Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2022 Oct 1.
Published in final edited form as: Psychol Trauma. 2021 Jul 15;13(7):759–767. doi: 10.1037/tra0001076

Racial/ethnic discrimination as race-based trauma and suicide-related risk in racial/ethnic minority young adults: The Explanatory Roles of Stress Sensitivity and Dissociation

Lillian Polanco-Roman 1, Regina Miranda 2,3, Denise Hien 4, Deidre M Anglin 3,5
PMCID: PMC8563437  NIHMSID: NIHMS1738583  PMID: 34264740

Abstract

Objective:

Drawing on race-based trauma models, the present study examined common reactions to trauma exposure (i.e., stress sensitivity, dissociative symptoms, depressive symptoms), as potential explanatory factors in the relation between racial/ethnic discrimination and suicide-related risk among racial and ethnic minority young adults.

Method:

A group of racial and ethnic minority (N = 747; 61% women; 63% U.S.-born; 34% Asian American) young adults, ages 18-29 (M = 19.84; SD = 2.22), completed a battery of self-report measures online. Accounting for demographics and other trauma exposures, direct and indirect associations between racial/ethnic discrimination and suicide attempt (SA) through stress sensitivity, dissociative symptoms, depressive symptoms, and suicide ideation (SI) were examined using hierarchical linear regression models and bootstrapping methods.

Results:

There was a direct association between racial/ethnic discrimination and stress sensitivity, dissociative symptoms, and depressive symptoms, but not SI or SA, after accounting for demographics and trauma exposures. There was also an indirect association between racial/ethnic discrimination and SI and SA through stress sensitivity, dissociative symptoms, and depressive symptoms.

Conclusion:

Experiences of racial/ethnic discrimination may function as a source of traumatic stress in racial and ethnic minority young adults to confer risk for SI and SA via stress sensitivity, dissociation, and depressive symptoms. Addressing racial/ethnic discrimination may help reduce suicide-related risk by targeting stress-related exposures particularly relevant to racial and ethnic minority young adults.

Keywords: Racial/Ethnic Discrimination, Suicide Ideation, Suicide Attempts, Young Adults, Stress Sensitivity, Dissociation

Racial/ethnic minority communities are disproportionately burdened by youth suicide, as people under age 30 account for the majority of suicide deaths among Asian, Black, Hispanic, and Native American populations (Centers for Disease Control and Prevention, 2019a). This is in contrast to patterns among White populations, where suicide deaths are most prevalent during middle adulthood (i.e., ages 40-60). Higher rates of suicidal behaviors, well-documented indicators of suicide-related risk, are detected in Black and Latinx adolescents (CDC, 2019b) and college students (Sa et al., 2019), compared to their White peers. Other well-documented risk factors for suicide like a history of mental health problems are less reliable among racial and ethnic minority youth than among their White peers (Lee & Wong, 2020). Thus, there is a critical need to address the racial and ethnic disparities in youth suicidal behaviors. Significant underrepresentation of racial and ethnic minority youth in suicide studies has limited our understanding of the sociocultural context of suicide-related risk (Cha et al., 2018), that may be particularly relevant for racial and ethnic minority young adults.

Racial/ethnic discrimination, or unjust treatment predicated on an individual’s racial or ethnic group affiliation, are common experiences in the lives of many racial/ethnic minority individuals. For some individuals, racial/ethnic discrimination may increase suicide-related risk. Epidemiological studies report a direct association between racial/ethnic discrimination and suicide ideation and attempts across racial and ethnic minority adults in the U.S. (Oh et al., 2018; Perez-Rodriguez et al., 2014), with similar findings among Black adolescents (Assari et al., 2017). Longitudinal findings further support a direct and indirect association between racial/ethnic discrimination and suicidal ideation and attempts among racial and ethnic minority adults (Wang et al., 2018) and adolescents (Madubata et al., 2019).

There is growing evidence to suggest that the association may occur through stress-inducing sequelae of racial and ethnic discrimination (Berger & Sarnyai, 2015), as racial/ethnic discrimination is associated with stress-related (i.e., PTSD) and mood disorders (i.e., Depression) in racial/ethnic minority populations (Chou et al., 2012). In fact, recent findings suggest that psychiatric symptoms, namely depressive symptoms, may help explain the association between racial/ethnic discrimination and suicide-related risk (O’Keefe et al., 2015; Polanco-Roman et al., 2019; Walker et al., 2014).

Scholars have conceptualized some forms of racial discrimination as racial trauma (Comas-Diaz et al., 2019) or race-based traumatic stress (Carter et al., 2007). This framework highlights the cumulative, pervasive, and deleterious effects of persistent exposure to race-based stress wherein adaptations to this environmental threat develop over time. Adaptations may result to maintain safety and integrity to ward off the harmful effects from the emotional and psychological injury. These adaptations may undermine the arousal system and regulatory processes to render the individual more vulnerable to future stressors. This is consistent with the Complex PTSD framework that proposes developmental consequences resulting from cumulative trauma exposure (Cloitre et al., 2009). Indeed, a systematic review of longitudinal studies examining the developmental consequences of racial and ethnic discrimination in youth suggests that increased exposure over time is associated with poorer health outcomes in adulthood (Cave et al., 2020). Accordingly, traumatic stress reactions could viably be one pathway through which racial/ethnic discrimination may impact suicide-related risk.

Studies show that the sequelae of racial/ethnic discrimination may parallel posttraumatic stress symptomatology (Kirkinis et al., 2018) independent of more traditional forms of trauma exposure. Early evidence suggests that racial/ethnic discrimination is indirectly associated with suicidal ideation through PTSD symptoms (Polanco-Roman et al., 2019), though other relevant stress-related pathways like stress sensitivity and dissociative symptoms remain unexamined. Thus, the accumulation of trauma exposures, including race-based trauma, may increase vulnerability to suicide-related risk among racial/ethnic minority young adults.

