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. Author manuscript; available in PMC: 2022 Jul 1.
Published in final edited form as: J Community Psychol. 2021 Mar 6;49(5):1282–1295. doi: 10.1002/jcop.22543

African American Adolescent Suicidal Ideation and Behavior: The Role of Racism and Prevention

W LaVome Robinson 1, Christopher R Whipple 1, Leonard A Jason 1, Caleb E Flack 1
PMCID: PMC8222079  NIHMSID: NIHMS1678458  PMID: 33675671

Abstract

Suicide is one of the most devastating, yet preventable, health disparities for African American adolescents. African American adolescent suicidal ideation and behavior may have different manifestations and risk factors relative to those of adolescents from other ethnic backgrounds that impact prevention efforts. For example, in addition to more common manifestations of suicidal ideation and behavior, African American youth may engage in violent or high-risk behaviors, use more lethal means, or report ideation at lower depression levels. The Adapted-Coping with Stress Course (A-CWS), an adaptation of Gregory Clarke and colleagues’ Coping with Stress Course, was developed to address the cultural nuances of African American adolescents. The A-CWS is a 15-session cognitive-behavioral, group-based preventive intervention that aims to enhance adaptive coping skills and reduce suicidal ideation, by incorporating strategies that counter stressors associated with systemic racism that burden African American adolescents. This study evaluated the feasibility and acceptability of the A-CWS intervention, using a sample of predominantly African American ninth-grade students. Results indicated that the adolescents were very favorable and receptive to the A-CWS intervention and that the intervention could be conducted feasibly. The A-CWS intervention serves as a model to advance culturally-grounded, evidence-based preventive intervention, for an underserved sector of adolescents.

Keywords: Suicidal ideation and behavior, African American adolescents, racism, preventive intervention

African American adolescents persevere and thrive, in spite of inescapable encounters of personal and systemic racism. These adolescents experience and are affected by racism in multiple ways. Racism can be operative through (a) vicarious experiences such as media reports of hate crimes and bigotry (Tynes, Willlis, Steward, & Hamilton, 2019), (b) direct overt experiences that happen to individuals personally (Harrell, 2000; Unnever, Cullen, & Barnes, 2016), and (c) systemic institutional forms of racism such as disparate educational and job opportunities that lead to poor economic status (Saleem & Lambert, 2016). Experiences with racism, either singularly or in combination, are potentially traumatizing (Adams, 1990; Comas-Diaz & Jacobsen, 2001) and traumatic experiences during childhood and adolescence can affect later functioning across the life span (Myers et al., 2015). Of critical concern, traumatized youth, over their life span, are more likely to attempt suicide than youth who have not had such experiences (Jimenez-Trevino et al., 2016; Perez, Jennings, Piquero, & Baglivio, 2016; Thompson, Kingree, & Lamis, 2018).

Suicide is preventable, yet it is one of the most prevalent, devastating, and irreversible health disparities for African American adolescents. Historically, suicide rates among African Americans have been low, compared to suicide rates in Caucasian populations (Ivey-Stephenson, Crosby, Jack, Haileyesus, & Kresnow-Sedacca, 2017). However, in recent years, the rates of suicide among African Americans, particularly African American children and adolescents, have increased dramatically. Bridge et al. (2015) reported that the suicide rate among African American children, ages 5 to 11, doubled between 1993 and 2012, surpassing rates among White children in that age range. Additionally, Price and Khubchandani (2019) reported that rates of suicide among African American adolescent males and females increased by 60% and 182%, respectively, from 2001 to 2017. Currently, documented suicide is the third-leading cause of death for African American adolescent males and females, ages 15–19 (Centers for Disease Control and Prevention [CDC], 2018). However, although documented suicide rates for African American adolescents are extremely high, these reported rates are likely underestimates, related to cultural stigma and norms that perpetuate the underreporting or misclassifications of suicide within the African American community (Anderson, Lowry, & Wuensch, 2015; Goldston et al., 2008; Langhinrichsen-Rohling, Friend, & Powell, 2009). Thus, the problem of African American adolescent suicide may be far greater than reported, adding a heightened sense of urgency for the advancement of effective methods to prevent this outcome.

