A Mental Health Crisis and Call to Action: Increasing Trends in Suicide Among Black Women in the United States

Suicide, a leading cause of death in the United States, is a critical public health issue (1). Although suicide affects people of all ages, some groups have higher suicide rates than others. The priority data letter by Joseph et al. in this issue offers important data on the trends in suicide among Black women in the United States (2). In the first study examining the epidemiology of suicide among Black females in the United States by geographical region, the authors used the National Center for Health Statistics’ Multiple Cause of Death 1999–2020 database to estimate age-period-cohort effects of suicide rates among Black women aged 15–84 years and assess trends by census region. The study finds a concerning increasing trend in suicide death among the youngest Black girls and women born in recent years. The authors also identified state and regional variation and suggest this might guide geographically targeted prevention efforts. For context, their work is consistent with data that suicidal behaviors are increasing among minoritized youth (3). This work adds to the growing evidence that there is an urgent need to increase mental health care access, particularly among Black girls and women, and reduce other forms of structural racism (4).

Factors That Influence Suicide and Suicidal Behaviors in Black Girls and Women

Suicide and suicidal behaviors are influenced by negative conditions or factors. Among these are the social determinants of health, including racism and discrimination, adverse childhood experiences, poverty, lack of educational opportunities, food insecurity, housing instability, and barriers to mental and medical health care (1, 5). For Black women, structural sexism and racism combine to create intersectionality, in which an individual may experience multiple marginalized identities that interact to increase risk factors for suicide and suicidal behaviors (6). The data on mental health care access is also sobering. In 2018, 69% of Black adults and 67% of Hispanic/Latino adults did not receive any treatment for mental health problems according to data from the Substance Abuse and Mental Health Services Administration (7, 8). Joseph and colleagues (2) cogently describe stressors that may be particularly relevant to Black adolescents, such as cyberbullying and online racial attacks (9), and relevant to Black women in their late 20s, including intimate partner violence, neighborhood violence, and poverty (10, 11).

Strategies to Meet the Crisis of Suicide Among Black Girls and Women

Increase Capacity to Build Culturally Inclusive Mental Health Access.

To build culturally inclusive mental health systems that lower the barriers to access, it is imperative to first expand mental health education for professionals to deepen their understanding of structural racism, racial discrimination, intergenerational trauma, and historical racial trauma (and their impacts on mental health) (4, 12). This can be accomplished through thoughtful incorporation of the elements of cultural humility (e.g., commitment to lifelong self-evaluation and self-critique, desire to address power imbalances, and developing community partnerships to advocate for change) and structural competence (e.g., understanding how the social determinants of health influence clinical symptoms, problems, and diseases) into mental health curriculum and training programs (4). Another way to lower barriers that Black women experience in getting access to mental health care is to support, partner with, and elevate culturally responsive programs, such as the AAKOMA Project, Therapy for Black Girls, Black Girls Smile, Loveland Foundation, and the Black Emotional and Mental Health Collective, to name a few (13).

Increase Mental Health Workforce Leadership Opportunities for Black Women.

As recommended by the 2020 National Academies of Sciences, Engineering, and Medicine report, committed leadership is needed at all levels, not only to support women of color in professional fields, but also to ensure that Black women attain leadership positions in their work settings (14). The landmark Whitehall II study demonstrated an association between social status at work and poor mental health in women (15). Thus, support is needed to remove the barriers that Black women often face in attempting to rise to higher-status positions in the workplace. Indeed, leaders are in the best position to institute pragmatic, evidence-based solutions, and initiate programming to build accessible and culturally inclusive systems that incorporate community input. Targeted mentorship programs, including peer mentorship and professional development opportunities for Black women, are critical for leaders to implement (16). Building capacity for leadership involves intentional sponsorship programs for Black women across all sectors of the workforce. The result will be diversification of senior leadership, building community and support, and establishing Black women as role models for the next generation of leaders.

Target Research Opportunities.

Research that incorporates input from diverse community members and individuals with lived experiences is imperative. Community-partnered approaches to research and interventions enable sharing of resources and power and increasing trust within marginalized communities (17). Organizations like the American Foundation for Suicide Prevention (AFSP) are eager to fund research that will drive breakthroughs for suicide prevention and partner with researchers using community-based participatory research approaches. Indeed, the topic of diversity, equity, and inclusion is one of AFSP’s research grant priority areas; specifically, “suicide prevention research related to underrepresented communities, health and mental health disparities and inequities, as well as researchers from underrepresented backgrounds proposing research focused on understanding and preventing suicide” (18). In 2019, the National Institute of Mental Health (NIMH) formed the Suicide Research Team (SRT), which leads NIMH’s suicide research activities, including developing suicide-related workshops, webinars, and funding opportunities to address suicide prevention research gaps including “suicide etiology to suicide risk trajectories and risk identification to implementing practical and scalable interventions in a variety of settings that serve at-risk populations” (19). At the same time, early career researchers need research mentorship and protected time to develop competitive proposals, which may be an additional institutional barrier requiring attention.

Enhance Data-Driven Accountability.

Transparency in reporting throughout public and private mental health clinics, academic institutions, professional societies, foundations, and governmental funding agencies is critical to tracking outcomes on gender, racial, and ethnic inequities. Aggregating data collection at the intersection of gender, race, and ethnicity—rather than treating these as distinct categories—will mitigate concerns for unblinding and highlight gaps and opportunities for interventions.

Areas for Further Exploration

Joseph and colleagues’ study raises additional questions worthy of exploration. Given death certificate information includes only sex as assigned at birth and does not include information on prior psychiatric history or mental health service usage, future studies that include nonbinary constructs of sexual orientation, gender, and gender identity and more in-depth psychological history will add to our understanding of the risks associated with identifying with multiple marginalized identities. There is also a need for longitudinal studies with racially diverse samples to examine intergenerational trajectories and the impact of racism and trauma on suicidal behaviors.

The priority data letter by Joseph and colleagues (2) in this issue of the American Journal of Psychiatry contributes to the gap in understanding trends in suicide in Black women and regional variation as well as helps to dispel longstanding myths about which populations are at risk for suicide. It also represents a vital step in collecting more granular data to shape substantial and enduring transformational change to achieve improved mental health outcomes for Black women.