Trauma exposure, and associated features such as stress sensitivity and dissociation, are well-supported risk factors for suicidal behaviors. Increases in the number or frequency of traumatic events is associated with greater frequency of suicide attempts independent of other stressors (i.e., early life, daily life) (Suliman et al., 2009), and psychiatric disorders (Krysinska & Lester, 2010). Further, posttraumatic stress symptoms are associated with increases in suicidal ideation in non-clinical samples of youth (Hooper et al., 2015; Mazza, 2000), and with suicide attempts in a nationally representative U.S. sample of adults (Selaman et al., 2014). Considering that stress dysregulation is a common reaction to trauma exposure (Grasso et al., 2012), and a strong correlate of suicidal behaviors (Giletta et al., 2015; Wilson et al., 2016), stress sensitivity may be a potential pathway through which traumatic experiences may increase suicide-related risk (Miller & Prinstein, 2018). Thus, racial/ethnic discrimination may disrupt the stress response system (Berger & Sarnyai, 2015), wherein increased stress sensitivity, or lower threshold for subsequent stress exposures, may help explain the relation between racial/ethnic discrimination and suicidal behaviors, particularly among racial/ethnic minority young adults.

Another common reaction to trauma exposures that may be a potential pathway from racial/ethnic discrimination and suicide-related risk are dissociative symptoms—momentary lapses from reality in response to a threatening situation that is perceived as emotionally taxing and results from a loss of control over the environment (Carlson et al., 2012). Dissociation is also described as a culturally mediated process whereby racial/ethnic minority individuals may be more likely to dissociate in response to environmental stressors such as racial/ethnic discrimination, that may, in turn, create the sense of an unsafe and threatening environment (Lewis-Fernandez, 2007). Findings from a community sample of adults in the U.S. indicate that racial/ethnic minority individuals are more likely to exhibit dissociative experiences compared to their White peers (Seedat et al., 2003). Indeed, a study of racially/ethnically diverse young adults found increased frequency in racial/ethnic discrimination were positively associated with dissociative symptoms (Polanco-Roman et al., 2016). Further, dissociative symptoms are linked to increased risk for suicidal thoughts and behaviors, particularly among trauma-exposed individuals (Ford & Gomez, 2015). Thus, dissociative symptoms may also help explain the relation between racial/ethnic discrimination and suicide-related risk, particularly among racial/ethnic minority young adults.

The present study aimed to examine stress sensitivity, dissociation, and depressive symptoms, as potential stress-related pathways associated with trauma exposure, between racial/ethnic discrimination and suicidal ideation and attempts, independent of other trauma exposures, among racial/ethnic minority young adults. We hypothesized that increased frequency in racial/ethnic discrimination would be directly associated with increases in stress sensitivity, dissociative symptoms, depressive symptoms, SI, and SA. We also hypothesized that the relation between frequency of racial/ethnic discrimination and SI and SA would be explained, in part, by increases in stress sensitivity, dissociative symptoms, and depressive symptoms, independently of other trauma exposures.

Method

Sample

Participants (N = 747) were racial and ethnic minority young adults ages 18-29 (M = 19.84; SD = 2.22), recruited from an urban, public, commuter college in the Northeast U.S. Participants were recruited from a larger, ongoing study examining early markers for psychotic-like experiences (Anglin et al., 2014). The sample was predominantly female (61%), born in the U.S. (63%), and racially and ethnically diverse: 34% Asian, 33% Hispanic, 23% Black, and 10% other racial or ethnic minority group (e.g., Biracial, Middle Eastern).

Procedures

Participants completed a battery of self-report surveys online via Qualtrics in a research lab. Informed consent was obtained from all participants, who received credit toward partial course requirement for their participation. Study procedures were approved by the City University of New York Institutional Review Board, and thus, performed in accordance with the ethical standards as described by the latest version of the Declaration of Helsinki.

Measures

Suicide Ideation and Attempt.

The Self-Injurious Thoughts and Behaviors Interview (SITBI; Nock et al., 2007) inquires about history of suicidal ideation, suicidal plans, suicidal gestures, suicide attempts, and non-suicidal self-injury. The SITBI was adapted to be administered online. Suicidal ideation (SI) was assessed as frequency of SI in the past year (i.e., “During how many separate times in the past year have you had thoughts about killing yourself?”). Suicide attempt (SA), defined in the SITBI as an “attempt to kill yourself in which you had some intent to die,” was assessed as lifetime and past year frequency of SA (i.e., “How many suicide attempts have you made in [your lifetime/the past year]?”).

Racial/Ethnic Discrimination.

The Experiences of Discrimination (EOD) scale was used to assess lifetime frequency of racial/ethnic discrimination (Krieger et al., 2005). The EOD is a 9-item self-report scale where participants specify institutional settings (e.g., education, employment, healthcare, law enforcement) and frequency with which they experienced discrimination because of their race, ethnicity, or color. For each item endorsed, they rated the frequency on a Likert-type scale ranging from 1 (i.e., once) to 3 (i.e., 4 or more times). The EOD has demonstrated good internal consistency reliability (α = .74) and test-retest reliability (r = .70) in a racially/ethnically diverse non-clinical group of adults (Krieger et al., 2005). Total scores were computed by aggregating the frequency of endorsed discriminatory experiences across all settings. In the present sample, the scale scores demonstrated good internal consistency reliability (α = .70).

Stress Sensitivity.

The Perceived Stress Scale (PSS; Cohen et al., 1983) is a 14-item self-report scale that measures perceived global stress used to assess stress sensitivity. The PSS demonstrated strong validity and reliability in a probability-based sample of racially and ethnically diverse adults in the U.S. (Cohen & Williamson, 1988). Participants indicated how frequently they felt or thought a particular way in the last month. Responses range from 0 (“Never”) to 4 (“Very often”), with a higher rating indicating heightened stress sensitivity. Total scores were computed by summation of all responses. In the present sample, the scale scores’ internal reliability was good (α = .78).

