Skip to main content
NCBI home page
SSM - Population Health logoLink to SSM - Population Health
. 2022 Nov 3;20:101283. doi: 10.1016/j.ssmph.2022.101283

Meta-analysis of the effect of racial discrimination on suicidality

Bruno Messina Coimbra a,b,∗, Chris Maria Hoeboer a, Jutka Yik a, Andrea Feijo Mello b, Marcelo Feijo Mello b, Miranda Olff a,c
PMCID: PMC9646655  PMID: 36387016

Abstract

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there have been reports that minorities and marginalized groups exposed to RD are at a higher risk of suicide. Given that RD negatively impacts mental health and that suicide is a major public health concern, we meta-analytically reviewed the literature to investigate whether RD is associated with suicidal ideation (SI) and suicide attempt (SA). We identified 43 eligible articles investigating the association between RD and suicidality through PubMed, Embase, PsycINFO and Scopus, from which we pooled 39 effect sizes for SI (58,629 individuals) and 15 for SA (30,088 individuals). Results demonstrated that RD has a small but significant effect both on SI (r = 0.16, 95% CI: 0.12 to 0.19; p < 0.0001) and on SA (r = 0.13, 95% CI: 0.02 to 0.23; p = 0.018). We found no indication of publication bias, and fail-safe tests confirmed the robustness of the results. Furthermore, we tested the moderating effects of several study characteristics (e.g., age, race, RD and SI time frame assessment, and categorization of RD measures). The only study characteristic to moderate the effect of RD on SI was SI time frame assessment (r = 0.07; 95% CI: 0.015 to 0.12; p = 0.01). Our findings suggest that SI and SA are phenomena that may be influenced by exposure to RD. Thus, individuals that are discriminated based on race may develop more suicidal thoughts and an increased likelihood of attempting suicide. These findings underscore the need for more prevention and intervention efforts to attenuate the effect of RD on suicidality.

Keywords: Racial discrimination, Racism, Mental health, Ethnicity, Minority groups, Public health, Suicide

Highlights

  • •

    We conducted a meta-analysis of 62,349 individuals.

  • •

    We pooled effect sizes from 43 studies from seven countries.

  • •

    Racial discrimination has a statistically significant effect on suicidal ideation (r = 0.16, p < 0.0001).

  • •

    Racial discrimination has a statistically significant effect on suicide attempt (r = 0.13, p = 0.018).

1. Introduction

Racial discrimination (RD) is unfair treatment of individuals or groups based on race and related classifiers such as ethnicity and nationality (Pager & Shepherd, 2008; Paradies et al., 2015). It is a widespread, pervasive phenomenon, strongly intertwined in societal interrelations and an inherited aspect in the daily lives of many individuals (Bourabain & Verhaeghe, 2021). Evidence suggests that RD is a system embedded in social dynamics, resulting in heightened hostility toward minority and disadvantaged groups in society and the stratification of racial and ethnical groups into social hierarchies (Hackett et al., 2020; Williams & Medlock, 2017). Furthermore, RD reinforces stereotypes and attitudes against stigmatized racial groups, marginalizing individuals from societal resources and opportunities and contributing to the perpetuation of racism (Williams et al., 2019). Racism, a facet of RD and often used interchangeably with RD throughout the literature (Alhusen et al., 2016), implies an ideology of racial superiority/inferiority and the hierarchization of racial groups (Pager & Shepherd, 2008). Both individuals and social institutions can reproduce it, which can be persistent through governmental policies (Williams, 2018). Individuals exposed to RD may bear the stigma burden of their racial group, raising chronic vigilance, rumination of racial incidents, and anticipatory concerns over potential exposures (Hicken et al., 2018; Lewis et al., 2015).

New evidence suggests that RD is becoming more frequent in society. Individuals have been reporting more experiences of RD manifested through racial slurs (Huang & Cornell, 2019), hate crimes (Myers & Lantz, 2020), and governmental policies perceived as discriminatory by targeted groups (Williams & Medlock, 2017). Political shifts in several countries are also a factor that has been associated with more overt expressions of offensive language and attitudes toward minorities (da Silva & Larkins, 2019; Williams & Medlock, 2017). Additionally, social media represents a growing setting of exposure to RD (Criss et al., 2021). Thus, the pervasiveness of RD in society makes RD a constant source of psychological stress with detrimental implications for well-being (Vargas et al., 2020).

Evidence suggests that RD may contribute to a sense of diminished self-worth (Benner et al., 2018), loneliness (Priest et al., 2014), and hopelessness due to the reduced opportunities for upward mobility (Clark et al., 1999). Also, perceived RD may elicit cognitive appraisals of threat, as individuals become a deliberate target to others because of their inheritable characteristics (Dion, 2002). As a result, meta-analyses found associations between RD and lower life satisfaction (Harris et al., 2018), poorer self-rated health (Schmitt et al., 2014), and mental disorders such as depression (Britt-Spells et al., 2018), anxiety (Paradies et al., 2015), and posttraumatic stress disorder (Kirkinis et al., 2021). Notably, mental disorders are considered risk factors for suicide (Brådvik, 2018).

Suicide is among the twenty leading causes of death worldwide (around 700,000 suicides each year), with one person taking their own life every 40 s (WHO, 2019). Death by suicide represents an individual and a social tragedy with a significant psychological and socioeconomic impact on families, friends, and entire communities (Cerel et al., 2019). It is a significant public health problem and has been the focus of growing attention in social and health sciences and public awareness (Turecki et al., 2019). Although suicide rates declined globally in the 20th century, they increased by 7% in the late 20th/early 21st century (Naghavi & Collaborators, 2019) and by 30% in the U.S between 2000 and 2016 (Hedegaard et al., 2018). Racial groups may differ in suicide rates, but racial minorities and marginalized racial groups appear to be at high risk. Research findings report a higher suicide risk among migrants of ethnic minorities in Europe (Forte et al., 2018), indigenous groups in Oceania (Dickson et al., 2019; Hatcher, 2016) and South America (Troya et al., 2022), and increasing suicide rates for Blacks and Native Americans in the U.S (Lindsey et al., 2019; Shain, 2019). Notably, increasing rates of suicide among young individuals from minority groups have also been observed across different societies (Dickson et al., 2019; Forte et al., 2018), elevating suicide as the second leading cause of death among Native American youth and the third among African American youth (Heron, 2016; Shaughnessy et al., 2004).

Given that certain groups are more exposed to RD and RD has negative consequences for psychological well-being, studies began to investigate whether RD is associated with suicidal ideation (SI) and with a history of suicide attempt (SA). Several studies reported a positive association between RD and SI or SA across racially diverse groups in the U.S. (Chao et al., 2012; Choi et al., 2020; Galán et al., 2021; Perez-Rodriguez et al., 2014; Walls et al., 2007), among Blacks in Brazil (Santana et al., 2007) and Canada (Okoye & Saewyc, 2021), Aboriginals in Australia (Priest et al., 2011), Māori in New Zealand (Williams et al., 2018), and ethnic minorities in China (Pan & Spittal, 2013). As of yet, the only published meta-analysis investigating the association between RD and suicidality reported an association between the two phenomena (r = −0.16; Paradies et al., 2015). However, this meta-analysis compiled studies published in the literature until 2013, and only ten studies were available. Since then, more evidence has emerged, part of which reports mixed or null findings (Hong, 2019; Lacey et al., 2021; Layland et al., 2020; Oh & Nicholson, 2021; Polanco-Roman et al., 2021; Taliaferro et al., 2020), suggesting that the question whether RD is associated with suicidality needs to be further addressed in the literature. This highlights the importance of an updated meta-analysis investigating the magnitude of the relationship between RD and suicidality.