Adolescent suicidal ideation and behavior include suicidal (a) ideation and thoughts, (b) plans, and (c) attempts (O’Carroll et al. 1996; Posner et al., 2011), along with suicide-related thoughts and behaviors, such as verbal threats and self-injurious thoughts and behaviors, in addition to actual suicide completion (O’Carroll et al., 1996). Suicidal thoughts, particularly in combination with non-suicidal self-harm, warrant serious attention. Mars and colleagues (2019) recently assessed adolescents at age 16 for suicidal thoughts and non-suicidal self-harm. Of those who reported suicidal thoughts, 12% went on to attempt suicide. Of those who reported non-suicidal self-harm, 12% went on to attempt suicide (Mars et al., 2019). However, about 20% of those who reported both suicidal thoughts and non-suicidal self-harm, at age 16, went on to make a suicide attempt by age 21 (Mars et al., 2019). In contrast, only 1% of those not reporting either suicidal ideation or non-suicidal self-harm attempted suicide by age 21 (Mars et al., 2019). The recent findings of Mars and colleagues (2019) follow a similar pattern to earlier studies. Goldston (2000) reported that, of those adolescents who report suicidal ideation, 2.8–16.7% are likely to attempt suicide within the next year; in contrast, only 0.3% of adolescents who do not report suicidal ideation will attempt suicide within the next year. Understanding the factors that are associated with an increased suicide risk, as well as the various manifestations of suicidal ideation, suicidal behavior, or self-harm, is central to the discovery of effective preventive interventions.

It is likely that suicidal ideation and behavior, among African American adolescents, have different etiological risk factors than those for adolescents with different cultural and ethnic backgrounds and experiences (Goldston et al., 2008; Klibert, Barefoot, Langhinrichsen-Rohling, Warren, & Smalley, 2015) and, as such, prevention and intervention strategies must address these distinctive risk factors, to be effective (Hall, 2005; Wang, Lin, & Wong, 2018). Contextual hardships experienced by many African American adolescents, such as racial discrimination, can (a) directly increase the risk for suicidal ideation and behavior (Arshanapally, Werner, Sartor, & Bucholz, 2018; Assari, Moghani Lankarani, & Caldwell, 2017; Osiezagha, Kaur, Barker, & Bailey, 2009) or (b) indirectly increase the risk for suicidal ideation and behavior by interacting with psychiatric disorders often associated with suicidal ideation and behavior (Sani et al., 2011), adding to the complexity of this phenomenon for African American adolescents. The odds of experiencing suicidal ideation and behavior are approximately 2 times greater for African American adolescents and young adults who report racial discrimination, compared to those who do not (Arshanpally et al., 2018). The link between racial discrimination and suicidal ideation and behavior remains after controlling for depression and other psychosocial risk factors (Arshanpally et al., 2018), suggesting that racial discrimination independently contributes to suicide risk in African American adolescents.

Contrary to what we know for other adolescents, only half of African American adolescents who have attempted suicide had a diagnosed psychiatric disorder before the attempt (Joe, Baser, Neighbors, Caldwell, & Jackson, 2009). While depression is most predictive for other groups, having an anxiety disorder placed African American adolescents at the highest risk for attempted suicide (Joe et al., 2009). Similarly, other findings indicate that African American adolescent females report suicidal ideation at lower levels of depression than European American adolescent females (Robinson, Droege, Hipwell, Stepp, & Keenan, 2016). The findings of Joe et al. (2009) and Robinson et al. (2016), among other studies that also establish distinct patterns of risk and suicide manifestations for African American youth, call into question the appropriateness of traditional etiological models and predictors of suicide risk for African American adolescents, by which most current preventive intervention strategies are grounded. Preventive interventions for African American adolescents must consider the complexities of their social ecology, including the influence of systemic racism, along with the cognitive and behavioral management of their social context.