Dissociative Symptoms.

The Dissociative Symptoms Scale (DSS; Carlson et al., 2018) is a 20-item self-report questionnaire used to assess dissociative symptoms in response to trauma exposure in the past week. The DSS consists of four subscales: depersonalization/derealization, gaps in memory and awareness, sensory misperception, and cognitive/behavioral re-experiencing, and has demonstrated strong psychometric properties in clinical and non-clinical samples of adults (Carlson et al., 2018), though the samples were predominantly non-Hispanic White. In a previous study using a different sample of racial and ethnic minority college students drawn from the same population, we replicated the four factor solution described by the scale developers using a principal component analysis, and demonstrated strong internal consistency (Polanco-Roman et al., 2016). Participants reported on the frequency with which they experienced each item on a Likert-type scale ranging from 0 (i.e., Not at all) to 4 (i.e., More than once a day). Items were totaled. The scale scores demonstrated strong internal consistency reliability (α = .91) in the present sample.

Trauma History.

The Life Events Checklist (Gray et al., 2004) was used to assess lifetime trauma exposure. The self-report questionnaire lists 17 discrete threatening experiences (e.g., physical assault, sexual assault, natural disaster, combat/ war exposure), and participants were instructed to select whether each event happened directly to them. In the present study, an aggregate of the number of types of potentially traumatic events directly experienced by the participant was created to reflect a composite of cumulative trauma exposure.

Depressive Symptoms.

The brief version of the Center for Epidemiologic Studies Depression Scale (CESD; Kohout et al., 1993) is a 10-item self-report measure that assesses the frequency of depressive symptoms in the past week. The CESD has demonstrated strong validity and reliability in a racially and ethnically diverse group of adults from the community (Kohout et al., 1993). Participants responded on a Likert-type scale ranging from 0 (Rarely or none of the time) to 3 (All the time/5-7 days). In the present sample, scale scores demonstrated good internal consistency reliability (α = .81).

Demographic

Information was collected such as age, gender, race/ethnicity, place of birth of self and parents, household income.

Data Analysis

Gender differences in frequency of racial/ethnic discrimination, stress sensitivity, traumatic events, dissociative symptoms, depressive symptoms, past year frequency of SI, and lifetime frequency of SA were examined via t-tests; meanwhile, racial and ethnic group differences were examined via one-way ANOVA with post-hoc Bonferroni corrected t-tests. To examine a serial direct and indirect effect of stress sensitivity and dissociative symptoms to depressive symptoms on the relation between racial/ethnic discrimination frequency and past year SI and lifetime SA, multiple hierarchical linear regression models were created with racial/ethnic discrimination frequency entered as the focal predictor, stress sensitivity, dissociative symptoms, depressive symptoms, and SI as the mediators, and SA as the focal outcome. Direct and indirect associations and bootstrapping procedures were conducted with the SPSS computational tool PROCESS version 3.0 model 80 (Hayes, 2018), which does not require assumptions of normal distribution among the variables. The distribution was resampled 5,000 times, with calculation of 95% confidence intervals around estimates, All models adjusted for age, gender, race/ethnicity, and trauma exposure. Dummy variables were created for race/ethnicity. Men was entered as the reference group for gender, and Black was entered as the reference group for race/ethnicity.

Results

Descriptive and Bivariate Analyses

Fourteen percent (n = 114) of participants reported suicide ideation (SI) at least once in the previous year, and frequency ranged from 0-27. About 4% (n = 30) of participants had made a suicide attempt (SA) at least once in their lifetime, and frequency ranged from 0-6. Meanwhile, 2% (n = 11) reported at least one SA in the previous year, and frequency ranged from 0-2. Further analyses exclude past-year frequency of SA due to limited power.

There was a significant gender difference in stress sensitivity, t (746) = 2.21, p < .05, as women (M = 28.65; SD = 7.15) reported greater stress sensitivity than men (M = 27.47; SD = 7.16). However, there was no significant gender difference in frequency of racial/ethnic discrimination, t (747) = 0.34, p = .73, trauma exposure, t (747) = 0.72, p = .47, dissociative symptoms, t (746) = −0.20, p = .85, depressive symptoms, t (746) = 0.44, p = .66, past-year frequency of SI, t(746) = 0.34, p = .74, and lifetime frequency of SA, t(745) = 0.04, p = .97.

There were significant racial/ethnic differences in racial/ethnic discrimination, F (3, 748) = 4.71, p < .05, as Black young adults (M = 4.80; SD = 4.15) reported greater frequency of racial/ethnic discrimination compared to Asian (M = 3.63; SD = 3.66) and Hispanic (M = 3.44; SD = 4.02), but not young adults identifying as other race/ethnicity (M = 4.28; SD = 4.30). There was also a significant difference in trauma exposure, F (3, 748) = 3.11, p < .05, as Black individuals (M=2.68; SD=2.19) reported greater trauma exposure than Asian (M = 2.08; SD = 1.87) individuals. There was a significant difference in depressive symptoms, F (3, 747) = 4.21, p < .05, as Asian young adults (M = 9.21; SD = 5.05) reported greater depressive symptoms than Hispanic young adults (M = 7.72; SD = 4.91). There was a trending effect in dissociative symptoms, but it was not statistically significant, F(3, 748) = 2.36, p =.07. Furthermore, there was no significant difference across race/ethnicity in stress sensitivity, F (3, 748) = 0.77, p = .51, past year frequency of SI, F(3,747) = 3.00, p = .39, or lifetime frequency of SA, F(3,746) = 1.82, p = .14.