In the present article, we aimed to meta-analytically review the literature and investigate the magnitude of the relationship between racial discrimination (whether based on race or its related classifiers such as ethnicity and nationality) and suicidality. We considered both dimensional aspects of suicidality separately in our study: suicidal ideation and suicide attempt, and we conducted separate analyses to investigate the impact of RD on both. We defined SI as thoughts/wishes about ending one's own life, which may include suicidal plans or not (Turecki et al., 2019), and SA as an act of intention to take one's own life deliberately. As several studies indicate that RD and suicide are increasing phenomena among marginalized racial groups and racial minorities, we hypothesize that our meta-analytical review will find a statistically significant effect of RD on suicidality.

2. Methods

2.1. Search strategy

We retrieved articles for this meta-analysis from Embase, PubMed, PsycINFO, and Scopus with a publication date prior to September 25, 2021. Details of the protocol for this review were preregistered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42021268089. We used a comprehensive list of terms to conduct the systematic search (see supplementary material, Part 1). Two reviewers (BMC and JY) screened the initial 100 records together and the following 250 records independently. The independent search of the 250 records resulted in an excellent interrater agreement (kappa = 0.8). Each of the two reviewers (BMC and JY) screened half of the remaining records. Additionally, we hand-searched references of the eligible articles and other reviews to identify potential missing studies in our systematic search. The systematic search was conducted according to the updated guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Page et al., 2021)

2.2. Inclusion and exclusion criteria

Articles eligible for this meta-analysis were those that investigated whether racial discrimination in any form (e.g., racism, racial bullying, racial microaggression, discrimination due to ethnicity or nationality) is associated with suicidality, i.e., suicidal ideation and/or a history of a suicide attempt. All articles had to be written in English and published in peer-reviewed journals prior to September 25, 2021 (our final search date). For studies that measured different dimensions of RD on suicidality, we opted to consider the more direct forms of RD experiences (e.g., overt RD instead of subtle RD, interpersonal RD instead of vicarious RD). We excluded articles that a) investigated types of discrimination other than RD; and b) investigated multiple or combined types of discrimination where it is not possible to disentangle RD from other types of discrimination (e.g., gendered RD). Articles that only investigated death-wish without suicidal thoughts or non-suicidal self-injury/self-harm thoughts and behaviors were also excluded.

2.3. Data extraction and quality assessment

One reviewer (BMC) extracted data from the selected articles, and another reviewer (CH) verified the extraction accuracy. For all eligible articles, we extracted the following data: first author and year of publication; sample size; sex/gender (percentage of female-identifying individuals); age range (with mean age and SD if available); population (city, region, or country); race/ethnicity; sample recruitment (community sample, students, or larger study); study design; suicidality assessment and time frame of investigation; RD assessment, categorization, and time frame of exposure; outcomes and findings (see Table 1S in supplementary material, Part 2, for complete data extraction). Two raters (BMC and JY) independently assessed the quality of studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-sectional Studies (NIH, 2013). Studies were rated as good, fair, or poor. Ratings were discussed between the reviewers. Disagreements on the quality of the studies were resolved with the help of a third rater (CH).

2.4. Potential moderators

We coded several study characteristics to investigate potential moderators of the effect of RD on suicidality: a) RD and suicidality measures (dichotomous items versus Likert item(s)/non-validated scale versus validated scale); b) sample origin (U.S. versus non-U.S., given that we expect that the majority of eligible studies will be from the U.S.); c) study design (cross-sectional versus longitudinal); d) mean age; e) age (under 25 years of age versus all other ages); f) race (Black versus all other races, or native peoples versus all other races); g) quality assessment ratings; h) RD time frame assessment (>12 months/lifetime versus ≤12 months); i) SI time frame assessment (>12 months/lifetime versus ≤12 months); j) RD categorization, i.e., we categorized studies according to how they assessed RD: occurrence of exposure to RD (yes or no), frequency (how often), appraisal (rated stressfulness or reaction), or a combination of frequency/appraisal.

2.5. Statistical analysis

We used the R package meta for the analyses (Schwarzer, 2010). The effect of RD experiences on suicidality was determined by pooling effect sizes of the relationship between RD and SI and between RD and having a history of SA without any covariates. We standardized all effect sizes to Pearson's correlation coefficient (r). A positive correlation would indicate a positive relationship between RD and SI or between RD and SA. We contacted the authors for papers that did not provide sufficient data for calculating the effect size and requested additional data. Of the 14 studies whose authors we contacted, we obtained nine positive responses with the requested data. Authors from three studies did not respond to our e-mails, and authors from two studies responded that they no longer had access to data.

We verified heterogeneity between studies (assessed with the Q index) using a random-effects model. Also, in addition to visually inspecting the funnel plots for SI and SA for asymmetry (a sign of publication bias), we performed two rank tests: Kendall's tau and Egger's test. In case of an indication of publication bias, we used a trim and fill procedure to correct for bias of the missing studies. If direct findings of the effects of RD on SI and SA were statistically significant, we performed two fail-safe tests to assess the robustness of the results: Rosenthal's and Rosenberg's methods. Lastly, to test if the characteristics of the studies were related to differences in the effect sizes for SI and SA, we conducted moderation analyses with a meta-regression approach by fitting mixed-effect models.

3. Results

3.1. Literature search

The complete study identification process is visualized in the PRISMA diagram (Fig. 1). Our search strategy identified 3934 records through Embase, PubMed, PsycINFO, and Scopus, of which 2147 were duplicates. Of the 1787 remaining records, we excluded 512 records based on their titles, resulting in 1275 records for screening. Further, we assessed the abstracts of the 1275 records and excluded 550 based on their abstracts. The remaining 725 full-text articles were assessed, of which 677 were excluded (see Fig. 1 for reasons). Forty-eight articles were identified through the systematic search, and four articles identified through reference list review investigated the association between RD and suicidality. Of these 52 articles, we removed nine articles from the meta-analysis due to overlapping samples (k = 4), which would provide us with repeated effect sizes, or because we could not obtain effect sizes (k = 5). Lastly, we pooled effect sizes from 43 studies for the quantitative synthesis, resulting in 39 effect sizes for the association between RD and SI and 15 effect sizes for the association between RD and having a history of SA.

Fig. 1.

Fig. 1

Open in a new tab

Flow diagram of the article selection.

3.2. Characteristics of included studies

We provide the complete data extraction of all 52 articles investigating the association between RD and suicidality in Table 1S. In Table 1, we briefly describe the 43 studies available for the quantitative synthesis and the effect sizes pooled for the relationship between RD and SI and between RD and SA. The 43 studies contained 62,349 individuals, of which 58,629 individuals provided data for the relationship between RD and SI and 30,088 individuals for the relationship between RD and a history of SA. Most of the studies were from the U.S. (k = 36), were predominantly composed of females (k = 27), individuals under 25 years of age (k = 23), and had racially/ethnically diverse samples (k = 27, for two or more races/ethnicities).

Table 1.

Selected characteristics of studies examining the association between racial discrimination and suicidality.