Suicide is preventable (World Health Organization, 2014); yet, to date, there is a dearth of evidence-based, culturally- and contextually-appropriate suicide preventive interventions for African American adolescents (Bluehen-Unger et al., 2017; Mann et al., 2005; Miller, Eckert, & Mazza, 2009; Molock, Matlin, Barksdale, Puri, & Lyles, 2008), despite strong indicators of the need for such interventions. Given the dearth of culturally- and contextually-appropriate suicide preventive interventions for African American adolescents, the purpose of this study is to describe the development, feasibility, and acceptability of one innovative preventive intervention, the Adapted-Coping with Stress (A-CWS) intervention, that addresses the above-stated need.

The A-CWS intervention (Robinson, 2019) is an evidence-based, culturally- and contextually grounded preventive intervention for African American adolescents, developed using participatory methods and key informants from those to be served (i.e., urban African American adolescents living in low-resourced neighborhoods and their school personnel). The A-CWS intervention was originally culturally adapted in 2003. The adapted intervention has demonstrated efficacy for lowering African American adolescents’ suicide risk; adolescents who received the A-CWS intervention evidenced an 86% relative suicide risk reduction, compared to those in the standard care control condition (Robinson et al., 2016). The A-CWS also has demonstrated efficacy in helping African American adolescents cope with race-related stress and reduce their anxiety (Robinson, Droege, Case, & Jason, 2015). Among African American adolescents with a psychiatric disorder, those with anxiety disorders are most at risk to attempt suicide (Joe et al., 2009).

The startling increase in suicide risk for African American adolescents that has occurred since the initial cultural and contextual adaptation (Price & Kubchandani, 2019) highlighted a need to modernize the A-CWS, to effectively address current cultural and contextual needs. The revised A-CWS intervention and quantitative evaluative feedback from adolescents who participated in the revised A-CWS preventive intervention are presented here, to move forward the development of effective preventive intervention strategies for this sector of adolescents. A brief discussion of the original adaptation, as well as the modernization to the intervention, is provided. Real-world lessons learned and recommendations for future efforts to prevent suicide among African American adolescents also are discussed.

A-CWS Intervention

The A-CWS (Robinson, 2019) is a 15-session, culturally adapted, cognitive-behavioral preventive intervention aimed at enhancing African American adolescents’ skills for coping with individual and contextual stressors (e.g., personal and systemic racism, community violence) that may increase suicide risk factors (e.g., suicidal ideation, impulsivity, and hopelessness). The original cultural adaptation of the A-CWS curriculum utilized stakeholder input, following the theoretical framework presented by Bernal, Bonilla, and Bellido (1995). Bernal and colleagues (1995) established eight intervention dimensions by which cultural adaptations should focus: (1) language, (2) persons, (3) metaphors (4) content, (5) concepts, (6) goals, (7) methods, and (8) context. To address racial discrimination and other cultural nuances, Clarke and colleagues’ (1995) Coping with Stress Course, a cognitive-behavioral stress-reduction intervention, was culturally and contextually adapted, collaborating with adolescent key informants and their school personnel who served as consultants to the adaptation process.

The consultants provided essential feedback to adapt the language, activities, illustrations, examples, and flow of the intervention. Changes were made to each intervention dimension, following the structure suggested by Bernal and colleagues (1995): (a) Language: the language of the intervention was changed to reflect the common language of urban African American adolescents (e.g., proper names changed to reflect more common names among sample adolescents, terminology modified for sample population). (b) Persons: discussions were prepared to help facilitators consider differences between facilitator and participants (e.g., age, race). These discussions further prepared facilitators experienced in working with African American adolescents to address the specific contextual stressors these adolescents face. (c) Metaphors: replaced general cartoons with culturally and contextually relevant illustrations (see Figures 1 and 2). (d) Content: incorporated material consistent with African American culture, heritage, and values. (e) Concepts: cultural values and beliefs were incorporated into the didactic discussions. (f) Goals: implicit intervention goals not aligned with adolescents’ culture and goals were modified to be culturally consistent. (g) Methods: intervention activities and training focused on helping adolescents collaborate with others (e.g., peers, parents, and mentors), to cope with the stress of overt and covert personal and systemic racism. (h) Context: discussions and intervention activities incorporated contextually relevant stressful life experiences (e.g., racism and discrimination, community violence exposure, poverty, gang and criminal activity). For more information about the adaptation process for the A-CWS intervention, see Robinson et al. (2016).