Bivariate analyses were conducted with Pearson Correlations, with findings displayed in Table 1. There was a significant, positive relationship between racial/ethnic discrimination and trauma exposure, depressive symptoms, dissociative symptoms, stress sensitivity, and frequency of past-year SI, but not frequency of lifetime SA. Frequency of past-year SI was significantly and positively related to trauma exposure, dissociative symptoms, stress sensitivity, depressive symptoms, and lifetime frequency of SA. Lifetime frequency of SA was significantly and positively related to dissociation, trauma exposure, and depressive symptoms.

Table 1.

Bivariate analyses, means, and standard deviations for the variables entered in the regression models

1 2 3 4 5 6 7 M(SD)
1. Racial/Ethnic Discrimination - .32** 19** .25** .29** .08* .04 3.90 (3.99)
2. Traumatic Events - .10** .23** .22** .08* .11** 2.30 (2.01)
3. Stress Sensitivity - 41** .66** .22** .06 28.19 (7.18)
4. Dissociative Symptoms - .53** .16** .10** 8.61 (9.18)
5. Depressive Symptoms - .26** 17** 8.64 (5.19)
6. Frequency of Past Year SI - .31** .43 (1.99)
7. Frequency of Lifetime SA - .08 (0.46)
Open in a new tab

Note. SI =Suicide Ideation, SA = Suicide Attempt,

*

p < .05,

**

p < .01.

Direct and Indirect Associations Between Racial/Ethnic Discrimination and Suicide Attempts Through Stress Sensitivity, Dissociative Symptoms, Depressive Symptoms, and Suicide Ideation

Findings on the direct associations between racial/ethnic discrimination, dissociative symptoms, stress sensitivity, depressive symptoms, and past year frequency of SI on lifetime frequency of SA are displayed in Tables 2 and 3. In Model 1, racial/ethnic discrimination statistically predicting stress sensitivity accounted for 6% of the variance, R2 = .06, F (7,739) = 6.96, p < .01, with a significant direct association. In Model 2, racial/ethnic discrimination statistically predicting dissociative symptoms accounted for 12% of the variance, R2 = .12, F (7,739) = 13.91, p < .01, with a significant direct association. In Model 3, racial/ethnic discrimination, stress sensitivity, and dissociative symptoms statistically predicting depressive symptoms accounted for 49% of the variance, R2 = .54, F (9,737) = 95.57, p < .01. There was a significant direct association between racial/ethnic discrimination and stress sensitivity, racial/ethnic discrimination and dissociative symptoms, and racial/ethnic discrimination and depressive symptoms.

Table 2.

Direct associations between racial/ethnic discrimination, stress sensitivity, and dissociative symptoms, adjusting for demographics and trauma exposure

Stress Sensitivity (Model 1) Dissociative Symptoms (Model 2)
b (SE) 95%CI p b (SE) 95%CI p
Age −0.40 (0.12) −0.64 - −0.17 < .01 ** −0.56 (0.15) −0.85 - −0.27 < .01 **
Gender −1.23 (0.53) −2.26 - −0.19 < .05 * 0.09 (0.65) −1.20 - 1.37 .89
Hispanic −0.32 (0.70) −1.69 - 1.05 .65 −0.56 (0.87) −2.27 - 1.14 .52
Asian 0.23 (0.70) −1.14 - 1.60 .74 0.89 (0.86) −0.81 - 2.59 .30
Other 0.30 (0.99) −1.64 - 2.24 .72 1.11 (1.23) −1.30 - 3.51 .37
Trauma Exposures 0.18 (0.13) −0.09 - 0.44 .18 0.84 (.17) 0.51 - 1.16 < .01 **
Discrimination 0.36 (0.07) 0.22 - 0.50 < .01 ** 0.51 (0.09) 0.35 - 0.68 < .01 **
Constant 34.86 (2.43) 30.08 - 39.63 .001* 15.60 (3.02) 9.66 - 21.52 < .01**
R2 = .06, (7,739) = 6.96, p < .001 R2 = .12, (7,739) = 13.91, p < .001
Open in a new tab

Note. Bold

*

p < .05,

**

p < .01; b= unstandardized regression coefficient; SE = standard error; CI= Confidence Intervals.

Table 3.

Direct associations between racial/ethnic discrimination, stress sensitivity, dissociative symptoms, depressive symptoms, past year suicidal ideation, and lifetime suicide attempt, adjusting for demographics and trauma exposure

Depressive Symptoms (Model 3) Past Year Frequency of SI (Model 4) Lifetime Frequency of SA (Model 5)
b (SE) 95%CI p b (SE) 95%CI p b (SE) 95%CI p
Age 0.07 (0.06) −0.05 - 0.19 .24 0.05 (0.03) −0.02 - 0.11 .11 −0.01 (0.01) −0.02 - 0.01 .22
Gender 0.24 (0.27) −0.28 - 0.77 .37 0.02 (0.15) −0.27 - 0.30 .97 −0.01 (0.03) −0.07 - 0.06 .79
Hispanic −0.31 (0.35) −1.003 - 0.38 .38 −0.12 (0.19) −0.49 - 0.26 .55 0.03 (0.04) −0.05 - 0.12 .46
Asian 0.68 (0.35) −0.01 - 1.37 .05 −0.25 (0.19) −0.63 - 0.12 .19 −0.001 (0.04) −0.09 - 0.08 .99
Other 0.48 (0.50) −0.50 - 1.46 .34 −0.35 (0.27) −0.89 - 0.18 .19 0.14 (0.06) 0.02 - 0.26 .02 *
Trauma Exposures 0.21 (.07) 0.07 - 0.34 < .01 ** 0.01 (0.04) −0.07 - 0.08 .84 0.02 (0.01) 0.001 - 0.03 .03 *
Discrimination 0.11 (0.04) 0.04 - 0.18 < .01 ** −0.01 (0.02) −0.05 - 0.03 .71 −0.003 (0.004) −0.01 - 0.01 .57
Stress Sensitivity 0.38 (0.02) 0.34 – 0.42 < .01 ** 0.02 (0.01) −0.004 – 0.05 .10 −0.001 (0.003) −0.01 - −0.002 .01 *
Dissociative Symptoms 0.15 (0.02) 0.12 - 0.18 < .01 ** 0.01 (0.01) −0.01 - 0.03 .44 −0.0004 (0.002) −0.005 - 0.004 .87
Depressive Symptoms 0.08 (0.02) 0.03 - 0.12 < .01 ** 0.01 (0.005) 0.005 - 0.02 .01 *
Past Year SI 0.07 (0.01) 0.05 - 0.08 < .01 **
Constant 6.04 (1.34) −8.77 - −3.31 < .01** −1.82 (0.77) −3.32 - 0.31 .02 0.27 (0.11) −0.07 - 0.61 .12
R2 = .54, (9,737) = 97.57, p< .01 R2 = .08, (10,736) = 6.41, p < .001* R2 = 0.13, (11, 735) = 9.85, p < .001*
Open in a new tab