Reference Sample size Female, % Age range (mean, SD) Population Race/ethnicity Effect size (SI or SA) Analytic stratification* Quality assessment
Freedenthal et al., 2004 311 56.9% 12-20 (15.6, 1.6) Southwestern U.S. Native American 0.15 (SA) RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Yoder et al., 2006 201 46% 9-16 (12.12, 1.44) Reservations in Midwestern U.S. Native American 0.20 (SI) SI measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Good
Santana et al. (2007) 973 68.9% 10-21 (NA) Salvador, BA, Brazil Black & non-Black Brazilians 0.14 (SI) SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Good
Walls et al. (2007) 721 50% 10-13 (11.1, NR) Midwest U.S. & Canada Native American 0.14 (SI) SI measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Good
Hwang & Goto, 2008 186 63.9% NR (NR) Rocky Mountains, U.S. Asian American & Latino 0.146 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: frequency Good
Castle et al. (2011) 234 NR 18-24 (NR) Northeastern U.S. African-American 0.005 (SI)
0.005 (SA)		 SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal Fair
Gomez et al., 2011 969 68% 18-25 (18.8, 1.3) Northeastern U.S. Asian, Latino, Black & White 0.114 (SA) RD measure: validated scale; RD categorization: appraisal/frequency Good
Hightow-Weidman et al. (2011) 348 0% NR (20.4, NR) Bronx, NY; Chapel Hill, NC; Chicago, IL; Detroit, MI; Houston, TX; Los Angeles, CA; Oakland, CA; Rochester, NY African-American, Latino, and multiracial 0.0988 (SI)
0.0467 (SA)		 SI measure: dichotomous; RD measure: Likert item(s); RD categorization: occurrence of exposure Fair
Priest et al. (2011) 345 53% 16-20 (18.27, 1.06) Northern Territory, Australia Australian Aboriginal 0.23 (SI) SI measure: Likert item(s); RD measure: dichotomous; RD categorization: occurrence of exposure Good
Chao et al. (2012) 1555 63% 18-53 (23.14, 5.78) Midwestern U.S. African-American 0.30 (SI) SI measure: Likert item(s); RD measure: Likert item(s); RD categorization: appraisal Good
Luke et al., 2013 172 56.4% 19 (12–26, 4) Melbourne, Australia Australian Aboriginal 0.22 (SI)
0.31 (SA)		 SI measure: dichotomous; RD measure: dichotomous RD categorization: occurrence of exposure Fair
Pan and Spittal (2013) 8182 51.40% 13-15 (NR) Chinese cities of Beijing, Hangzhou, Wuhan & Urumqi Chinese (ethnicity not specified) 0.21 (SI) SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Polanco-Roman & Miranda (2013) 143 80% 18-25 (18.6, 1.19) Northeastern U.S. Asian, Black, Latino, White 0.08 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Good
Thoma & Huebner, 2013 276 33% 14-19 (17.45, 1.36) Indianapolis, IN, Oakland, CA, Boston, MA, Philadelphia, PA African-American, African-American mixed 0.12 (SI) SI measure: dichotomous; RD measure: validated scale; RD categorization: appraisal/frequency Fair
Perez-Rodriguez et al. (2014) 6359 49.1% 18-65+ (NR) U.S. (several areas) Hispanic 0.051 (SI)0.020 (SA) SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Walker et al., 2014 236 48.6% 18-59 (36.46, 12.47) One southeastern community in the U.S. African-American 0.13 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Fair
Brockie et al., 2015 285 for SI, 279 for SA 51% 15-24 (19.25, 2.9) One reservation (unidentified) in the U.S. Native American 0.155 (SI)
0.130 (SA)		 Si measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Good
Chesin & Jeglic, 2015 118 86% ≅20 Northeastern U.S. African American, White & other 0.20 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Good
O'Keefe et al., 2015 405 61.4% 18-48 (19.65, NR) Midwest U.S. African-American, Asian American, Hispanic & Native American 0.13 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Good
Gattis & Larson, 2016 89 52% 16-24 (20.60, 2.06) Milwaukee, WI African-American 0.31 (SI) SI measure: dichotomous; RD measure: validated scale; RD categorization: appraisal/frequency Good
Sutter & Perrin, 2016 200 53% NR (29.5, 9.93) U.S. (several areas) African American, Latino, Asian, Native American & mixed race 0.14 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: frequency Good
Arshanapally et al. (2018) 796 50% 13-32 (17.9, NR) Missouri, MS African-American 0.2799 (SI)
0.1795 (SA)		 SI measure: dichotomous; RD measure: validated scale; RD categorization: appraisal/frequency Fair
Hong et al. (2018) 289 61.2% 18-25 (20.47, 1.83) Southwestern U.S. African-American, Asian American, Hispanic 0.24 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: frequency Fair
Kwon & Han, 2018 1916 49% NR (37.35, 14.64) U.S. (several areas) Latino 0.1949 (SI) SI measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Fair
Li et al., 2018 3123 57.7% 60+ (72.3, 8.3) Chicago, IL American Chinese 0.1543 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Good
Williams et al. (2018) 1623 54.4% 12-19 (NR) New Zealand Maori 0.21 (SA) RD measure: Likert item(s); RD categorization: occurrence of exposure Good
Hong (2019) 292 56.5% Over 19 (42.6, 10.3) Seoul and nearby areas, South Korea Korean Chinese 0.20 (SI) SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Polanco-Roman et al. (2019) 1344 72% 18-29 (19.88, 2.25) Northeastern U.S. African-American, Hispanic/Latino, White, Asian & other 0.09 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: frequency Good
Choi et al. (2020) 786 56.35% 11-19 (15, 1.91) Chicago area, IL Asian American (Korean & Filipino) 0.26 (SI) Si measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Good
Edwards et al., 2020 400 54.9% 12-18 (13.88, 1.30) Great Plains, U.S. American Indian & Alaska Native 0.18 (SI) SI: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Layland et al. (2020) 817 50.8% 18-68 (39.1, 12.3) U.S. (several areas) Non-Hispanic Black and Hispanic 0.08 (SA) RD measure: validated scale; RD categorization: appraisal/frequency Good
Taliaferro et al. (2020) 435 56% 18-26 (NR) Midwestern & Southeastern, U.S. Asian, European, Hispanic/Latino, African, Middle Eastern, and other 0.24 (SI) SI measure: Likert item(s); RD measure: validated scale; RD categorization: frequency Good
Argabright et al., 2021 11235 47.7% 9-10 (10.9, 0.64) U.S. (several areas) White, Black, Asian, American Indian, Native Hawaiian & other 0.32 (SI) SI measure: dichotomous; RD measure: Likert item(s); RD categorization: occurrence of exposure Good
Galán et al. (2021) 3650 53.7% NR (15.7, 1.3) Pittsburgh, PA White, Black, or African American, Asian, American Indian, or Alaska Native, Native Hawaiian or Other Pacific Islander, and other 0.071 (SI) SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Goodwill et al. (2021) 1271 0% 18-93 (43.53, 16.18) U.S. (several areas) African-American 0.091 (SI) SI measure: dichotomous; RD measure: validated scale; RD categorization: frequency Good
Lacey et al. (2021) 3277 100% NR (42.5, NR) U.S. (several areas) African American & Caribbean Black 0.04 (SI) SI measure: dichotomous; RD measure: validated scale; RD categorization: frequency Good
Mallory & Russel, 2021 585 49% 15-24 (19, 1.79) One city in the Northeast and one city in the Southwest, U.S. Black, Latino, Asian, Multi-racial, Native American, Hawaiian & Pacific Islander 0.21 (SI) SI measure: validated scale; RD measure: validated scale; RD categorization: appraisal/frequency Good
Oh and Nicholson (2021) 5191 NR 18+ (NR) U.S. (several areas) African Americans & Caribbean Black Americans 0.01 (SI)
0.008 (SA)		 SI measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Fair
Okoye and Saewyc (2021) 535 for SI, 533 for SA 48% NR (15.1, NR) British Columbia, Canada African Canadians 0.17 (SI)
0.20 (SA)		 SI measure: dichotomous; RD measure: dichotomous; RD categorization: occurrence of exposure Fair
Polanco-Roman et al. (2021) 747 61% 18-29 (19.84, 2.22) Northeast U.S. Asian, Hispanic, Black & other 0.08 (SI)
0.04 (SA)		 SI measure: validated scale; RD measure: validated scale; RD categorization: frequency Good
Wang et al., 2021 960 76% NR (44.47, 15.65) U.S. (several areas) Non-Hispanic Black, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian/Native Hawaiian/Other Pacific Islander, and Hispanic 0.06 (SI)
0.02 (SA)		 SI measure: dichotomous; RD measure: Likert item(s); RD categorization: frequency Good
Madubata et al. (2022) 157 49% 14-17 (15.1, 0.53) Southeast U.S. African-American & Latinx 0.14 (SI) SI measure: validated scale; RD measure: Likert item(s); RD categorization: frequency Good
Zimmerman & Miller-Smith (2022) 1147 50.31% 9-12 (10.61, 1.54) Chicago, IL Hispanic, African-American, White, Asian, Pacific Islander, Native American, mixed-race 0.1067 (SI) SI measure: dichotomous; RD measure: Likert item(s); RD categorization: occurrence of exposure Good
Open in a new tab