Figure 1.

Figure 1.

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Example of culturally and contextually relevant illustration created for the A-CWS intervention

Figure 2.

Figure 2.

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Example of culturally and contextually relevant illustration created for the A-CWS intervention

To modernize the intervention to address African American adolescents’ current needs, student consultants were recruited to participate in focus groups. During these focus groups, student consultants were provided with the rationale and theory of the intervention and participated in an in-depth review of the intervention sessions. Guided by dimensions suggested by Bernal et al. (1995), student consultants provided valuable feedback about both the content and delivery of the intervention. During the process, student consultants readily provided insight into their context and how such experiences impact them.

The student consultants, during the adaptation focus groups, provided many examples from their own lives, illustrative of the chronic contextual stressors they face daily. The consultants identified stressors like racial discrimination, community violence exposure, school issues, and family matters. The focus group responses highlighted chronic exposure to direct personal stressful racial discrimination, as well as systemic racism (see Figures 1 & 2). Students spoke frequently and forthrightly about their experiences with racism on multiple levels (e.g., media portrayals of African Americans, interactions with police, being followed while shopping, modern segregation, etc.).

Experience with racial discrimination was identified as a pivotal stressor among student consultants. Such discrimination often came from strangers and police officers. Many student consultants identified negative interactions with police or negative portrayals of African Americans in media as being particularly stressful. Several student consultants described being harassed, unjustly searched, or racially profiled by police officers. Other student consultants said that African Americans are often portrayed in the media as criminals. Many students reported specific experiences of racial discrimination while shopping or doing other activities. It was commonly reported that students would often be followed while in stores and that those store owners often assumed that they would try to steal. Given the commonality of these experiences and the negative effects they had on the students, specific adaptations were focused on these issues, including giving students time to discuss these and other experiences as stressors, creating illustrations specific to interacting with police and being followed at a store (see Figures 1 and 2), and engaging in activities to help the adolescents address these situations in positive ways, to reduce stress and adverse sequelae.

Following the cultural and contextual update of the A-CWS intervention, the intervention was deployed in a randomized controlled trial. To ensure that the intervention was acceptable to the population of interest and that the intervention could be feasibly conducted, feasibility and acceptability were evaluated.

Method

Participants

A randomized controlled trial was conducted and the feasibility, acceptability, and efficacy of the A-CWS intervention were assessed. As the current study reports only on the feasibility and acceptability of the A-CWS intervention, only participants who were randomly assigned to the intervention condition are included. A total of 190 participants were randomly assigned to the intervention condition. Participants were recruited from four public high schools with predominantly African American student enrollment. Across the four participating schools, African American and African American multi-racial students accounted for about 92% of the student population. Students were recruited during their ninth-grade year. The average age of participants was 14.53 years (SD = 0.62). Of the 190 participants, 105 identified as female (55.30%), 150 identified as solely African American (78.90%), 24 identified as multi-racial (12.60%), 3 identified as European American (1.60%), 1 identified as American Indian or Alaska Native (0.50%), and 12 identified as some other race or ethnicity (6.30%).

Procedures

The intervention was implemented at four predominantly African American public high schools in a large Midwestern city. The Institutional Review Board at DePaul University and the school district research review board approved all intervention and research activities. Research staff attempted to recruit all students in the ninth grade for participation. Recruitment efforts included attending freshman registration days at school during the summer, speaking to adolescents at the start of the academic year, and contacting adolescents during their lunch period. Using these varied approaches, excellent participation rates were achieved. Overall and across the four participating schools, 73.3% of the African American freshman students’ parents/legal guardians gave their permission for their children to participate and the children gave their assent to participate, also. Students with both student assent and parent/guardian permission completed a self-report screening survey to determine whether they were eligible to participate in the intervention. Students reporting high levels of suicidal ideation, suicidal behavior, and other indicators of serious emotional distress were immediately referred to mental health professionals at the student’s school-based health center (SBHC) and did not continue in the program. All remaining students completed a self-report baseline assessment and then were randomized to the intervention group (A-CWS) or the standard care control group.