Note. Bold

*

p < .05,

**

p < .01; b = unstandardized regression coefficient; SE = standard error; CI = Confidence Intervals.

SI = Suicide Ideation; SA = Suicide attempt.

In Model 4, racial/ethnic discrimination, stress sensitivity, dissociative symptoms, and depressive symptoms statistically predicting past year frequency of SI accounted for 8% of the variance, R2 = .08, F (10,736) = 6.41, p < .01. There were no significant direct associations between racial/ethnic discrimination, stress sensitivity, dissociative symptoms, and past year frequency of SI, but there was a direct association between depressive symptoms and past year frequency of SI.

In Model 5, racial/ethnic discrimination, stress sensitivity, dissociative symptoms, depressive symptoms, and past year frequency of SI statistically predicting lifetime frequency of SA accounted for 13% of the variance, R2 = .13, F (11,735) = 9.85, p < .01. There was no significant direct association between racial/ethnic discrimination or dissociative symptoms with lifetime frequency of SA, but stress sensitivity, depressive symptoms, and past year frequency of SI had a direct association with lifetime frequency of SA.

Findings on the indirect associations between racial/ethnic discrimination and lifetime frequency of SA through stress sensitivity, depressive symptoms, and past year frequency of SI are displayed in Figure 1. The indirect association between racial/ethnic discrimination with lifetime SA was significant through the following paths: through depressive symptoms only; through stress sensitivity to depressive symptoms; through dissociative symptoms to depressive symptoms; through depressive symptoms to past-year frequency of SI; through stress sensitivity to depressive symptoms to past year frequency of SI; and through dissociative symptoms to depressive symptoms to past year frequency of SI. There were no indirect associations through stress sensitivity only, b = −0.002, 95% CI = −0.004 – 0.0001, through dissociative symptom only b = −0.002, 95% CI = −0.003 – 0.003, through past-year frequency of SI only, b = −0.001, 95% CI = −0.005 – 0.002, through stress sensitivity to past-year frequency of SI, b = 0.0003, 95% CI = −0.0001 – 0.001, or through dissociative symptoms to past year frequency of SI, b = 0.0003, 95% CI = −0.001 – 0.002.

Figure 1.

Figure 1

Open in a new tab

Direct and indirect associations between racial/ethnic discrimination and lifetime suicide attempts (SA) through stress sensitivity, dissociative symptoms, depressive symptoms, and past year suicide ideation (SI), adjusting for demographics and trauma exposure.

Note. Bold solid line * p < .05; Unstandardized regression coefficient; 95 % Confidence Intervals. [Direct effects] (Indirect effects).

Discussion

There is growing evidence to suggest that experiences of racial/ethnic discrimination may increase suicide-related risk among racial and ethnic minority young adults (Madubata et al., 2019; Oh et al., 2018; O’Keefe et al., 2015; Polanco-Roman et al., 2019; Walker et al., 2014). The present study examined common traumatic stress reactions (i.e., stress sensitivity, dissociative symptoms, depressive symptoms) as potential stress-related explanatory factors in the relation between racial/ethnic discrimination and suicidal ideation and attempts among racial/ethnic minority young adults, accounting for other trauma exposures. The findings partially supported the study hypotheses in that there was a direct association between racial/ethnic discrimination with stress sensitivity, dissociative symptoms, and depressive symptoms after accounting for trauma history. No direct association was detected, however, between racial/ethnic discrimination and suicide ideation and attempt after accounting for depressive symptoms, trauma exposure, stress sensitivity, and dissociative symptoms. Further, there was an indirect association between racial/ethnic discrimination and suicide ideation and attempt through stress sensitivity and dissociative symptoms to the extent that they were associated with depressive symptoms. Consistent with previous findings, depressive symptoms play an important role in explaining the association between discrimination and suicide-related risk among racial and ethnic minority young adults (Polanco-Roman & Miranda, 2013; Walker et al., 2014; O’Keefe et al., 2015). Findings are also consistent with previous research demonstrating that increased frequency of racial/ethnic discrimination experiences are associated with trauma-related stress reactions (Kirkinis et al., 2018). Thus, disruptions in stress-related and mood processes may help clarify potential mechanisms underlying the mental health consequences of racial/ethnic discrimination experiences in relation to suicide-relate risk.

