Suicide rates among Black youth have risen sharply in recent years, surpassing those of other racial and ethnic groups. In 2023, it was the third leading cause of death for Black youth aged 10-24 years. However, research examining factors contributing to suicide in this population remains limited.
A new study, published today in JAMA Network Open and led by Cynthia Fontanella, PhD , principal investigator for the Center for Suicide Prevention and Research at Nationwide Children's Hospital, is the first large-scale study to examine multi-level risk and protective factors for suicide among Medicaid-enrolled Black youth with a lifetime mental health diagnosis.
"We focused on a Medicaid population because Black youth are disproportionately covered by Medicaid compared to other child populations," says Dr. Fontanella. "They often face social and economic challenges that impact both health and health care navigation. This study allowed us to gain a deeper understanding of intragroup patterns with the hope of more targeted suicide prevention strategies."
The study included 875 Black youth aged 9-24 years who died by suicide between January 1, 2010, and December 31, 2019. Each suicide case was matched with 10 living controls (8,750 individuals) on age, sex and state. There was a total of 9,625 individuals with 6,950 of them being males. All cases and controls were Medicaid-enrolled and had a documented lifetime mental health diagnosis.
The study found factors associated with increased odds of suicide included:
- Depression and schizophrenia/psychosis diagnoses
- Prior deliberate self-harm
- Prior psychiatric acute care
- Brain injury
- Exposure to violence
- Family relational problems
- Foster care and disability status
- Living in an urban community or in a county with a moderate to high socially vulnerable index – these counties face significant challenges due to poverty, low education, high unemployment, inadequate transportation or crowded housing
The highest risk for suicide for Black youth was prior deliberate self-harm (56.4%). According to Dr. Fontanella, timely assessment and continuous follow-up after deliberate self-harm is crucial in decreasing risk of suicide.
"Research shows that one of the highest risk periods for suicide in all youth is after hospitalization for psychiatric care," says Dr. Fontanella. "We need to target these critical periods. In a previous study, we found that kids that received a timely follow-up after hospitalization were significantly less likely to die by suicide. However, there are huge disparities in race. Black youth were less likely to receive follow-up, putting them at a greater risk."
Protective factors associated with decreased odds of suicide included diagnoses of anxiety and developmental disorders and living in a county with moderate to high rates of religious institutions.
"Community involvement and religiosity were found to be important protective factors for Black youth," says Dr. Fontanella. "This was a big finding. There is very little research looking at the direct impact of religion in these communities, so this is a definite area for further research. Learning what interventions are effective in this population, including culturally tailored interventions and psychosocial interventions are crucial."
About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report's 2025-26 list of "Best Children's Hospitals," Nationwide Children's Hospital is one of America's largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children's to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children's faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children's Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research .
