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. 2022 May 10;15(4):1179–1189. doi: 10.1007/s40653-022-00452-7

Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents?

Timothy I Lawrence 1,✉, Ariel A Mcfield 2
PMCID: PMC9684375  PMID: 36439662

Abstract

Previous studies suggest that mental illness symptoms among adolescents, such as conduct disorder, oppositional defiant disorder, and panic disorder symptoms often associate with suicidal ideations. Despite this, few studies have examined whether these mental illness symptoms associate with suicidal ideations among African American adolescents. To address these limitations, the current study examined whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations (N = 261). Using binominal logistic regression, results suggest that conduct disorder symptoms were associated with a higher likelihood of endorsing suicidal ideations than oppositional defiant disorder symptoms. Finally, panic disorder symptoms and gender differences were not associated with suicidal ideations. Preventive efforts and psychotherapy implications are discussed.

Keywords: Conduct disorder, Oppositional disorder, Panic disorder symptoms, Suicidal ideations, Prevention

Introduction

Studies suggest that suicide is the leading cause of death in the United States and the third leading cause of death among adolescents (Johnson et al., 2000; Portzky et al., 2005). Risk factors for adolescents’ suicide include but are not limited to poverty, that is, life stressors related to impoverished circumstances (Mignone & O’neil, 2005), trauma and social victimization (Horwitz et al., 2021), school bullying (Hertz et al., 2013; Kim et al., 2009; Bauman et al., 2013; Klomek et al., 2011), sensation-seeking behavior (Ortin et al., 2012), and mental illness such as depressive symptoms (Wong et al., 2012). More specifically, depressive symptoms often increase the likelihood for youth to contemplate and die by suicide (Bolger et al., 1989; Gould et al., 2003; Kessler et al., 1999; Mann et al., 1999; Robinson et al., 1995). Another reason for this could be that adolescents who often endorse depressive symptoms are less likely to engage in problem-solving behavior, which then increases their likelihood to contemplate or die by suicide (Dixon et al., 1994; Haaga et al., 1995).

Although social factors and depressive symptoms often associate with suicidal ideations among adolescents, few articles have examined the relationships among other mental illness symptoms associated with suicidal ideations such as conduct disorder (CD), oppositional defiant disorder (ODD), and panic disorder (PD) symptoms among African American adolescents. Studies suggest that adolescents with conduct disorder (Brent et al., 1993) oppositional defiant disorder (Boekamp et al., 2018) are often more likely to endorse suicidal ideations. Additionally, studies have indicated that adolescents with panic disorder are also more likely to endorse suicidal ideations (Johnson et al., 1990; Noyes, 1991; Schmidt et al., 2001).

Despite these results, the previewed studies have failed to specifically explore the potential associations among CD, ODD, and PD symptoms associating with suicidal ideations among African American adolescents. Exploring the associations of these symptoms on suicidal ideation among African American adolescents is important because African American and Caucasian adolescents with the same diagnoses often display different clinical symptoms in therapy (Mandell et al., 2002), which could influence different treatment modalities. In addition, African Americans with suicidal ideations are often underreported due to a higher likelihood of self-conceal, which could exacerbate other mental illness symptoms and increase mortality rates (Hogge & Blankenship, 2020). Finally, there are racial differences internalizing symptoms of the same disorder. That is, although both African Americans and Caucasians are often diagnosed with the same disorder, African American adolescents often display aggressive behavior and physiological agitation, whereas Caucasians typically experience persistent sadness and isolate themselves from others (McLaughlin et al., 2007). Considering these variations and the importance of assessment and treatment of adolescent suicidal ideations, it is critical to better understand whether African American adolescents with CD, ODD and PD symptoms often endorse suicidal ideations. Therefore, the current study builds on prior studies while also providing additional information about mental illnesses symptoms and suicidal ideations among African American adolescents.

Mental Illness

As stated earlier, individuals who contemplate suicide often meet the criteria for one or two mental illness disorders (Cavanahg et al., 2003; Marco et al., 2017; Nordentoft et al., 2011). Studies have associated mood disorders, eating disorders, schizophrenia, impulsivity, and suicidal ideations (Arling et al., 2009; Okusaga et al., 2011). As previous literature has linked mental illness and suicidal ideations, it is important to further examine the degree to which CD, ODD, and PD symptoms associate with suicidal ideations. This investigation could provide results and implications that address methods to assess and treat African American adolescents with CD, ODD, and PD symptoms.