Standard care control consisted of services customarily provided by the SBHC. While actual services varied across the SBHCs, services generally included one-to-one or group sessions to help students develop coping skills for managing stress. All standard care services were provided by mental health professionals indigenous to the respective SBHC. Repeated assessments occurred for all randomized students at immediate post-intervention and 6 and 12 months after the intervention (Figure 3).

Figure 3.

Figure 3.

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Flow chart of participant involvement in research activities

The A-CWS intervention groups were conducted weekly at the participating schools, during non-instructional times (e.g., during lunch or homeroom). Group facilitators were trained to criterion before intervention implementation; they also received booster training in weekly facilitator training meetings during the entire implementation phase of the project, in addition to their training prior to the start of intervention implementation. Facilitators also were debriefed after the delivery of each session.

Intervention groups consisted of eight to ten students and were facilitated by Masters-level clinicians with prior experience working with African American adolescents. Each session was 45 minutes in duration. During sessions, students would (a) learn about a different aspect of stress, aggression, suicidal ideation and behavior, or coping, (b) participate in discussions with facilitators and group members, and (c) engage in cognitive and behavioral activities. At the end of each session, students were asked to complete a home activity, practice what they learned during the session, and track their stress levels each day until the next session (see Figure 3).

Measures

Feasibility and acceptability.

To determine whether implementing the A-CWS intervention was feasible and acceptable, intervention fidelity was measured and students were surveyed about their experiences with attending the program. Intervention fidelity refers to “the degree to which … program providers implement programs as intended by the program developers” (Dusenbury, Brannigan, Falco, & Hansen, 2003, p. 240). Ensuring intervention fidelity is crucial to understanding the effects of the intervention on the individual and to draw accurate conclusions (Bellg et al., 2004). If intervention fidelity is high and significant intervention effects are achieved, researchers may confidently assume that the intervention produced these effects, rather than outside factors (e.g., facilitator differences, intervention adaptations).

Trained research staff measured intervention fidelity. Research staff observed 20% of all intervention sessions, chosen randomly, and assessed intervention fidelity using a 9-item measure to gauge adherence to the A-CWS curriculum and facilitator competence (Clarke, 1998). Items were rated on a 3-point scale, assessing whether the facilitator (a) accomplished the session objective, (b) partially accomplished the session objective, or (c) did not accomplish the session objective. Questions regarding curriculum adherence included whether facilitators (a) incorporated and reviewed previous session material, (b) provided structured practice for skills as specified by the manual, (c) adhered to timed components of sessions and were able to present the entire session, and (d) assigned home practice. Questions regarding facilitator competence included assessing (a) facilitator’s skill for ensuring a safe and respectful group environment, (b) whether facilitators attempted to promote equal speaking time, (c) the pace and clarity of intervention delivery, (d) whether the facilitator was organized, and (e) the ability of the facilitator to keep participants engaged and on task. Fidelity ratings were then summed, divided by the highest possible score, and multiplied by 100 to create a fidelity percentage score.

Acceptability of the A-CWS intervention was assessed using items measuring participant satisfaction included in Clarke and Lewinsohn’s (1995) original curriculum. These items gauged participants’ satisfaction with the intervention curriculum and facilitator, as well as feelings about the impact of the curriculum on their stress and coping. During the eighth session, intervention participants were asked to fill out anonymous surveys regarding their feelings about and experience with the intervention. Students were asked questions like: “How much do you like the program?” “Do you feel that participating in the program will help you to meet most of your goals about reducing stress?” “How do you feel about your session leader (facilitator)?” and “Since the last meeting, I have thought about this program….”

