Author(s) Celeste Krewson, Assistant Editor

Key Takeaways

- Prior self-harm was the strongest predictor of suicide, with an odds ratio of 16.40, underscoring the need for close follow-up and intervention after deliberate self-harm.

- Recent psychiatric care, traumatic brain injury, violence exposure, and educational or occupational problems were significantly associated with increased suicide risk among Black youth enrolled in Medicaid.

- Family and contextual stressors—including abuse or neglect, relational conflict, economic hardship, and high social vulnerability— were more common among suicide decedents, highlighting the importance of multi-level prevention strategies.

A study highlights prior self-harm, traumatic brain injury, family instability, and social vulnerability as major risk factors associated with suicide among Black youth.

Risk factors driving rising suicide rates among Black youth identified

Researchers have identified factors contributing to the significant rise in suicide rates among Black youth, publishing their findings in JAMA Network Open.1

These factors include depression, brain injury, exposure to violence, and more. Prior self-harm was the most common risk factor among Black youth committing suicide, with a prevalence of 56.4% This indicates a critical avenue of follow-up to decrease the odds of suicide in this population.1

“We focused on a Medicaid population because Black youth are disproportionately covered by Medicaid compared to other child populations,” said Cynthia Fontanella, PhD, principal investigator at Nationwide Children’s Hospital.1

Assessing suicide risk factors in Black youth

The population-based matched case-control study was conducted to provide a deeper understanding of intragroup patterns and correlates of suicide among Black youth.2 Participants included non-Hispanic Black patients aged 9 to 24 years with Medicaid enrollment between January 1, 2010, and December 31, 2019.

All participants had a lifetime mental health diagnosis including posttraumatic stress disorder, anxiety, psychotic, mood, disruptive behavior, substance use disorders, and attention-deficit/hyperactivity disorder. Youth with suicide after at least 10 months of Medicaid enrollment were considered cases.2

Each case was matched to 10 controls based on sex, age, and state of residence. These controls included Black youth with a lifetime mental health diagnosis who were alive on the index date, defined as the case’s death date.2

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Relevant data and participant characteristics

Data was obtained from the Medicaid Analytic eXtract, Transformed Medicaid Statistical Information System Analytic File, and National Death Index. Suicide death was reported as the primary outcome based on International Statistical Classification of Diseases and Related Health Problems, Ninth and Tenth Revision cause of death codes.2

Patient covariates included Medicaid eligibility reason, mental health and general medical conditions, prior deliberate self-harm (DSH), social determinants of health, and acute or outpatient mental health care within 1 month before the index date. Child abuse or neglect, family relational problems, and economic problems were reported as family covariates.2

There were 9625 participants included in the final analysis, 875 of whom were cases and 8750 were controls. Of patients, 72.2% were male, with a mean age of 18.9 years reported at the index date. Hanging or suffocation was the most common suicide method, reported in 43.5%. This was followed by firearms in 31.8% and poisoning in 8.2%.2

Strongest individual- and family-level risk factors

Individual, family, and contextual factors significantly differed between groups. These included increased odds of Medicaid enrollment through disability or foster care among cases, with adjusted odds ratios (aORs) of 1.22 and 1.85, respectively.2

Additional aORs highlighting risk factors of suicide included 2.12 for recent acute mental health care, 4.38 for traumatic brain injury or concussion, and 2.71 for violence exposure. DSH and educational or occupational problems had unadjusted odds ratios of 16.40 and 2.36, respectively. There were also multiple health disorders more common in cases vs controls.2

Family-level factors were also more common in suicide decedents. After adjustment, only family relational problems had a significant link, with an aOR of 2.18. Unadjusted odds ratios in this population included:2

- 2.21 for child abuse or neglect history

- 3.45 for family relational problems

- 4.83 for economic or housing problems

Implications

Finally, contextual-level factors such as living in urban areas or a county with moderate to high social vulnerability were more likely in Black youth who committed suicide. Overall, the results highlighted a variety of factors that may be used to inform suicide prevention strategies in this population.2

“Research shows that one of the highest risk periods for suicide in all youth is after hospitalization for psychiatric care,” said Fontanella.1 “We need to target these critical periods.”

References

- Understanding the rising suicide risk among Black youth. Nationwide Children’s Hospital. February 18, 2026. Accessed February 20, 2026. https://www.eurekalert.org/news-releases/1117030

- Fontanella CA, Xia X, Llamocca EN, et al. Suicide risk and protective factors among medicaid-enrolled Black youth with a mental health diagnosis. JAMA Netw Open. 2026;9(2):e2559657. doi:10.1001/jamanetworkopen.2025.59657 https://standingabovethecrowd.com/?p=16593