = .002; OR = 3.73, p < .001, respectively).

Table 3.

Logistic Regression Predicting Suicidal Ideation in Midlife, N = 825.

Unadjusted Associations Adjusted Model
OR (95% CI) p aOR (95% CI) p
Female versus Male 0.78 (0.47, 1.29) .330 0.65 (0.37, 1.15) .139
Childhood factors
 Poverty status (Yes) 1.00 (0.61, 1.66) .988 1.12 (0.58, 2.15) .738
Family type (Ref: Mother alone)
 Mother father 1.18 (0.66, 2.09) .547 1.62 (0.77, 3.39) .197
 Mother other 1.11 (0.51, 2.41) .798 1.29 (0.54, 3.10) .567
 Mother absent 2.41 (0.96, 6.02) .060 3.74 (1.29, 10.92) .016
Adolescent factors
 Family affection 0.81 (0.62, 1.05) .107 0.86 (0.61, 1.22) .399
 Family involvement 0.83 (0.64, 1.08) .172 0.97 (0.68, 1.38) .865
 Parental rule-setting 0.78 (0.63, 0.97) .027 0.78 (0.61, 0.99) .040
 Depressive symptoms 1.53 (1.15, 2.10) .008 1.40 (0.98, 2.00) .062
Young adult factors
 Social roles 0.69 (0.50, 0.95) .025 0.92 (0.62, 1.32) .587
 Social bonding 0.79 (0.57, 1.10) .161 0.90 (0.60, 1.29) .503
 Family social support 0.77 (0.65, .916) .003 0.83 (0.69, 0.99) .079
 Drug use disorder 2.75 (1.43, 5.28) .002 2.18 (1.01, 4.69) .046
 Major depressive disorder 3.73 (2.11, 6.57) <.001 3.56 (1.83, 6.93) <.001
 R2 — .110
 F — 3.06
 P — <.001
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Note. N = sample size, aOR = adjusted odds ratio, 95% CI = 95% confidence interval.

Table 3 also shows the results of the adjusted logistic regression analysis. The adjusted model was significant (F = 3.06, p < .001) and had an R2 of .11, and included a total of 12 constructs. Mother alone families demonstrated lower rates of suicidal ideation when compared to mother–father families in midlife; the model showed that children who lived without their mother in their childhood household had 3.74 times the risk of suicidal ideation in midlife compared to those who lived in a household with their mother without another adult (p = .016). Adolescents with less parental rule-setting had an increased risk of suicidal ideation in midlife (OR = 0.78, p = .040). Young adults who met the criteria for a drug use disorder had more than double the risk of suicidal ideation in midlife compared to those who did not meet the criteria (OR = 2.18, p = .046). Those who met the criteria for lifetime depression by young adulthood had 3.56 times the risk of suicidal ideation in midlife compared to those who never met the criteria for lifetime depression by young adulthood in the adjusted model (p < .001).

Discussion

The purpose of this study was to examine the associations between family and social factors over the life course and suicidal ideation in midlife among urban African Americans using longitudinal data gathered from age 6 to age 42. We hypothesized that children from households without a maternal figure would have an increased risk of suicidal ideation in midlife compared to those who grow up in other family types (H1). We also hypothesized that there would be a decreased risk of suicidal ideation in midlife when adolescents had higher family involvement (H2), higher family affection (H3), and parental rulesetting (H4). Further, we hypothesized that young adults would have a lower risk of suicidal ideation in midlife if they had a greater number of social roles (H5), social bonds (H6), and a higher amount of family support (H7). This study addresses a critical gap in suicide research for urban African American populations. We found that both family factors (parental rule-setting in adolescence and family social support in young adulthood) and social roles in young adulthood were associated with midlife suicidal ideation. However, only family factors (i.e., family structure and parental rule-setting) remained salient in the full model. As family factors early in the life course were found to be associated with future social roles and bonds, future research should test these potential pathways.

Hypotheses 1–3

We hypothesized that (1) children who grow up in families absent a maternal figure would have an increased risk of suicidal ideation in midlife compared to those who grow up in other family types. We also hypothesized that adolescents with higher (2) family involvement and (3) family affection would have a decreased risk of suicidal ideation in midlife.