In accordance with the race-based traumatic stress frameworks, increases in frequency of experiences of racial/ethnic discrimination was associated with increased stress sensitivity and dissociative symptoms. Further, the present findings provide preliminary evidence identifying potential pathways through which racial/ethnic discrimination may confer suicide-related risk in racial/ethnic minority young adults. Whereas previous research has identified depressive symptoms as a potential pathway (O’Keefe et al., 2014; Polanco-Roman et al., 2019; Walker et al., 2014), the present study suggests stress-related reactions associated with trauma exposure, such as stress sensitivity and dissociative symptoms, may also help explain potential mechanisms underlying the relation between racial/ethnic discrimination and suicide-related risk. An accumulation of experiences of racial/ethnic discrimination over time may confer risk for thinking about and attempting suicide in racial/ethnic minority young adults to the degree that it increases vulnerability for stress sensitivity and dissociative symptoms, which in turn, may increase vulnerability to psychiatric problems associated with trauma exposure, including depressive symptoms. This is consistent with developmental models of youth suicide risk that cite disruptions in stress response systems that render youth vulnerable to subsequent stressors, and consequently, suicidal thoughts and behaviors (Miller & Prinstein, 2018).

By accounting for other trauma exposure and examining stress-related reactions associated with trauma exposure like stress sensitivity or dissociative symptoms, the findings extend previous research identifying PTSD symptoms as a potential pathway in the discrimination-suicidal ideation relation (Polanco-Roman et al., 2019). This is important, given the high prevalence, and greater severity, of stress-related disorders like PTSD (McLaughlin et al., 2018), as well as dissociative experiences (Seedat et al., 2003) among racial/ethnic minority populations. Thus, the present findings clarify that racial/ethnic discrimination may engender stress sensitivity and dissociative symptoms, independent of other trauma exposures, which in turn, may increase risk for suicidal ideation and attempts. As a potential source of traumatic stress, identifying racial/ethnic discrimination may help refine preventive strategies to improve screening for suicide-related risk. This information could also provide novel targets for interventions targeted at reducing risk among racial/ethnic minority young adults.

Although the potential effect of racial/ethnic discrimination on suicide-related risk may be small, this significant association may be indicative of a more distal relation in that racial/ethnic discrimination may increase vulnerability to more proximal risk factors such as psychiatric vulnerability. Pathways from racial/ethnic discrimination to psychiatric symptoms may also be influenced by other factors such as coping strategies (Polanco-Roman et al., 2016), as well as ethnic identity (Polanco-Roman & Miranda, 2013) and religiosity (Walker et al., 2014), culture-specific protective factors linked to attenuated suicide-related risk. Experiences of racial/ethnic discrimination may also vary by gender and across race/ethnicity, which may differentially impact suicide-related risk (Polanco-Roman et al., 2019).

Strengths, Limitations, and Future Directions

There are several notable strengths of the present study, including the racial/ethnic diversity in the sample, especially as racial/ethnic minority individuals remain underrepresented in suicide research (Cha et al., 2018). This facilitates a timely and important investigation on the impact of racial/ethnic discrimination on suicide-related risk in marginalized groups in the U.S. Nevertheless, there are limitations to note. The present study relied exclusively on survey data that is subject to recall and social desirability bias, and thus, more objective assessment of stress was not used. Participants were recruited from a college setting; though representative of the larger community from which the students were recruited, findings may not generalize to the larger young adult population or non-college attending peers, who may be at greater risk for suicidal thoughts and behaviors (Mortier et al., 2018). Nevertheless, in the present study, the prevalence of participants endorsing SI, though not SA, in the past year was greater than rate reported in previous research (Mortier et al., 2018). The data are cross-sectional and the timeframe across the variables range from lifetime (i.e., racial/ethnic discrimination) to past week (i.e., dissociative and depressive symptoms). Thus, causal inferences are limited and the temporal relation among the variables is somewhat obscured. However, by focusing on lifetime racial/ethnic discrimination, the study aimed to assess the influence of increased exposure across the life span in relation to psychological functioning in young adulthood. Nevertheless, the present study adheres to recommended guidelines for examining direct and indirect effects using cross-sectional data (Hayes, 2018).

Although individual-level racism like racial/ethnic discrimination is the most studied form of racism, specifically as it relates to suicide risk, there is emerging evidence indicating that different forms of discrimination may differentially associate with suicide-related risk. These include institutional racism, or racial biases in policies and practices of organizations and institutions and interpersonal racism (Wang et al., 2018). There is also evidence that covert forms of discrimination may be more relevant for Black youth compared to overt discrimination (Madubata et al., 2019). Recent studies have identified more contemporary forms of discrimination via online settings that may be particularly pernicious for the mental health of Black and Latinx youth (Tynes et al 2020). Thus, there is a need to better understand the additive effect of various forms of racism in relation to suicide-related risk among racial/ethnic minority youth.

The effects of racial/ethnic discrimination may also extend beyond the lifespan and to the next generation. For instance, maternal experience of racial discrimination was associated with youth suicide-related risk, accounting for youth personal experiences of racial discrimination and youth psychiatric symptoms (Arshanapally et al., 2018). Similarly, maternal experiences of racial discrimination were associated with cortisol disruptions in 12-month-old Black infants (Dismukes et al., 2018). The timing of exposure to experiences of racial discrimination may also play an important role in suicide-related risk and warrants further study, as earlier age of exposure to racial discrimination is associated with poorer health outcomes in adulthood, which may be due, in part, to greater exposure over time (Cave et al., 2020).

Conclusion

In summary, there is growing evidence to suggest experiences of racial/ethnic discrimination may increase suicide-related risk, particularly among racial and ethnic minority young adults. Potential pathways through which racial/ethnic discrimination may confer risk for suicidal ideation or attempts are poorly understood. Stress-related reactions commonly associated with trauma exposures may help explain this relation. The present study found no direct association between racial/ethnic discrimination and suicide ideation and attempts among racial/ethnic minority young adults. An indirect association, however, was detected, which was explained, in part, by increases in stress sensitivity, dissociative symptoms, and depressive symptoms. This information has important clinical implications as it could help refine preventive strategies targeted at reducing suicide-related risk and provide novel targets for intervention., particularly among racial and ethnic minority young adults.

Clinical Impact Statement.