Note. NR: Not reported; SI: Suicidal ideation; SA: Suicide attempt. * All SA measures were dichotomous.

3.3. Measures of RD and suicidality across studies

The literature presents a significant variability of approaches to measure RD and SI (see Table 1, analytical stratification). Of the 43 available studies for the qualitative analysis, most studies used a single dichotomous item (participants were coded for “yes” or “no” answers) or Likert item(s)/non-validated instruments to assess RD experiences (k = 23). Twenty studies used 11 different validated instruments to measure RD. Except for appraisal (k = 2), RD categorization was well distributed across eligible articles: occurrence of RD exposure (k = 14), frequency (k = 13), and appraisal/frequency (k = 14).

Similarly, there was a large variability of validated instruments to assess SI: ten different validated instruments were applied across 13 studies. Most studies measuring SI used a dichotomous item (responses were coded “yes” or “no” if participants presented SI, k = 22) or Likert item(s)/non-validated instruments (k = 4). For SA, eligible studies used a dichotomous item to code whether participants have ever tried to take their own life.

Furthermore, we observed that time frame assessments of RD and SI differed across studies (from current to lifetime). Thirty studies queried lifetime RD or in a period longer than the past 12 months, whereas 13 studies queried RD in the past year or less. As for SI, 14 studies investigated lifetime SI or in a period longer than the past 12 months, and 25 studies investigated it in the past year. Except for one study, all studies investigating SA queried lifetime SA. We offer a detailed assessment of the time frame in Table 1S.

3.4. Effect of racial discrimination on suicidality

Fig. 2 shows the main results for the analysis on RD and SI, and Fig. 3 shows the main results for the analysis on RD and having a history of SA. The pooled correlation between RD and SI was 0.16 (p < 0.0001), and the pooled correlation between RD and SA was 0.13 (p = 0.018). The heterogeneity between studies for both SI and SA was high: I2 = 94.91%, p < 0.0001 and I2 = 98.72%, p < 0.0001, respectively. Visual inspection of the funnel plots did not suggest asymmetry (Fig. 4, Fig. 5), which was confirmed by the Kendall's tau correlation coefficient (0.13, p = 0.21 for SI; 0.16, p = 0.43 for SA) and by the Egger's test (t = −0.93, p = 0.35 for SI; t = −1.58, p = 0.13 for SA). The safe-fail tests confirmed the robustness of the results (Rosenberg fail-safe n = 18,362 for SI and n = 6040 for SA. Rosenthal fail-safe n = 14,442 for SI and n = 2887 for SA).

Fig. 2.

Fig. 2

Open in a new tab

Forest plot with Pearson's Correlation coefficient (r) between racial discrimination and suicidal ideation.

Fig. 3.

Fig. 3

Open in a new tab

Forest plot with Pearson's Correlation coefficient (r) between racial discrimination and suicide attempt.

Fig. 4.

Fig. 4

Open in a new tab

Funnel plot with Pearson's correlation coefficient (r) between racial discrimination and suicidal ideation.

Fig. 5.

Fig. 5

Open in a new tab

Funnel plot with Pearson's correlation coefficient (r) between racial discrimination and suicide attempt.

3.5. Effect of potential moderators of the effect of racial discrimination on suicidality

Table 2, Table 3 show the results of the moderation analyses. Moderators were age, sample origin, RD and suicidality measures, study design, race, quality assessment ratings, RD time frame assessment, and SI time frame assessment. The only moderator associated with the effect of RD on SI was the SI time frame assessment (p = 0.01). We found a more significant effect size for studies that assessed SI in the past year than those that measured lifetime SI or in a period longer than 12 months (r = 0.18 versus r = 0.11). We also found a trend of significance between RD time frame assessment (past 12 months) and SI (p = 0.09). None of the moderators was associated with the effect of RD on SA. Although we observed a trend of significance between having a history of SA and younger mean age (p = 0.07) and between SA and non-US samples (p = 0.08), these relationships did not reach statistical significance levels.

Table 2.

Effect of racial discrimination on suicide ideation and moderation analysis.

k Pearson's r 95% CI p
Overall outcome 39 0.16 0.12 to 0.19 <0.0001
Moderation Analyses
 Mean age 30 −0.001 −0.003 to 0.001 0.28
 Age 29 −0.02 −0.08 to 0.03 0.42a
 Sample origin 39 −0.04 −0.12 to 0.26 0.24a
 RD measure 39 −0.008 −0.04 to 0.02 0.63a
 RD categorization 39 −0.0005 −0.02 to 0.02 0.96a
 SI measures 38 −0.004 −0.03 to 0.02 0.76a
 Study design 39 −0.009 −0.08 to 0.06 0.80a
 Black vs other 39 0.008 −0.06 to 0.07 0.80a
 Native vs other 39 0.02 −0.04 to 0.10 0.45a
 Quality assessment 39 0.02 −0.03 to 0.08 0.39a
 RD time frame 39 0.05 −0.008 to 0.10 0.09a
 SI time frame 39 0.07 0.015 to 0.12 0.01a
Open in a new tab

Note.a P-value indicates whether the effect size of subgroups differs significantly. Categorical moderators: age (under 25 years of age versus all other ages); Sample origin (U.S. versus non-U.S.); RD measure (dichotomous items versus Likert items/non-validated scale versus validated scale); RD categorization (occurrence of RD versus frequency versus appraisal versus appraisal/frequency); SI measures (dichotomous items versus Likert items/non-validated scale versus validated scale; Study design (cross-sectional versus longitudinal); Black versus all other races; Native peoples versus all other races; Quality assessment ratings; RD time frame assessment (>12 months/lifetime versus ≤12 months), SI time frame assessment (>12 months/lifetime versus ≤12 months).

Table 3.

Effect of racial discrimination on suicide attempt and moderation analysis.

k Pearson's r 95% CI p
Overall outcome 15 0.13 0.02 to 0.23 0.018
Moderation Analyses
 Mean age 10 −0.008 −0.01 to 0.52 0.07
 Age 12 −0.04 −0.18 to 0.10 0.58a
 Sample origin 15 −0.13 −0.27 to 0.01 0.08a
 RD measures 15 −0.03 −0.11 to 0.04 0.36a
 RD categorization 15 −0.03 −0.07 to 0.016 0.2a
 Study design 15 −0.11 −0.35 to 0.12 0.35a
 Black vs other 15 0.009 −0.15 to 0.16 0.91a
 Native vs other 15 0.09 −0.04 to 0.23 0.18a
 Quality assessment 15 0.03 −0.08 to 0.16 0.57a
Open in a new tab

Note.a P-value indicates whether the effect size of subgroups differs significantly. Categorical moderators: age (under 25 years of age versus all other ages); Sample origin (U.S. versus non-U.S.); RD measures (dichotomous items versus Likert items/non-validated scale versus validated scale); RD categorization (occurrence of RD versus frequency versus appraisal versus appraisal/frequency); Study design (cross-sectional versus longitudinal); Black versus all other races; Native peoples versus all other races; Quality assessment ratings.