Our first hypothesis, that family structure at age six predicts suicidal ideation in midlife, was supported by our findings, as we found that participants who grew up in mother-absent families had an increased risk of suicidal ideation compared to children who grew up with only their mothers and no difference between mother alone and mother/father or mother/other adult homes. This aligns somewhat with previous research. Past research found single-mother households to be associated with a higher risk of suicidal ideation (Juon et al., 1997; Royal et al., 2017). It should be noted that single-mother households are often stigmatized and are more common among African American families; however, the adverse health outcomes are likely due to the intersection of systematic oppression, poverty, educational inequity, and limited employment opportunities (Jones et al., 2007; Royal et al., 2017), rather than simply being from a single-mother household. Participants in mother-absent homes may have been in foster care or have mothers who were incarcerated, deceased, or have serious mental health or drug problems. Possible explanations for this increased risk among those in a mother absent household may be that these participants have less family stability, which could impact emotional support, maternal bonding, supervision, and thereby later suicidal ideation. Our findings do not support our second and third hypotheses that higher family involvement and attachment would be associated with a decreased risk of suicidal ideation.

Hypothesis 4

We hypothesized that adolescents who experienced greater parental rule-setting would have a decreased risk of suicidal ideation in midlife. Our findings support the hypothesis that parental rule-setting in adolescence was protective against suicidal ideation in midlife. Rule-setting is a measure of parental supervision. Past studies have examined the reciprocal relationship between parental supervision and their children’s adolescent delinquency and drug use (Cookston, 1999; Flanagan et al., 2019; Jang & Smith, 1997), and lack of parental supervision is a cited risk factor for mental illness (Donovan, 2004; Hilts & Greene, 2018). Our finding supports that parental supervision, rule-setting specifically, can be a protective factor of suicidal ideation in urban African Americans, supporting previous attachment theory research. This is a potentially important protective factor to consider for the field of Black psychology when developing interventions for child and adolescent suicide prevention.

Hypotheses 5–7

We hypothesized that young adults with a greater number of (5) social roles (6) social bonds and (7) family support during young adulthood would have a decreased risk of suicidal ideation in midlife. The results of our final model do not support hypotheses five through seven. However, we found that major depressive disorder and drug use disorder by young adulthood is associated with midlife suicidal ideation and offers essential areas for intervention.

Limitations

Limitations of this study include self-reported data and attrition. Also, because outcome data were collected 17–18 years ago, their generalizability may be limited today, particularly regarding social roles. We must also emphasize that these participants are from a single urban African American neighborhood and may not be generalizable to other settings. Adolescent measures were developed by Kellam et al. (1977), for the Time 1 assessment in the 1960s, so there are some measures with limited evidence for convergent and discriminant validity, as noted in the method section. Our final model only explained 11% of the variance in suicidal ideation, and therefore, additional predictive factors should be explored and are discussed in the future directions section. Moreover, the study lacks information regarding why mothers may be absent from the household. As such, we are not able to identify factors related to the mother’s absence that may be detrimental to the participant’s mental health and can only speculate about the circumstance.

Strengths

The study’s strengths stem from the study population, an urban community cohort of African Americans, and the longitudinal design of the study of over 35 years. Many studies on suicide are done in clinical settings with those already diagnosed with mental health disorders. This study design allows us to examine the midlife prevalence of suicidal ideation and malleable protective and risk factors from a temporal standpoint within an urban community population that is historically understudied, especially regarding mental health outcomes.

Implications for Practice

In practice, we call for an emphasis on early intervention, potentially with families and in school settings by counselors, regarding supervision and early detection and treatment of depressive symptoms as potential ways to potentially decrease suicidal ideation in later life. Care providers, including adults living with children, teachers, and extracurricular coaches, should place special attention on children who grow up in mother absent homes, and additional support from caretakers for youths in mother absent households is warranted. The type of support may vary from encouraging the parental figure to ensure the child is being attended to and has a sense of structure (Nilsson & Ängarne-Lindberg, 2016) to providing social caseworkers to emotionally support the children and parent figures in cases of family crisis (Geiger et al., 2017).

Future Directions

This study supports past research that calls for the identification of existing and new social support networks to assist caretakers in helping to raise their children (Royal et al., 2017). Future studies should delve into the precise mechanisms behind why growing up in a mother absent family is particularly related to midlife suicidal ideation. Future research should examine possible interactions between the variables assessed that this study was underpowered to examine. For example, suicidal ideation may be higher in participants who report lower levels of parental affection and lower levels of rule-setting, or perhaps rule-setting is only associated with lower suicidal ideation when there are also higher levels of parental affection. Future research should examine potential pathways between early family factors to young adult social roles and bonding to midlife suicidal ideation. For example, examining other family factors, such as paternal attachment can create a more wholistic picture. Researchers should continue to identify protective family and social factors in childhood and suicide among African Americans to inform the development of suicide prevention interventions and test the generalizability of these findings. Learning about the pathways to suicide and identifying protective factors or factors that interrupt risk trajectories and promote positive mental health for Black populations is a high priority in the field of Black psychology.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute on Drug Abuse (R01DA042748-01).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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