The findings from the present study identify dissociative symptoms as a potential pathway through which experiences of racial/ethnic discrimination may confer risk for suicide ideation and attempts in racial and ethnic minority young adults. Racial and ethnic discrimination, a common culture-specific stressor for many racial and ethnic minority individuals, may function as a potentially traumatic exposure to yield trauma-related stress reactions like dissociative symptoms. Accounting for racial and ethnic discrimination among racial and ethnic minority young adults presenting with stress-related and mood symptoms may help to improve the cultural sensitivity of prevention and intervention strategies to reduce suicide-related risk.

Acknowledgements:

This work was supported by the National Institutes of Health [GM056833]; and by a grant from the New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York State Office of Mental Health. The authors have no conflicts of interest to report.

References

  1. Anglin DM, Lighty Q, Greenspoon M, & Ellman LM (2014). Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults. Social Psychiatry and Psychiatric Epidemiology, 49(10), 1545–1555. [DOI] [PubMed] [Google Scholar]
  2. Arshanapally S, Werner KB, Sartor CE, & Bucholz KK (2018). The association between racial discrimination and suicidality among African-American adolescents and young adults. Archives of Suicide Research, 22(4), 584–595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Assari S, Moghani Lankarani M, & Caldwell CH (2017). Discrimination increases suicidal ideation in black adolescents regardless of ethnicity and gender. Behavioral Sciences, 7(4), 75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Berger M, & Sarnyai Z (2015). “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress, 18(1), 1–10. [DOI] [PubMed] [Google Scholar]
  5. Carlson EB, Dalenberg C, & McDade-Montez E (2012). Dissociation in posttraumatic stress disorder part I: Definitions and review of research. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 479–489. [Google Scholar]
  6. Carlson EB, Wealde L, Palmieri PA, Smith S, McDade-Montez E, & Macia K (2018). Development and Validation of the Dissociative Symptom Scale. Assessment, 25(1), 84–98. [DOI] [PubMed] [Google Scholar]
  7. Carter RT (2007). Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based Traumatic Stress. The Counseling Psychologist, 35(1), 13–105. [Google Scholar]
  8. Cave L, Cooper MN, Zubrick SR, & Shepherd CC (2020). Racial discrimination and child and adolescent health in longitudinal studies: A systematic review. Social Science & Medicine, 112864. [DOI] [PubMed] [Google Scholar]
  9. Centers for Disease Control and Prevention (2019a). U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. [Google Scholar]
  10. Centers for Disease Control and Prevention. (2019b). Youth Risk Behavior Survey. Available at: www.cdc.gov/YRBSS.
  11. Cha CB, Tezanos KM, Peros OM, Ng MY, Ribeiro JD, Nock MK, & Franklin JC (2018). Accounting for diversity in suicide research: Sampling and sample reporting practices in the United States. Suicide and Life-Threatening Behavior, 48(2), 131–139. [DOI] [PubMed] [Google Scholar]
  12. Chou T, Asnaani A, & Hofmann SG (2012). Perception of racial discrimination and psychopathology across three US ethnic minority groups. Cultural Diversity and Ethnic Minority Psychology, 18(1), 74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cloitre M, Stolbach BC, Herman JL, Kolk BVD, Pynoos R, Wang J, & Petkova E (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399–408. [DOI] [PubMed] [Google Scholar]
  14. Cohen S, Kamarck T, & Mermelstein R (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 385–396. [PubMed] [Google Scholar]
  15. Cohen S and Williamson G (1998). Perceived Stress in a Probability Sample of the United States. Spacapan S and Oskamp S (Eds.) The Social Psychology of Health. Newbury Park, CA: Sage. [Google Scholar]
  16. Comas-Díaz L, Hall GN, & Neville HA (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist, 74(1), 1. [DOI] [PubMed] [Google Scholar]
  17. Dismukes A, Shirtcliff E, Jones CW, Zeanah C, Theall K, & Drury S (2018). The development of the cortisol response to dyadic stressors in Black and White infants. Development and Psychopathology, 30(5), 1995–2008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Ford JD, & Gómez JM (2015). The Relationship of psychological Trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review. Journal of Trauma & Dissociation, 16(3), 232–271. [DOI] [PubMed] [Google Scholar]
  19. Grasso DJ, Ford JD, & Briggs-Gowan MJ (2012). Early life trauma exposure and stress sensitivity in young children. Journal of Pediatric Psychology, 1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gray MJ, Litz BT, Hsu JL, & Lombardo TW (2004). Psychometric properties of the life events checklist. Assessment, 11(4), 330–341. [DOI] [PubMed] [Google Scholar]
  21. Giletta M, Calhoun CD, Hastings PD, Rudolph KD, Nock MK, & Prinstein MJ (2015). Multi-level risk factors for suicidal ideation among at-risk adolescent females: the role of hypothalamic-pituitary-adrenal axis responses to stress. Journal of Abnormal Child Psychology, 43(5), 807–820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hayes AF (2018). An introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press. [Google Scholar]
  23. Hooper LM, Tomek S, Bolland KA, Church WT, Wilcox K, & Bolland JM (2015). The Impact of Previous Suicide Ideations, Traumatic Stress, and Gender on Future Suicide Ideation Trajectories Among Black American Adolescents: A Longitudinal Investigation. Journal of Loss and Trauma, 20(4), 354–373. [Google Scholar]
  24. Kirkinis K, Pieterse AL, Martin C, Agiliga A, & Brownell A (2018). Racism, racial discrimination, and trauma: A systematic review of the social science literature. Ethnicity & Health, 1–21. [DOI] [PubMed] [Google Scholar]