Results

Feasibility of the A-CWS Intervention

Fidelity ratings evidenced high fidelity to the intervention curriculum. Adherence and competence ratings averaged 95.31% and 96.76%, respectively, and overall total fidelity ratings averaged 96.10% (i.e., adherence and competence items). In addition to high levels of observed fidelity to intervention implementation, students also reported on feasibility aspects of the intervention. Students generally supported meeting at least once per week (92.26%) and 76.13% thought sessions should be held more often (i.e., two or more times per week). Regarding the length of sessions, 46.54% believed that the current length (i.e., 45 minutes) was about right and 42.77% believed that intervention sessions should be longer than 45 minutes. Only 10.69% of participants felt that the sessions should be shorter. Overall, participants felt that the intervention was feasible and, in some cases, even felt like we should meet together more often.

Acceptability of the A-CWS Intervention

Student participants overwhelmingly liked the program and facilitators and thought that the program was useful. When asked, “How much do you like the program?” 89.94% of students reported that they liked the program, either a little or a lot, with 70.44% reporting that they liked the program a lot (Figure 4). Participants’ perceptions of the A-CWS intervention’s usefulness for reducing stress were high. Most of the participants (83.02%) either agreed or strongly agreed that participating in the A-CWS intervention would help them meet their stress reduction goals (Figure 4). Participants were quite satisfied with their group facilitators; 94.34% of participants were either very satisfied or satisfied with their group facilitator (Figure 4). Lastly, participants reported on how frequently they thought about the program since the last meeting. The vast majority of students (93.67%) thought about the program at least once during the past week, with 73.4% thinking about the program more frequently than once per week (see Figure 4). Overall, participants were very positive about participating in the A-CWS intervention. Means, standard deviations, and possible response options for each item are presented in Table 1.

Figure 4.

Figure 4.

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Graphs of student responses to the questions: “How much do you like the program [A-CWS]?” “How do you feel about your session leader?” “Do you feel that participating in the program will help you to meet most of your goals about reducing stress?” and “Since the last meeting, I have thought about this program [A-CWS]….”

Table 1.

Items, Response Options, Sample Size, and Means and Standard Deviations for Feasibility and Acceptability Questions

Item Response Options n M (SD)
How often do you think the program should meet? 1 = Once a month
2 = Once every two weeks
3 = About the same – once a week
4 = Two times a week
5 = More than twice a week		 156 3.97 (1.04)
What are your thoughts about the length of the meetings? 1 = Should be much shorter
2 = Should be shorter
3 = The current length is about right
4 = Should be longer
5 = Should be much longer		 159 3.49 (1.02)
How much do you like the program? 1 = Dislike it a lot
2 = Dislike it a little
3 = Neutral – neither like it or dislike it
4 = Like it a little
5 = Like it a lot		 159 4.56 (0.80)
Do you feel that participating in the program will help you to meet most of your goals about reducing stress? 1 = Strongly disagree
2 = Disagree
3 = Undecided
4 = Agree
5 = Strongly agree		 159 4.13 (0.86)
How do you feel about your session leader (facilitator)? 1 = Very dissatisfied
2 = Dissatisfied
3 = Undecided
4 = Satisfied
5 = Very Satisfied		 159 4.58 (0.63)
Since the last meeting, I have thought about this program… 1 = Not at all
2 = Once during the past week
3 = Several times during the past week
4 = Once every day
5 = Several times every day		 158 3.46 (1.23)
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Note: n = sample size; M = mean; SD = standard deviation

Discussion

Lessons Learned and Recommendations

This intervention experience supports that African American adolescents are eager to participate in prevention programs when programs are respectful and appropriately address their needs. Our quantitative data sources indicate that the students were very receptive and positive about the intervention. There is a common misconception, among researchers and practitioners, that African American adolescents will not participate in mental health services (Caldwell, Assari, & Breland-Noble, 2016; Willis, Coombs, Drentea, & Cockerham, 2003). Our findings do not support this assertion; on multiple occasions, our participants asked that we bring the program to every student in the school and that we increase the number of visits per week to the school. One attractive aspect of the program was the use of scenarios and other materials that were directly relevant to the adolescent’s life experiences (e.g., systemic racism, police brutality) so that they could adequately acquire adaptive coping skills to manage their realities. The A-CWS program focuses on connecting emotions to life experiences, and the capacity to correctly recognize and distinguish one’s emotions, especially feelings of distress. Most importantly, because the adolescents were key informants and active participants in the adaptation process, there was shared ownership of the program. Our older adolescent key informants often served as self-appointed emissaries to the A-CWS program, publicizing the benefit of being a part of A-CWS.