Conduct Disorder

Conduct disorder refers to the persistent and pervasive behavior among adolescents that often violates other people’s rights, initiation of fights, bullying others, vandalizing other people’s properties, or running away from home (American Psychiatric Association, 2013; Dodge, 1993; Frick & Dickens, 2006; Schubiner et al., 2000; Robins, 1991; Zoccolillo, 1993). Studies have shown risk factors for the onset of CD, such as low self-esteem, lack of moral judgment, impulsivity, attachment styles, and community influence (Cohen et al., 1993; Lahey et al., 2000).

More specifically, adolescents with low self-esteem often display CD-related symptoms such as callous-unemotional traits, engaging in fights, bullying others, and impulsivity (Barry et al., 2003; Ha et al., 2008; Guillon et al., 2003). Further, adolescents who were exposed to violence within their community were likely to develop CD compared to adolescents who never experienced violence within their community (Gelhorn et al., 2005; Slutske et al., 1997; True et al., 1999). As these studies provide risk factors for CD, prior literature has highlighted the prevalence rates of CD symptoms among African American adolescents. For instance, one study suggests that using a sample of low-income urban adolescents, 7.7% met the criteria for CD (Byck et al., 2013). In contrast, a more recent study found that African American adolescents were not likely to display externalizing symptoms consistent with CD, as prior literature suggested (Goings et al., 2021). Despite these inconsistent results, studies have shown that CD symptoms are often associated with suicidal ideation (Brent, 1995; Spirito et al., 1991; Wei et al., 2016). These studies suggest that adolescents who often display CD-related symptoms are often at a higher risk to endorse suicidal ideations. In contrast, other studies found that CD alone does not relate to suicidal ideations, rather the interaction of CD and substance dependence (IIomaki et al., 2007; Loeber & Keenan, 1994). Though the current study does not examine the interaction between CD and substances relating to suicidal ideations, much is still unknown of whether African American adolescents with CD symptoms often endorse suicidal ideations. This might be due to African American adolescents who often endorse mental illness symptoms are less likely to disclose their symptoms, which could increase suicidal ideations (Morrison & Downey, 2000). Thus, more studies are needed to better understand these relationships.

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is the pervasive pattern of defiance, argumentative, hostility, vengefulness, vindictiveness among adolescents (American Psychiatry Association, 2013; Lavigne et al., 2001). Due to the overlap of symptoms of ODD and CD, research suggested that ODD is the precursor to CD (Angold & Costello, 1996; Boden et al., 2010; Maughan et al., 2004). These findings suggest that though certain ODD symptoms are often normal during adolescence (Lavigne et al., 1996), certain adolescents eventually develop CD. Although adolescents with ODD often develop CD, prior literature indicated that adolescents with ODD are often impulsive and more likely to engage in risk-taking behavior, increasing their risk of attempting suicide (Humphreys & Lee, 2011; Lanza & Drabick, 2011).

Given that ODD often associate with suicidal ideations among adolescents, it is important to examine whether African American adolescents with ODD symptoms also associate with suicidal ideation. This is critical because studies suggest that the expression of clinical symptoms often varies across race and culture, which could influence differential diagnosis (Brown et al., 1996; Raskin et al., 1975; Tonks et al., 1970). These studies suggest that although African Americans and Caucasians often present with similar mood symptoms, they differ in somatic symptoms, behavioral symptoms, and response to treatment. These differences might be related to differences in coping and social support resources (Chung & Singer, 1995). Considering differences ODD symptoms, it is possible that African American adolescents with ODD symptoms might increase the odds of experiencing suicidal ideations, as previous studies indicated.

Panic Disorder

Panic disorder (PD) is characterized by unexpected sudden anxiety attacks that could last for minutes. Symptoms of panic disorder include sudden dizziness, feelings of losing control, trembling, sweaty palms, and sometimes nauseated (American Psychiatry Association, 2013). Risk factors for PD include drug and alcohol use (Tietbohl-Santos et al., 2019), childhood trauma (Leskin & Sheikh, 2002; Marshall et al., 2000). To reduce the frequency of experiencing these symptoms, individuals often avoid emotionally eliciting places and events (Gardenswartz & Craske, 2001; Klein et al., 2006; McNally, 1990). When coping with PD symptoms are unsuccessful, individuals often use substances, which increases their chances of experiencing depressive symptoms, which then could lead to suicide attempts (Kecskes et al., 2002; Sareen et al., 2006; Öst et al., 1995; Valentiner et al., 2004).

