Suicide prevention efforts among a 'hidden population' living in public housing

New research suggests that African American families living in public housing are a "hidden population" when it comes to national suicide prevention efforts.

The study showed 11% of Black teens and young adults living in a mid-Atlantic public housing development reported that in the previous 12 months, they had made a plan to die by suicide.

The finding fits with what previous research has shown: that African American youths are the fastest-growing group engaging in suicidal behavior and dying by suicide, and have the highest suicide death rate increase among any other racial or ethnic minority group, from 2.55 per 100,000 in 2007 to 4.82 per 100,000 in 2017.

Males were more likely than females to have come up with a suicide plan, and certain family dynamics increased the chances a youth would engage in suicidal behavior: mothers who were currently incarcerated or fathers with a history of alcohol abuse.

Researchers suggest the findings warrant expansion of the types of locations that national suicide prevention experts have targeted as the best places to deliver prevention programs. Rather than basing interventions at community hospitals or schools, the researchers argue, culturally tailored suicide-prevention interventions should be offered within public housing communities themselves as well as these other locations.

Though public housing was originally envisioned as a temporary residence for transitory families, societal changes - the collapse of manufacturing jobs, crack cocaine epidemic and welfare-to-work mandates among others - combined to leave most families in these developments without the means to move out.

I call it a 'constellation of correlations.' There was no more transition and these communities were devastated, and as a result, you see a 'Lord of the Flies' type of narrative where children were unintentionally left to their own devices."

Camille R. Quinn, lead author of the study and assistant professor of social work, The Ohio State University

"Today, even though there is not as much drug trafficking, it is still part of the tapestry in these communities and that has definitely left an imprint. And parents and their children are likely living with the aftermath," Quinn said. "If either parent is in or out of the prison system, or has charges or offenses on their record, that makes it harder for them to find employment, and that makes it difficult for them to do the best they can for their children."

The study is published online in the Journal of Racial and Ethnic Health Disparities.

This study used select data from a larger research project examining the association for residents in public housing between neighborhood factors and health risk behaviors. The sample of a subset of the participants in the initial study included 190 African American youths and young adults between ages 15 and 24.

Quinn and colleagues analyzed results from survey questions asking the youths if they had made a plan to attempt suicide in the past 12 months, if either parent were currently or had previously been in jail, and if either parent had ever had problems with illegal substances or consuming too much alcohol.

Almost 34% of fathers and 8.4% of mothers were incarcerated at the time the survey data were collected, and more dads than moms had had drug and alcohol problems. Statistical analysis showed that a father's past alcohol problem or a mother's current incarceration had the strongest association with a youth's plan to die by suicide. Males were significantly more likely than females to have planned a suicide.

"It's significant that so many males reported a plan to die by suicide, which is really stark," said Quinn, adding that this finding matches patterns seen in previous research: Girls and women as a whole are much more likely to think about, plan and attempt suicide but survive, while young men who have decided they are going to die are more likely to follow through.

The researchers cite U.S. Census data showing that public housing constitutes almost a quarter of households in the most highly segregated and lowest-opportunity neighborhoods in the United States, and African American households represent 51% of the families living in public housing in these neighborhoods. Of those families, 29% have been contacted by child protective services - suggesting these housing communities are marked by violence and social problems, including parental substance misuse and jail time, which have been linked in previous research with youths' suicidal behavior.

The study findings imply that African American families living in public housing should be targeted for family-centered, evidence-based interventions delivered in their residential communities, the researchers say, which could lead to development of the most effective suicide prevention practices for this specific population.

The National Action Alliance for Suicide Prevention Research Prioritization Task Force published a plan in 2014 to reduce suicide attempts and deaths by 40% or more by 2024. The plan recommended reaching "boundaried" populations by delivering interventions in hospital emergency rooms, schools, correctional facilities, and mental health and substance abuse centers - systems from which families living in public housing may be isolated and therefore missed by suicide prevention outreach.

In the meantime, Quinn is investigating potential factors beyond the family that could influence - positively or negatively - suicidal behavior in African American teens and young adults living in public housing.

"What impact might school have, or peers?" she said. "In this paper, we don't even know whether or not the young people in this sample have any involvement with any system - child welfare, special education or juvenile justice. We would guess that if they were, that would have implications for what kind of considerations might be made for treatment."