4. Discussion

In the present meta-analysis, we investigated whether racial discrimination is associated with suicidal ideation and having a history of suicide attempt. We located 52 studies investigating the association between RD and suicidality, from which 43 studies were eligible for the quantitative synthesis. Our meta-analysis indicates that RD has a small but statistically significant effect on SI (r = 0.16, p < 0.0001) and on SA (r = 0.13, p = 0.018). Also, we identified that the SI time frame measure has a significant moderating effect on SI outcomes. Studies that measured SI in the past year had a larger effect size than studies that measured lifetime SI or in a period longer than 12 months (r = 0.18 versus r = 0.11, p = 0.01). This suggests a pattern that SI should be assessed in a more time-limited way when investigating to what extent SI is affected by discriminatory experiences. Assessing lifetime SI may be subjected to memory bias, and perception of SI is likely more salient when assessing individuals using a time-limited and more recent time frame approach. Apart from the SI time frame, the effect of RD on suicidality could not be explained by other studies’ characteristics, as none of the other analyzed moderators reached statistical significance levels.

Furthermore, we found no indication of publication bias in our approach to investigating the effect of RD on SI and SA after performing two different tests (Egger's test and Kendall's tau). Fail-safe tests confirmed the robustness of our results (Rosenberg's and Rosenthal's methods). Our findings suggest that suicidality is a phenomenon that race-related discriminatory experiences may influence. Thus, we confirmed our hypothesis that individuals who experience discrimination based on race might develop more suicidal thoughts and an increased likelihood of attempting suicide.

Our results align with findings reported by a previous meta-analysis that conducted a comprehensive investigation of the effects of RD on multiple health problems, including suicidality (Paradies et al., 2015). However, this meta-analysis reported findings on ten available studies of RD and suicidality, whereas ours found 43 studies, thus, offering an updated status of the literature. Our meta-analytical study is the first to consider an exclusive investigation of RD and suicidality and to perform two separate analyses measuring the effects of RD both on SI and on SA. Our study adds to the growing body of literature indicating that RD is pernicious to well-being and may be a driver of health disparities in society, as groups exposed to RD may exhibit accentuated decline in mental health parameters (Coimbra et al., 2020; Kairuz et al., 2021; Metzner et al., 2022; Williams & Williams-Morris, 2000). As such, more awareness of the issue of RD and the appropriate development of more effective intervention strategies to tackle its effects should be a concern among health workers, researchers, educators, and policymakers.

The majority of the studies in our meta-analysis enrolled samples of adolescents and young adults. Research findings suggest the plausibility that RD is increasingly influential in youth suicide deaths (Al-Mateen & Rogers, 2018). Young individuals may be more aware of racial tensions in society nowadays (Sewell et al., 2016) and more vulnerable to RD exposure on social media (Criss et al., 2021). As the racial composition is shifting in the U.S. and more individuals identify with a non-White racial/ethnical group, young racial minority adults will likely comprise a growing percentage of the nation's suicides (Castle et al., 2011). Although this highlights the relevance of studies on suicidality among the youth, we did not find age to have a moderating effect on the association of RD with SI and SA. This suggests that race-based discrimination may affect suicidality regardless of age and that further studies should not overlook samples with older individuals.

Although most of the studies in our review are from the U.S., we retrieved eligible studies from Canada, Brazil, China, South Korea, Australia, and New Zealand. The current state of the evidence does not show distinctions between U.S. and non-U.S. studies, suggesting that RD may affect suicidality independently of cross-national differences in social dynamics. However, the underrepresentation of samples from developing nations is worth mentioning, as it limits conclusions to high-income countries. Researchers recommend further expanding knowledge on RD and suicide in low- and middle-income countries (Glenn et al., 2020; Olusanya, 2021). This expansion could further our understanding of whether the effect of RD on suicidality that we found in our meta-analysis is indeed a worldwide phenomenon.

Our study has some limitations. First, the complexity of measuring RD is acknowledged in the literature (Williams, 2016). Challenges may be related to the accuracy of measurements of elements related to racially discriminatory experiences, e.g., appraisal, frequency, severity, stress, and time frame of exposure. Future studies should address these issues (Williams et al., 2019). Since we performed a meta-analysis, we are limited to the instruments used across studies. We attempted to categorize RD measures to investigate some of these issues, but we did not find a moderating effect on suicidality.

Moreover, many studies in our article selection use a single dichotomous item or Likert item to assess the occurrence, frequency, or appraisal of RD and/or SI. Such measures might not capture essential nuances of adverse experiences and perceptions related to RD and suicidality. We urge future studies to include validated instruments in their assessments.

A further limitation may be related to our moderators. The effect sizes used in this meta-analysis were primarily pooled from studies with racially diverse samples of both females and males. Various statistical models with the inclusion of multiple covariates were used in these studies to investigate the effect of RD on suicidality. Although we successfully obtained a large number of effect sizes of the correlation between RD and suicidality, our approach with the selected moderators may have been limited to capturing differences in SI and SA according to race because we could not obtain effect sizes for specific groups within studies. Thus, as some eligible articles in our review investigated suicidality only in Blacks (k = 10) and in Native peoples (k = 7), we compared the effect sizes from these studies with effect sizes from studies with multiple races or with other single races. However, these studies with multiple racial groups also generally contained Blacks and Native peoples, which may have yielded our approach too imprecise; and it is important to note that most studies in our article selection with individuals from multiple racial groups did not report the results of an investigation separate by race. The exceptions are Gomez et al. (2011), who reported increased SA among Latinos and non-American Whites compared to Asians, Whites, and Blacks; Madubata et al. (2022), who found increased SI for Blacks compared to Latinx; and Hwang & Goto (2008), who reported no differences between Latinos and Asian Americans. Furthermore, by the time we completed our systematic search, there was no published evidence on the effects of race-based discrimination on suicidality among Asian Americans during the Covid-19 pandemic. As Asian Americans have reported increased experiences of RD in the Covid-19 emergence with adverse mental health consequences (Lee et al., 2022), the literature may benefit from studies that target this specific group in suicidality studies.

Similarly, we could not disentangle differential effects regarding sex/gender and investigate it as a moderator. Although some papers in our review found sex differences in the associations between RD and suicidality in their models (Polanco-Roman et al., 2019; Zimmerman & Miller-Smith, 2022), other papers reported no differences (Arshanapally et al., 2018; Chao et al., 2012). However, the vast majority of papers did not consider sex differences, and only three studies enrolled same-sex samples (Goodwill et al., 2021; Hightow-Weidman et al., 2011; Lacey et al., 2021), invalidating any comparative analysis. RD may affect males' and females' expression of suicidality in different ways. However, our study could not contribute to more specific knowledge on sex/gender differences due to the limited data.

In summary, our study successfully investigated RD and suicidality across 43 studies from seven countries, providing a quantitative synthesis of the effect of RD on suicidality. We found that RD has a small but statistically significant effect on SI and SA. Thus, among other factors that may influence suicidality, RD may be a social factor that increases the risk of developing suicidal thoughts and attempting suicide. These findings may be relevant to researchers in the field of social sciences and mental health. Lastly, our meta-analysis is the first to investigate the effects of RD in explaining SI and SA separately. Furthermore, only studies that investigated racial discrimination apart from any other form of discrimination were included. As emerging evidence indicates that racial discrimination is an increasing social phenomenon, more prevention and intervention efforts are needed to attenuate its effect on suicidality.