This relationship is especially prevalent among adolescents. For example, studies suggest that adolescents diagnosed with PD have attempted suicide at least once (Aschenbrand et al., 2003; Johnson et al., 1990; Pincus et al., 2010; Reed & Wittchen, 1998). Though the relationship between PD and suicide is well established, these studies have not particularly focused on African Americans adolescents with PD symptoms. The lack of inclusion of African American adolescents with PD symptoms might compromise the prevalence rates of adolescents with PD symptoms among African Americans and the degree to which they endorse suicidal ideations. Thus, more studies are needed to better understand the role of CD, ODD, and PD symptoms on suicidal ideations.

Control Variable

Investigating the associations of mental illness symptoms and suicidal ideations requires controlling for gender because there are gender differences in Mental illness predicting and disclosing suicidal ideations among adolescents. More specifically, prior literature suggests that girls with CD symptoms are often more likely to endorse suicidal ideations than boys (IIomaki et al., 2007; Wannan & Fombonne, 1998). This is often the case because males are less likely to disclose suicidal ideations, which increases their risk of attempting suicide (Cibis et al., 2012; Langhinrichsen-Rohling et al., 2009; Lewinsohn et al., 2001). Therefore, to examine the associations of CD, ODD, PD symptoms on suicidal ideations, gender was considered a control variable.

Current Study

Previous studies suggest that CD, ODD, and PD symptoms often increase suicidal ideation among adolescents. However, these studies have failed to investigate whether CD, ODD, and PD symptoms associate with suicidal ideations among African American adolescents. It is essential to address these limitations to better understand clinicians and psychologists to assess and treat African American adolescents with these symptoms. In addition, the results could inform methods to implement suicidality assessments for intake sessions and advance theoretical implications for the detection of suicidality among adolescents.

Research Questions

  • RQ1: Does conduct disorder symptoms associate with suicidal ideations among African American adolescents?

  • RQ2: Does oppositional defiant disorder symptoms associate with suicidal ideations among African American adolescents?

  • RQ3: Does panic disorder symptoms associate with suicidal ideations among African American adolescents?

Method

This study used the National Survey of American Adolescent sample (NSAL-A; Jackson et al., 2004), which was originally conducted at the program for research on Black Americans through the University of Michigan institution for social research. In order to participate in the study, adolescent’s legal guardian give consent and the adolescent gave assent and then interviewed by a trained research assistant. Respondents were given US$50 for their participation. All interviews were conducted in English, and approximately 82% of the interviews were conducted in person. Participants comprised of 1,170 adolescents, 99.6% African American, 48.1% males, 51.9 females, average age was 15 years (SD = 1.64 and SD = 0.60).

Approximately 10% of interviews were conducted by a trained clinician using the modified version of the Structured Clinical Interview for the DSM-IV (SCID). When necessary, diagnoses were given by clinicians using the SCID. The overall response rate was 80.6% for African Americans, and 83.5% for Caribbean American adolescents. Though the overall sample size was 1,170 adolescents, a power analysis suggests the appropriate sample size needed for a small effect was 175; therefore, N = 261 was sufficient.

Measures

Suicidal Ideations

Suicidal ideations were measured by asking adolescents, “Have you had serious thoughts about killing yourself at any time in the past 12 months”? which were coded as yes (0) or no (1).

Conduct Disorder Symptoms

The interviewer/clinician asked adolescents various questions consistent with conduct disorder symptoms such as ever bullied people, using a weapon in a fight, being cruel to animals, ever hurt people on purpose, ever forcing somebody to do sexual things. After these questions, the interviewer/clinician asked whether they engaged or experienced these symptoms during 12-month (0) yes and (1) no.

Oppositional Defiant Disorder Symptoms

The interviewer/clinician asked adolescents various questions consistent with oppositional defiant disorder symptoms such as ever easily losing temper, often being resentful or vengeful toward people, often arguing with authority figures, or often blaming others for their mistake. After these questions, the interviewer/clinician asked whether they engaged or experienced these symptoms during 12-month (0) yes and (1) no.

Panic Disorder Symptoms

The interviewer/clinician asked adolescents questions consistent with various panic disorder symptoms such as ever experiencing fear or avoiding places, often experiencing dizziness or nausea due to fear, sometimes feeling numb or experiencing chest pain, and recurring feelings of losing control due to fear. After these questions, the interviewer/clinician asked whether they engaged or experienced these symptoms during 12-month (0) yes and (1) no.