  25. Kohout FJ, Berkman LF, Evans DA, & Cornoni-Huntley J (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. Journal of Aging Health, 5(2), 179–193. [DOI] [PubMed] [Google Scholar]
  26. Krieger N, Smith K, Naishadham D, Hartman C, & Barbeau EM (2005). Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Social Science & Medicine, 61(7), 1576–1596. [DOI] [PubMed] [Google Scholar]
  27. Krysinska K, & Lester D (2010). Post-traumatic stress disorder and suicide risk: a systematic review. Archives of Suicide Research, 14(1), 1–23. [DOI] [PubMed] [Google Scholar]
  28. Lee CS, & Wong YJ (2020). Racial/ethnic and gender differences in the antecedents of youth suicide. Cultural Diversity and Ethnic Minority Psychology. Online First. [DOI] [PubMed] [Google Scholar]
  29. Lewis-Fernández R, Martínez-Taboas A, Sar V, Patel S, Boatin A (2007). Cross-cultural assessment of psychological trauma and PTSD, p. 279–317. The cross-cultural assessment of dissociation. Springer, US. [Google Scholar]
  30. Madubata I, Spivey LA, Alvarez GM, Neblett EW, & Prinstein MJ (2019). Forms of racial/ethnic discrimination and suicidal ideation: a prospective examination of African American and Latinx Youth. Journal of Clinical Child & Adolescent Psychology, 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Mazza JJ (2000). The Relationship Between Posttraumatic Stress Symptomatology and Suicidal Behavior in School-Based Adolescents. Suicide and Life-Threatening Behavior, 30(2), 91–103. [PubMed] [Google Scholar]
  32. McLaughlin KA, Alvarez K, Fillbrunn M, Green JG, Jackson JS, Kessler RC, … & Alegría M (2019). Racial/ethnic variation in trauma-related psychopathology in the United States: a population-based study. Psychological Medicine, 49(13), 2215–2226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Miller AB, & Prinstein MJ (2019). Adolescent suicide as a failure of acute stress-response systems. Annual Review of Clinical Psychology, 15, 21.1–21.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Mortier P, Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, … & Nock MK (2018). Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys. Social Psychiatry and Psychiatric Epidemiology, 53(3), 279–288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Nock MK, Holmberg EB, Photos VI, & Michel BD (2007). Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19, 309–317. [DOI] [PubMed] [Google Scholar]
  36. Oh H, Waldman K, Koyanagi A, Anderson R, & DeVylder J (2020). Major discriminatory events and suicidal thoughts and behaviors amongst Black Americans: Findings from the National Survey of American Life. Journal of Affective Disorders, 263, 47–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. O’Keefe VM, Wingate LR, Cole AB, Hollingsworth DW, & Tucker RP (2015). Seemingly harmless racial communications are not so harmless: Racial microaggressions lead to suicidal ideation by way of depression symptoms. Suicide and Life-Threatening Behavior, 45(5), 567–576. [DOI] [PubMed] [Google Scholar]
  38. Perez-Rodriguez MM, Baca-Garcia E, Oquendo MA, Wang S, Wall MM, Liu SM, & Blanco C (2014). Relationship between acculturation, discrimination, and suicidal ideation and attempts among US Hispanics in the National Epidemiologic Survey of Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 75(4), 399–407. [DOI] [PubMed] [Google Scholar]
  39. Polanco-Roman L, & Miranda R (2013). Culturally related stress, hopelessness, and vulnerability to depressive symptoms and suicidal ideation in emerging adulthood. Behavior Therapy, 44(1), 75–87. [DOI] [PubMed] [Google Scholar]
  40. Polanco-Roman L, Danies A, & Anglin DM (2016). Racial discrimination as race-based trauma, coping strategies, and dissociative symptoms among emerging adults. Psychological Trauma: Theory, Research, Practice, and Policy, 8(5), 609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Polanco-Roman L, Anglin DM, Miranda R, & Jeglic EL (2019). Racial/ethnic discrimination and suicidal ideation in young adults: The role of traumatic stress and depressive symptoms varies by gender not race/ethnicity. Journal of Youth and Adolescence, 48(10), 2023–2037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Sa J, Choe CS, Cho CBY, Chaput JP, Lee J, & Hwang S (2020). Sex and racial/ethnic differences in suicidal consideration and suicide attempts among US college students, 2011-2015. American Journal of Health Behavior, 44(2), 214–231. [DOI] [PubMed] [Google Scholar]
  43. Seedat S, Stein MB, & Forde DR (2003). Prevalence of dissociative experiences in a community sample: relationship to gender, ethnicity, and substance use. The Journal of Nervous and Mental Disease, 191(2), 115–120. [DOI] [PubMed] [Google Scholar]
  44. Selaman ZM, Chartrand HK, Bolton JM, & Sareen J (2014). Which symptoms of post-traumatic stress disorder are associated with suicide attempts? Journal of Anxiety Disorders, 28(2), 246–251. [DOI] [PubMed] [Google Scholar]
  45. Suliman S, Mkabile SG, Fincham DS, Ahmed R, Stein DJ, & Seedat S (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50(2), 121–127. [DOI] [PubMed] [Google Scholar]
  46. Tynes BM, Giang MT, Williams DR, & Thompson GN (2008). Online racial discrimination and psychological adjustment among adolescents. Journal of Adolescent Health, 43(6), 565–569. [DOI] [PubMed] [Google Scholar]
  47. Walker RL, Salami TK, Carter SE, & Flowers K (2014). Perceived racism and suicide ideation: Mediating role of depression but moderating role of religiosity among African American adults. Suicide and Life-Threatening Behavior, 44(5), 548–559. [DOI] [PubMed] [Google Scholar]
  48. Wang L, Lin HC, & Wong YJ (2018). Perceived racial discrimination on the change of suicide risk among ethnic minorities in the United States. Ethnicity & Health, 1–15. [DOI] [PubMed] [Google Scholar]
  49. Wilson ST, Chesin M, Fertuck E, Keilp J, Brodsky B, Mann JJ, … & Stanley B (2016). Heart rate variability and suicidal behavior. Psychiatry Research, 240, 241–247. [DOI] [PubMed] [Google Scholar]

RESOURCES