The A-CWS program is structured and manualized, to increase ease of use and translation to service providers working with similar adolescents in similar environments. However, when working with African American adolescents who are contending with multiple threats to their wellbeing (e.g., racism, poverty, and violence) that can lead to thoughts and behaviors that can be harmful to self and others, we recommend that those who facilitate the program have prior experience in working with these adolescents. The facilitators for our program represented multiple ethnicities and cultures and each of them had at least one year of experience in working with African American adolescents. Additionally, we conducted weekly training and debriefing sessions with the facilitators, to make sure they were prepared to facilitate their group sessions; observations of the facilitators occurred with regularity, to provide feedback to the facilitators.

In the conduct of the A-CWS and other programs that address the stress and trauma associated with racism and discrimination and where suicidal ideation and behavior and other serious adversities are a risk, we recommend the use of procedures to monitor the emotional status of the participants as they progress through the program. We also recommend that crisis intervention methods and procedures are developed before the program starts and are in place when working with these vulnerable adolescents, and we recommend that each person involved with program delivery be trained relative to the program’s crisis protocol procedures.

Conclusion

African American adolescent suicide is a burgeoning health problem and among the most ominous and complex health threats for African American adolescents. There is a strong association between perceived racial discrimination and suicide, for African Americans (Wang et al., 2018). Furthermore, the risk of suicide increases for those who reside in communities saturated by poverty (Farrell, Bolland, & Cockerham, 2015) and violence (Bennett & Joe, 2015), along with exposure to racial discrimination (Walker et al., 2017). In other words, suicide risk, for African American adolescents, may have multiple precipitants and precursors that are aggravated by racism and discrimination (Arshanapally et al., 2018;Goldston et al., 2008).

Overall, suicide rates among African American adolescents have increased dramatically over the past 20 years (Price & Khubchandani, 2019), and suicide rates among African American children have surpassed rates among White children (Bridge et al., 2015). The increasing suicide rates for African American adolescents, particularly younger African American youth, signals the need to address this problem with immediacy and effectively. Suicide is preventable and, as such, the discovery of effective preventive interventions for vulnerable African American adolescents has to be a priority. The A-CWS intervention is one innovative and tested intervention that addresses the gap of culturally sensitive, effective suicide prevention programs for African American adolescents.

There is a growing research literature indicating that cultural integration is important for effective prevention programming for urban, African American adolescents living in low-resourced neighborhoods (Bryant & Harder, 2008; Hall, Ibaraki, Huang, Marti, & Stice, 2016; Robinson, Brown, Beasley, & Jason, 2017); however, we urge interventionists to proceed with caution. Even well-intentioned efforts sometimes are harmful; so, while it is imperative that we respond to suicide risk and other health threats for African American youth, using culturally- and contextually grounded methods, our efforts must always be anchored in science and promote and protect the rights and welfare of adolescents. As interveners and researchers, we must uphold the highest ethical standards in working with vulnerable African American adolescents. Principles of nonmaleficence (i.e., avoid harm) and beneficence (i.e., ensure wellbeing) must always be honored.

Acknowledgments

The research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, under Award Number HD072293, and by the National Institute of Mental Health, under Award Number MH118382. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors very much appreciate the willingness of the youth to participate in the research presented in this article, as well as the many school and community officials who supported the implementation of the preventive intervention. The authors offer a sincere expression of gratitude to Simone Parkas, for her assistance in editing this manuscript.

Footnotes

Data Availability Statement The data referenced in this study are available from the corresponding author upon reasonable request.

Conflicts of Interest The authors declare that they have no conflicts of interest.

Ethical Approval All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and later amendments or comparable ethical standards. The Institutional Review Board at DePaul University and the school district Research Review Board approved all research procedures.

Informed Consent Student assent and parent/guardian permission were obtained from all adolescents included in the study.

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