Gender

Adolescents' gender was coded as female (0) and male (1).

Analytic Strategy

A power analysis using Gpower was conducted to determine the appropriate sample size needed to establish a small effect size (f2 = 0.10). Gpower suggested that a sample of 175 participants with a power of 0.90. was sufficient. Therefore, a sample of 261 participants is enough to establish a small to medium effect. A binominal logistic regression was performed to assess whether CD, ODD, and PD symptoms associated with suicidal ideation because both the independent variables and the dependent variables were all dichotomous.

Results

Prior to final analysis, univariate and multivariate were assessed, which indicated the data was normally distributed (see Table 1). Then, a binominal logistic regression was used to assess whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations among African American adolescents. The overall model was significant (X2 = 11.80, p = .01, Nagelkerke R2 = .11, Cox & Snell R2 = .05, -2LL = 211.971 while controlling for gender. Conduct disorder symptoms increased the odds of experiencing suicidal ideations, (b = .79), SE = .21, Wald = 4.801, p = .03. However, oppositional defiant disorder symptoms lowered the odds of endorsing suicidal ideations, (b = –28), SE = .34, Wald = 4.78, p = .01. Finally, panic disorder symptoms, (b = .54), SE = .34, Wald = 2.51, p = .11 and genders (b = .11), SE = .09, Wald = 5.17, p = .69 were not statistically associated with suicidal ideations (see Table 2).

Table 1.

Logistic regression for suicide ideations among adolescents

Variable b(SE) Wald Exp (B) 95% CI p
Conduct S .79(.21) 4.80 2.25 [1.090, 4.684] .03
Oppositional S –.28(.11) 4.78 .46 [.234, .923] .01
Panic S .54(.34) 2.51 1.73 [.878, 3.410] .11
Gender .11(.09) 5.17 6.81 [.219,198] .69
Open in a new tab

Conduct D = Conduct S = Conduct Disorder Symptoms, Oppositional S = Oppositional Defiant Disorder Symptoms, Panic S = Panic Disorder Symptoms. Bolded terms are significant values at p < .05

Table 2.

Mean, standard deviation, and skew statistics

Variable Mean S.D Skew
1. Conduct Disorder-S .60 .500 –.39
2. Oppositional Defiant-S .51 .491 –.04
3. Panic Disorder-S .31 .48 .57
4. Gender .69 .21 .20
5. Suicidal Ideations .49 .500 .05
Open in a new tab

Conduct Disorder-S = Conduct Disorder Symptoms, Oppositional Defiant-S = Oppositional Defiant Disorder Symptoms, Panic Disorder-S = Panic Disorder Symptoms, S.D = Standard Deviation

Discussion

The goal of the present study was to examine whether CD, ODD, and PD symptoms were associated with suicidal ideations among African American adolescents. Results suggest adolescents who experienced conduct disorder symptoms within a year endorsed suicidal ideations. This is partially consistent with prior literature, which suggested adolescents with conduct disorder symptoms often endorse suicidal ideations (Apter et al., 1988; Linker et al., 2012; Wei et al., 2016).

One possible reason for this could be due to increased emotional instability and impulsivity often experienced by adolescents with CD symptoms (Fanti et al., 2018; Mathias et al., 2007); these episodes could have influenced the reoccurrence of suicidal ideations among African American adolescents. Another explanation could be because inconsistent parental supervision is often a risk factor for CD symptoms (Kim et al., 2015; Tackett et al., 2011), adolescents might have endorsed suicidal ideations due to helplessness and hopelessness. Finally, it is possible that African Americans adolescents within this sample were economically disadvantaged, which has shown to increase suicidal ideations (Zimmerman et al., 1999).

Pertaining to ODD symptoms, though previous literature found that adolescents with ODD symptoms often endorse suicidal ideations (Boekamp et al., 2018), we did not find such results within this study. Rather, results suggest African American adolescents with ODD symptoms were less likely to endorse suicidal ideations. Although not tested, it is possible that adolescents with ODD symptoms had a secure attachment with their parents, which has shown to decrease emotional dysregulation (Craig et al., 2021); thus, inversely associated with suicidal ideation. When examining the role of PD symptoms on suicidal ideations, we found null results, such that African American adolescents with PD symptoms did not endorse suicidal ideations. Surprisingly, this contradicts previous studies, which suggested adolescents with PD symptoms were more likely to endorse suicidal ideations (Johnson et al., 1990; Pilowsky et al., 1999; Vickers & McNally, 2004). Perhaps we found null results because due to the infrequent and short duration of PD symptoms, these symptoms were not pervasive enough to influence suicidal ideations.