Ethical statement

Hereby, I Bruno Messina Coimbra consciously assure that for the manuscript “Meta-analysis of the effect of racial discrimination on suicidality” the following is fulfilled:

  • 1)

    This material is the authors' own original work, which has not been previously published elsewhere.

  • 2)

    The paper is not currently being considered for publication elsewhere.

  • 3)

    The paper reflects the authors' own research and analysis in a truthful and complete manner.

  • 4)

    The results are appropriately placed in the context of prior and existing research.

  • 5)

    All sources used are properly disclosed (correct citation). Literally copying of text must be indicated as such by using quotation marks and giving proper reference.

  • 6)

    All authors have been personally and actively involved in substantial work leading to the paper, and will take public responsibility for its content.

Grant numbers and funding information

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. Additional grant support was provided by CNPq 303389/2016-8. The funders had no role in the study design or the decision to publish this article.

Declaration of competing interest

None.

Acknowledgments

We are particularly grateful to those authors who shared data with us (Krim Lacey, Soyoung Kwon, Gregory Zimmerman, Yoonsun Choi, Michael Park, Teresa Brockie, Kathleen Keenan Bucholz, Alison Culyba, Chardée A. Galán, Regina Miranda, Helen Okoye). Also, we would like to thank UNIFESP Professor Dr. Adriana Marcassa Tucci.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.ssmph.2022.101283.

Appendix A. Supplementary data

The following are the Supplementary data to this article:

Multimedia component 1
mmc1.docx (12.5KB, docx)
Multimedia component 2
mmc2.docx (44.4KB, docx)

Data availability

No data was used for the research described in the article.