Although not measured within this study, traumatic events, such as early exposure to family and community violence, often significantly contributes to the development of CD (Maniglio, 2015; McCabe et al., 2005; Ritter et al., 2002) ODD (Burnette, 2013; Frick et al., 1992; Greene et al., 2002) and PD symptoms (Goodwin et al., 2005). This is often the case among African American adolescents. For instance, African American adolescents are often more likely to witness traumatic events socially and in their homes, which increases their odds of endorsing PTSD and other mental illness symptoms (Hunt et al., 2011; Sargnent et al., 2020).

It appears that experienced and vicarious trauma often leads to the endorsement of mental illness symptoms among African American adolescents, which could increase the odds of endorsing suicidal ideations. Thus, when in treatment, clinicians and psychologists should assess and treat various forms of traumatic symptoms among African American adolescents using evidence-based practices (EBP) such as cognitive-behavioral therapy (CBT) (Wilson & Cottone, 2013), trauma-focused cognitive behavioral therapy (TF-CBT) (Thornback & Muller, 2015). These interventions have shown to be effective in addressing traumatic symptoms that could increase the odds of adolescents internalizing and externalizing mental illness symptoms (Huey & Polo, 2008).

Social Considerations for African American Mental Health

When examining the experience of African American Adolescents, it is important to consider factors, such as social issues that may also have an impact on mental health, perceptions related to diagnoses, and culturally competent interventions. African American adolescents are more likely than adolescents of other racial and ethnic groups to experience racist and discriminatory situations (Metzger et al., 2021). Some research studies have found relationships between racial discrimination and depression among African Americans (Hagiwara et al., 2016; Hudson et al., 2015), which also may increase the risk of suicidal ideations. One study found that increased reports of racial discrimination were significantly related to suicidal ideations and moderated by depressive symptoms (Walker et al., 2014). Though many factors may be associated with suicidal ideations, the cultural experience of African Americans and the increased likelihood of experiencing racial discrimination may also increase vulnerability to engage in risky behaviors, poor coping, and negatively impact overall mental health (Xie et al., 2020), with a potential of increasing suicidal ideations.

With consideration to the cultural experience of African Americans, interventions and therapeutic treatment should attempt to address these cultural factors that may increase the risk of experiencing mental illness symptoms. In addition to the standard cultural competency training and classes, clinicians, stakeholders, and community members may also engage in cultural adaptations of mental health treatment, which entails methodical adjustments that consider language and the overall cultural context of the individual receiving the service (Bernal et al., 1995). Some examples of cultural adaptations include treatment goals that address the cultural factors, such as discrimination that might influence stressors, the use of familiar dialect, and culturally relevant metaphors in treatment (Bernal et al., 1995). Research suggests that cultural adaptations are associated with increased engagement and improvement in the overall treatment experience (Casonguay & Beutler, 2006; Smith & Trimble, 2016). The incorporation of more culturally competent methods may also increase overall help-seeking behaviors among African Americans, which would assist in decreasing symptomology related to suicidal ideations and improve overall psychological well-being.

Prevention and Early Intervention

Prevention and early interventions are vital in mitigating suicidal ideations. Early Interventions that may be effective for African American Adolescents include positive racial socialization, and systematic methods of increasing the awareness and understanding of racial-ethnic identity. Specifically, providers and systems may assist in creating safe spaces for African American Adolescents to address beliefs and meanings of the role of the race while also encouraging families to do the same. African American Adolescents who have a greater sense of self-experience have higher levels of overall psychological well-being (Crocetti, 2017), which can also decrease mental illness symptomology. Additionally, established prevention programs such as the Signs of Suicide (SOS) (Aseltine & DeMartino, 2004) and Good Behavior Game (GBG) (Barrish et al., 1969) should examine effectiveness among more racially and culturally diverse adolescent populations in addition to developing cultural adaptations to the prevention interventions.

As clinicians assess and treat CD symptoms, certain adolescents with symptoms such as callous and unemotional traits are often not responsive to treatment (Frick et al., 2014). This is often due to less effective parental disciplinary interventions such as harsh punishments and time-outs (Dadds & Salmon, 2003; Haas et al., 2011; Hawes & Dadds, 2005). In contrast, when parents and clinicians teach empathy through improving positive social interactions and strengthening parent and child engagement, there was a significant reduction callous and unemotional traits (Fanti, 2013; Fanti et al., 2017). Taken from these results, parents should strengthen their relationships with their children and increase positive reinforcements within the home.

There are also effective prevention interventions for ODD and PD symptoms. For example, as consistent with CD symptoms, improving positive social engagements and parent-child relationships can prevent ODD symptoms (Winther et al., 2014). Pertaining to PD symptoms, adolescents who participated in a CBT randomized control trial treatment reported fewer PD symptoms, which was consistent within six months, follow up (Gardenswartz & Craske, 2001; Pincus et al., 2010). To prevent the symptomology of CD, ODD, and PD symptoms, clinicians and psychologists should use these interventions to assess and treat the early onset of these disorders.

Clinical and Psychotherapy Implications

The presence of CD and ODD symptoms were associated with suicidal ideations in different directions. As such, adolescents with CD symptoms were more likely to endorse suicidal ideations in contrast to ODD symptoms. Though there are known environmental and parental risk factors for the development of CD symptoms, mental health practitioners should focus on identifying early signs of CD in school or any other facilities that often have adolescents. Identifying early CD symptoms could increase the degree to which adolescents are likely to accept treatment, which could increase the positive prognosis of CD symptoms. In addition, early identification of CD symptoms tends to decrease persistent antisocial cognition and behavior (Odgers et al., 2007; Offord & Bennett, 1994). One challenge to this could be the lack of cooperation by parents to engage in family therapy with their children.

One way to address this could be to educate families on the efficacy of treatment, specifically when adolescents with CD are engaging in therapy. If successful, several therapeutic interventions are often effective in treating adolescents with CD symptoms, such as problem-solving skills training (PSST) and cognitive behavioral therapy (CBT), which consist of interventions focused on reframing cognition, information processing, and behavior (Kazdin et al., 1992; Kazdin, 1997; Lambert et al., 2001; Sukhodolsky et al., 2004). While using the PSST, the clinician often challenges distorted thinking patterns and introduce effective strategies to address peer conflict or familial disagreements without engaging in aggressive behavior (Kazdin et al., 1987). Prior literature indicated that PSST and CBT are often effective in reducing CD symptoms such as aggressiveness, callous and unemotional tendencies, and impulsivity (Kimonis et al., 2019; White et al., 2013; Wilkinson et al., 2016). Although this study’s result suggests that adolescents with ODD had lower odds of endorsing suicidal ideations and found null results of PD symptoms, clinicians and psychologists should always assess for suicidal ideation among adolescents who endorse these symptoms. In doing so, clinicians and psychologists could detect internalizing and externalizing risk factors of suicidal ideations in the infancy stage.

Limitations

There are apparent limitations of this study. The first limitation is that there are obviously other mental illness symptoms that could associate with suicidal ideations that were not measured within this study. Therefore, future studies should examine whether post-traumatic stress disorder, disruptive mood dysregulation disorder, and depression are associated with suicidal ideations among African American adolescents. Another limitation is that severity of symptoms was not measured associating with suicidal ideations. It is possible that moderate compared to severe symptoms of these disorders could vary in associating with suicidal ideation. For example, moderate symptoms might not increase the risk of suicidal ideation compared to severe symptoms. Therefore, future studies should investigate this pattern. Another limitation is that this study only measured suicidal ideation compared to suicidal attempts. It is quite possible that adolescents who often endorse CD, ODD, or PD symptoms might not engage in suicidal attempts. Thus, future studies should examine whether these symptoms increase the risk for suicide attempts among African American adolescents. Lastly, as prior literature indicated that comorbidity of mental illness symptoms often leads to suicidal ideation. Although this study did not examine the interaction effects of mental illness and suicidal ideation, future studies should test whether the interaction between CD and ODD symptoms associate with suicidal ideations.

Conclusion

This study examined whether CD, ODD, and PD symptoms associated with suicidal ideations among African American adolescents. Results suggest that CD symptoms increased the likelihood of endorsing suicidal ideations in contrast to ODD symptoms. In addition, PD symptoms and gender differences were not associated with suicidal ideations. To disrupt these patterns, clinicians and psychologists should assess for suicidal ideation during therapy intake sessions and advocate for community mental health facilities, specifically for financially disadvantaged families.

Declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Timothy I. Lawrence, Email: Tlawrence3@pvamu.edu

Ariel A. Mcfield, Email: Mcfield_a@utpb.edu

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