References

  1. Al-Mateen C.S., Rogers K.M. Suicide among African-American and other African-origin youth. Suicide among Diverse Youth. 2018:31–49. [Google Scholar]
  2. Alhusen J.L., Bower K.M., Epstein E., Sharps P. Racial discrimination and adverse birth outcomes: An integrative review. Journal of Midwifery & Women's Health. 2016;61(6):707–720. doi: 10.1111/jmwh.12490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Arshanapally S., Werner K.B., Sartor C.E., Bucholz K.K. The association between racial discrimination and suicidality among african-American adolescents and young adults. Archives of Suicide Research. 2018;22(4):584–595. doi: 10.1080/13811118.2017.1387207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benner A.D., Wang Y., Shen Y., Boyle A.E., Polk R., Cheng Y.-P. Racial/ethnic discrimination and well-being during adolescence: A meta-analytic review. American Psychologist. 2018;73(7):855–883. doi: 10.1037/amp0000204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bourabain D., Verhaeghe P.-P. Everyday racism in social science research: A systematic review and future directions. Du Bois Review: Social Science Research on Race. 2021;18(2):221–250. doi: 10.1017/S1742058X21000102. [DOI] [Google Scholar]
  6. Brådvik L. Suicide risk and mental disorders. International Journal of Environmental Research and Public Health. 2018;15(9):2028. doi: 10.3390/ijerph15092028. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Britt-Spells A.M., Slebodnik M., Sands L.P., Rollock D. Effects of perceived discrimination on depressive symptoms among black men residing in the United States: A meta-analysis. American Journal of Men's Health. 2018;12(1):52–63. doi: 10.1177/1557988315624509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Castle K., Conner K., Kaukeinen K., Tu X. Perceived racism, discrimination, and acculturation in suicidal ideation and suicide attempts among black young adults. Suicide and Life-Threatening Behavior. 2011;41(3):342–351. doi: 10.1111/j.1943-278X.2011.00033.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cerel J., Brown M.M., Maple M., Singleton M., van de Venne J., Moore M., Flaherty C. How many people are exposed to suicide? Not six. Suicide and Life-Threatening Behavior. 2019;49(2):529–534. doi: 10.1111/sltb.12450. [DOI] [PubMed] [Google Scholar]
  10. Chao R.C.-L., Mallinckrodt B., Wei M. Co-occurring presenting problems in African American college clients reporting racial discrimination distress. Professional Psychology: Research and Practice. 2012;43(3):199–207. doi: 10.1037/a0027861. [DOI] [Google Scholar]
  11. Choi Y., Park M., Noh S., Lee J.P., Takeuchi D. Asian American mental health: Longitudinal trend and explanatory factors among young Filipino- and Korean Americans. SSM - Population Health. 2020;10 doi: 10.1016/j.ssmph.2020.100542. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Clark R., Anderson N.B., Clark V.R., Williams D.R. Racism as a stressor for African Americans. A biopsychosocial model. American Psychologist. 1999;54(10):805–816. doi: 10.1037//0003-066x.54.10.805. [DOI] [PubMed] [Google Scholar]
  13. Coimbra B.M., Carvalho C.M., Ota V.K., Vieira-Fonseca T., Bugiga A., Mello A.F., Mello M.F., Belangero S.I. A systematic review on the effects of social discrimination on telomere length. Psychoneuroendocrinology. 2020;120 doi: 10.1016/j.psyneuen.2020.104766. [DOI] [PubMed] [Google Scholar]
  14. Criss S., Michaels E.K., Solomon K., Allen A.M., Nguyen T.T. Twitter fingers and echo chambers: Exploring expressions and experiences of online racism using twitter. Journal of Racial and Ethnic Health Disparities. 2021;8(5):1322–1331. doi: 10.1007/s40615-020-00894-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Dickson J.M., Cruise K., McCall C.A., Taylor P.J. A systematic review of the antecedents and prevalence of suicide, self-harm and suicide ideation in Australian aboriginal and torres strait islander youth. International Journal of Environmental Research and Public Health. 2019;16(17):3154. doi: 10.3390/ijerph16173154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Dion K.L. The social psychology of perceived prejudice and discrimination. Canadian Psychology/Psychologie Canadienne. 2002;43(1):1–10. doi: 10.1037/h0086899. [DOI] [Google Scholar]
  17. Forte A., Trobia F., Gualtieri F., Lamis D.A., Cardamone G., Giallonardo V., Fiorillo A., Girardi P., Pompili M. Suicide risk among immigrants and ethnic minorities: A literature overview. International Journal of Environmental Research and Public Health 2018. 2018;15(7):1438. doi: 10.3390/IJERPH15071438. 15, Page 1438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Galán C.A., Stokes L.R., Szoko N., Abebe K.Z., Culyba A.J. Exploration of experiences and perpetration of identity-based bullying among adolescents by race/ethnicity and other marginalized identities. JAMA Network Open. 2021;4(7) doi: 10.1001/jamanetworkopen.2021.16364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Glenn C.R., Kleiman E.M., Kellerman J., Pollak O., Cha C.B., Esposito E.C., Porter A.C., Wyman P.A., Boatman A.E. Annual research review: A meta-analytic review of worldwide suicide rates in adolescents. Journal of Child Psychology and Psychiatry. 2020;61(3):294–308. doi: 10.1111/jcpp.13106. [DOI] [PubMed] [Google Scholar]
  20. Gomez J., Miranda R., Polanco L. Acculturative stress, perceived discrimination, and vulnerability to suicide attempts among emerging adults. Journal of Youth and Adolescence. 2011;40(11):1465–1476. doi: 10.1007/s10964-011-9688-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Goodwill J.R., Taylor R.J., Watkins D.C. Everyday discrimination, depressive symptoms, and suicide ideation among african American men. Archives of Suicide Research. 2021;25(1):74–93. doi: 10.1080/13811118.2019.1660287. [DOI] [PubMed] [Google Scholar]
  22. Hackett R.A., Ronaldson A., Bhui K., Steptoe A., Jackson S.E. Racial discrimination and health: A prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020;20(1):1652. doi: 10.1186/s12889-020-09792-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Harris R.B., Stanley J., Cormack D.M. Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and well-being measures using national survey data. PLoS One. 2018;13(5) doi: 10.1371/journal.pone.0196476. e0196476–e0196476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hatcher S. Indigenous suicide: A global perspective with a New Zealand focus. Canadian Journal of Psychiatry. 2016;61(11):684–687. doi: 10.1177/0706743716644147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hedegaard H., Curtin S.C., Warner M. Suicide rates in the United States continue to increase. NCHS Data Brief. 2018;309:1–8. [PubMed] [Google Scholar]
  26. Heron M. Deaths: Leading causes for 2014. National Vital Statistics Reports : From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2016;65(5):1–96. [PubMed] [Google Scholar]
  27. Hicken M.T., Lee H., Hing A.K. The weight of racism: Vigilance and racial inequalities in weight-related measures. Social Science & Medicine. 2018;199:157–166. doi: 10.1016/j.socscimed.2017.03.058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Hightow-Weidman L.B., Phillips G. 2nd, Jones K.C., Outlaw A.Y., Fields S.D., Smith J.C. Racial and sexual identity-related maltreatment among minority YMSM: Prevalence, perceptions, and the association with emotional distress. AIDS Patient Care and STDs. 2011;25(Suppl 1):S39–S45. doi: 10.1089/apc.2011.9877. [DOI] [PubMed] [Google Scholar]
  29. Hong J. Effects of ethnic identity on the relationship between mental health and perceived discrimination among ethnic return migrants: The case of Korean Chinese return-migrated to South Korea. Journal of Immigrant and Minority Health. 2019;21(3):522–532. doi: 10.1007/s10903-018-0775-9. [DOI] [PubMed] [Google Scholar]
  30. Hong J.H., Talavera D.C., Odafe M.O., Barr C.D., Walker R.L. Does purpose in life or ethnic identity moderate the association for racial discrimination and suicide ideation in racial/ethnic minority emerging adults? Cultural Diversity & Ethnic Minority Psychology. 2018 doi: 10.1037/cdp0000245. [DOI] [PubMed] [Google Scholar]
  31. Huang F.L., Cornell D.G. School teasing and bullying after the presidential election. Educational Researcher. 2019;48(2):69–83. doi: 10.3102/0013189X18820291. [DOI] [Google Scholar]
  32. Hwang W.-C., Goto S. The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultural Diversity & Ethnic Minority Psychology. 2008;14(4):326–335. doi: 10.1037/1099-9809.14.4.326. [DOI] [PubMed] [Google Scholar]
  33. Kairuz C.A., Casanelia L.M., Bennett-Brook K., Coombes J., Yadav U.N. Impact of racism and discrimination on physical and mental health among aboriginal and torres strait islander peoples living in Australia: A systematic scoping review. BMC Public Health. 2021;21(1):1302. doi: 10.1186/s12889-021-11363-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Kirkinis K., Pieterse A.L., Martin C., Agiliga A., Brownell A. Racism, racial discrimination, and trauma: A systematic review of the social science literature. Ethnicity and Health. 2021;26(3):392–412. doi: 10.1080/13557858.2018.1514453. [DOI] [PubMed] [Google Scholar]
  35. Lacey K.K., Mouzon D.M., Parnell R.N., Laws T. Severe intimate partner violence, sources of stress and the mental health of U.S. Black women. Journal of Women's Health. 2021;30(1):17–28. doi: 10.1089/jwh.2019.8215. 2002. [DOI] [PubMed] [Google Scholar]
  36. Layland E.K., Exten C., Mallory A.B., Williams N.D., Fish J.N. Suicide attempt rates and associations with discrimination are greatest in early adulthood for sexual minority adults across diverse racial and ethnic groups. LGBT Health. 2020;7(8):439–447. doi: 10.1089/lgbt.2020.0142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lee Y.H., Liu Z., Fatori D., Bauermeister J.R., Luh R.A., Clark C.R., Bauermeister S., Brunoni A.R., Smoller J.W. Association of everyday discrimination with depressive symptoms and suicidal ideation during the COVID-19 pandemic in the all of us research program. JAMA Psychiatry. 2022;79(9):898–906. doi: 10.1001/jamapsychiatry.2022.1973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Lewis T.T., Cogburn C.D., Williams D.R. Self-reported experiences of discrimination and health: Scientific advances, ongoing controversies, and emerging issues. Annual Review of Clinical Psychology. 2015;11(1):407–440. doi: 10.1146/annurev-clinpsy-032814-112728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Lindsey M.A., Sheftall A.H., Xiao Y., Joe S. Trends of suicidal behaviors among high school students in the United States: 1991-2017. Pediatrics. 2019;144(5) doi: 10.1542/peds.2019-1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Madubata, I., Spivey, L.A., Alvarez, G.M., Neblett, E.W., & Prinstein, M.J. (2022). Forms of racial/ethnic discrimination and suicidal ideation: A prospective examination of African-American and Latinx Youth. Journal of Clinical Child and Adolescent Psychology : The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 51(1), 23–31. 10.1080/15374416.2019.1655756. [DOI] [PMC free article] [PubMed]
  41. Metzner F., Adedeji A., Wichmann M.L.-Y., Zaheer Z., Schneider L., Schlachzig L., Richters J., Heumann S., Mays D. Experiences of discrimination and everyday racism among children and adolescents with an immigrant background - results of a systematic literature review on the impact of discrimination on the developmental outcomes of minors worldwide. Frontiers in Psychology. 2022;13 doi: 10.3389/fpsyg.2022.805941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Myers W., Lantz B. Reporting racist hate crime victimization to the police in the United States and the United Kingdom: A cross-national comparison. British Journal of Criminology. 2020;60(4):1034–1055. doi: 10.1093/bjc/azaa008. [DOI] [Google Scholar]
  43. Naghavi M., Collaborators, =Global Burden of Disease Self-Harm . Vol. 364. 2019. Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the global burden of disease study 2016; p. l94. (BMJ (Clinical research ed). [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. NIH . 2013. Quality assessment Tool for observational Cohort and cross-sectional studies.https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools [Google Scholar]
  45. Oh H., Nicholson H. Perceived skin tone discrimination and suicidal ideation black Americans: Findings from the national survey of American life. Journal of Affective Disorders. 2021;284:143–148. doi: 10.1016/j.jad.2021.02.023. [DOI] [PubMed] [Google Scholar]
  46. Okoye H.U., Saewyc E. Fifteen-year trends in self-reported racism and link with health and well-being of african Canadian adolescents: A secondary data analysis. International Journal for Equity in Health. 2021;20(1):108. doi: 10.1186/s12939-021-01446-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Olusanya B.O. Systemic racism in global health: A personal reflection. Lancet Global Health. 2021;9(8):e1051–e1052. doi: 10.1016/S2214-109X(21)00147-9. [DOI] [PubMed] [Google Scholar]
  48. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., Li T., Loder E.W., Mayo-Wilson E., McDonald S.…Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews. 2021;10(1):89. doi: 10.1186/s13643-021-01626-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Pager D., Shepherd H. The sociology of discrimination: Racial discrimination in employment, housing, credit, and consumer markets. Annual Review of Sociology. 2008;34:181–209. doi: 10.1146/annurev.soc.33.040406.131740. http://www.ncbi.nlm.nih.gov/pubmed/20689680 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Pan S.W., Spittal P.M. Health effects of perceived racial and religious bullying among urban adolescents in China: A cross-sectional national study. Global Public Health. 2013;8(6):685–697. doi: 10.1080/17441692.2013.799218. [DOI] [PubMed] [Google Scholar]
  51. Paradies Y., Ben J., Denson N., Elias A., Priest N., Pieterse A., Gupta A., Kelaher M., Gee G. Racism as a determinant of health: A systematic review and meta-analysis. PLoS One. 2015;10(9) doi: 10.1371/journal.pone.0138511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Perez-Rodriguez M.M., Baca-Garcia E., Oquendo M.A., Wang S., Wall M.M., Liu S.-M., Blanco C. Relationship between acculturation, discrimination, and suicidal ideation and attempts among US hispanics in the national epidemiologic survey of alcohol and related conditions. Journal of Clinical Psychiatry. 2014;75(4):399–407. doi: 10.4088/JCP.13m08548. [DOI] [PubMed] [Google Scholar]
  53. Polanco-Roman L., Anglin D.M., Miranda R., Jeglic E.L. Racial/ethnic discrimination and suicidal ideation in emerging adults: The role of traumatic stress and depressive symptoms varies by gender not race/ethnicity. Journal of Youth and Adolescence. 2019;48(10):2023–2037. doi: 10.1007/s10964-019-01097-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Polanco-Roman L., Miranda R. Culturally Related Stress, Hopelessness, and Vulnerability to Depressive Symptoms and Suicidal Ideation in Emerging Adulthood. Behavior Therapy. 2013;44(1):75–87. doi: 10.1016/j.beth.2012.07.002. [DOI] [PubMed] [Google Scholar]
  55. Polanco-Roman L., Miranda R., Hien D., Anglin D.M. 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. Psychological Trauma : Theory, Research, Practice and Policy. 2021;13(7):759–767. doi: 10.1037/tra0001076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Priest N.C., Paradies Y.C., Gunthorpe W., Cairney S.J., Sayers S.M. Racism as a determinant of social and emotional well-being for Aboriginal Australian youth. Medical Journal of Australia. 2011;194(10):546–550. doi: 10.5694/j.1326-5377.2011.tb03099.x. [DOI] [PubMed] [Google Scholar]
  57. Priest N., Perry R., Ferdinand A., Paradies Y., Kelaher M. Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students. Journal of Youth and Adolescence. 2014;43(10):1672–1687. doi: 10.1007/s10964-014-0140-9. [DOI] [PubMed] [Google Scholar]
  58. Santana V., Almeida-Filho N., Roberts R., Cooper S.P. Skin colour, perception of racism and depression among adolescents in urban Brazil. Child and Adolescent Mental Health. 2007;12(3):125–131. doi: 10.1111/j.1475-3588.2007.00447.x. [DOI] [PubMed] [Google Scholar]
  59. Schmitt M.T., Branscombe N.R., Postmes T., Garcia A. The consequences of perceived discrimination for psychological well-being: A meta-analytic review. Psychological Bulletin. 2014;140(4):921–948. doi: 10.1037/a0035754. [DOI] [PubMed] [Google Scholar]
  60. Schwarzer G. 2010. meta: Meta-Analysis with R. R package version 1.6-1.http://CRAN.R-Project.Org/Package=Meta [Google Scholar]
  61. Sewell W., Horsford C.E., Coleman K., Watkins C.S. Vile vigilance: An integrated theoretical framework for understanding the state of Black surveillance. Journal of Human Behavior in the Social Environment. 2016;26(3–4):287–302. doi: 10.1080/10911359.2015.1127735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Shain B.N. Increases in rates of suicide and suicide attempts among black adolescents. Pediatrics. 2019;144(5) doi: 10.1542/PEDS.2019-1912/38209. [DOI] [PubMed] [Google Scholar]
  63. Shaughnessy L., Doshi S.R., Jones S.E. Attempted suicide and associated health risk behaviors among native American high school students. Journal of School Health. 2004;74(5):177–182. doi: 10.1111/j.1746-1561.2004.tb08217.x. [DOI] [PubMed] [Google Scholar]
  64. da Silva A.J.B., Larkins E.R. The bolsonaro election, antiblackness, and changing race relations in Brazil. Journal of Latin American and Caribbean Anthropology. 2019;24(4):893–913. doi: 10.1111/jlca.12438. [DOI] [Google Scholar]
  65. Taliaferro L.A., Muehlenkamp J.J., Jeevanba S.B. Factors associated with emotional distress and suicide ideation among international college students. Journal of American College Health. 2020;68(6):565–569. doi: 10.1080/07448481.2019.1583655. [DOI] [PubMed] [Google Scholar]
  66. Troya M.I., Spittal M.J., Pendrous R., Crowley G., Gorton H.C., Russell K., Byrne S., Musgrove R., Hannam-Swain S., Kapur N., Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine. 2022;47 doi: 10.1016/j.eclinm.2022.101399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Turecki G., Brent D.A., Gunnell D., O'Connor R.C., Oquendo M.A., Pirkis J., Stanley B.H. Suicide and suicide risk. Nature Reviews Disease Primers. 2019;5(1):74. doi: 10.1038/s41572-019-0121-0. [DOI] [PubMed] [Google Scholar]
  68. Vargas S.M., Huey S.J., Jr., Miranda J. A critical review of current evidence on multiple types of discrimination and mental health. American Journal of Orthopsychiatry. 2020;90(3):374–390. doi: 10.1037/ort0000441. [DOI] [PubMed] [Google Scholar]
  69. Walls M.L., Chapple C.L., Johnson K.D. Strain, emotion, and suicide among American Indian youth. Deviant Behavior. 2007;28(3):219–246. doi: 10.1080/01639620701233100. [DOI] [Google Scholar]
  70. WHO . World Health Organization; 2019. Suicide in the world: Global health estimates.https://www.who.int/news-room/fact-sheets/detail/suicide [Google Scholar]
  71. Williams D.R. The cost of racism for people of color: Contextualizing experiences of discrimination. American Psychological Association; 2016. Improving the measurement of self-reported racial discrimination: Challenges and opportunities; pp. 55–83. [DOI] [Google Scholar]
  72. Williams D.R. Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior. 2018;59(4):466–485. doi: 10.1177/0022146518814251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Williams A.D., Clark T.C., Lewycka S. The associations between cultural identity and mental health outcomes for indigenous Māori youth in New Zealand. Frontiers in Public Health. 2018;6:319. doi: 10.3389/fpubh.2018.00319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Williams D.R., Lawrence J.A., Davis B.A. Racism and health: Evidence and needed research. Annual Review of Public Health. 2019;40(1):105–125. doi: 10.1146/annurev-publhealth-040218-043750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Williams D.R., Medlock M.M. Health effects of dramatic societal events - ramifications of the recent presidential election. New England Journal of Medicine. 2017;376(23):2295–2299. doi: 10.1056/NEJMms1702111. [DOI] [PubMed] [Google Scholar]
  76. Williams D.R., Williams-Morris R. Racism and mental health: The african American experience. Ethnicity and Health. 2000;5(3–4):243–268. doi: 10.1080/713667453. [DOI] [PubMed] [Google Scholar]
  77. Zimmerman G.M., Miller-Smith A. The impact of anticipated, vicarious, and experienced racial and ethnic discrimination on depression and suicidal behavior among Chicago youth. Social Science Research. 2022;101 doi: 10.1016/j.ssresearch.2021.102623. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Multimedia component 1
mmc1.docx (12.5KB, docx)
Multimedia component 2
mmc2.docx (44.4KB, docx)

Data Availability Statement

No data was used for the research described in the article.

Articles from SSM - Population Health are provided here courtesy of Elsevier

RESOURCES