A recent report from the Centers for Disease Control and Prevention (CDC) noted that youth suicide rates increased from 2018 to 2021 for Asian, American Indian/Alaska Native (AI/AN), Black, and Hispanic youth—but not for White youth. While national data on suicide rates for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth are nonexistent, 2021 Youth Risk Behavior Survey data show that 22 percent of lesbian, gay, bisexual, and queer/questioning youth reported a suicide attempt in the past year, compared to 6 percent of heterosexual youth. These disparities—part of a broader public health crisis—suggest the need for prevention approaches that are tailored to the populations most in need of support. Community-based organizations (CBOs) that design and implement youth suicide prevention efforts should tailor their efforts in ways that acknowledge the systemic inequities that a particular population may face and should be guided by that population’s unique community strengths.
This brief presents three recommendations to help youth-serving CBOs tailor their efforts in this way, which we refer to as applying an equity lens to their youth suicide prevention efforts. By understanding that there is no “one size fits all” approach, CBOs can create safe spaces for Asian, Black, Indigenous, Hispanic, and LGBTQ+ youth to share their unique barriers to seeking care, their assets and protective factors, and what they need in their respective communities. We end each recommendation with a practical action step to help CBOs implement equity-centered practices to youth suicide prevention.
Applying an equity lens in prioritizing suicide prevention efforts for populations with the highest youth suicide rates involves three main components: centering youth voice in community discussions; identifying salient risk and protective factors; and partnering with these youth’s communities to account for their histories and values. By observing these practices, community-level stakeholders serving youth are better positioned to implement community-based approaches to reducing rates of youth suicide. While researchers have found that some clinical approaches are effective in reducing suicidal behaviors, these approaches tend to focus on individuals and fail to consider factors within communities and society that may serve as protective or risk factors for suicide—especially those factors with disproportionate impacts on Asian, Black, Indigenous, Hispanic, and LGBTQ+ youth.
CBOs should include youth voices in their suicide prevention programming to ensure that programmatic efforts are relevant for their intended audiences. In many communities, youth have a strong interest in learning to help their friends and families. For example, in suicide prevention programs, youth report wanting to learn skills to help a loved one who has had thoughts of self-harm and provide them with general information about mental health. Such an approach would contrast with programs and interventions that are created by individuals who are not part of the group an intervention is intended to benefit. Youth at higher risk for suicide may find more value in programs that allow young people to serve as assets for their families and friends, relative to programs that focus exclusively on helping youth recognize their own distress and acquire skills for coping with stress and accessing care.
Youth are assets to their communities, not problems to be solved. Young people can help CBOs shift toward approaches that will resonate better with youth in their communities. This outlook is especially important for partnering with Asian, Black, Indigenous, Hispanic, and LGBTQ+ youth to prevent suicide. For example, in some communities, Black youth may be less comfortable with suicide prevention programs held in certain institutions, such as school, religious, or clinical mental health settings. LGBTQ+ youth may feel more comfortable in familiar institutions like schools and health care settings when those settings affirm their sexual orientation and gender identity and foster a greater sense of belonging—both of which are prominent protective factors against suicide risk. Community organizations can play a unique role in creating safe spaces for youth to engage in relevant and respectful suicide prevention interventions and in helping them advocate for changes to the ways in which familiar institutions implement suicide prevention efforts in their communities.
CBOs designing or implementing youth suicide prevention efforts should form youth advisory councils that include youth from the populations most affected by youth suicide. CBOs should encourage youth engagement by compensating council participants and providing opportunities for youth to assume leadership roles in developing, implementing, and evaluating each stage of a proposed suicide prevention initiative.
CBOs must identify salient risk factors for the population they serve to properly address the root causes of youth suicide. Risk factors, or factors that are associated with increasing the likelihood of youth suicidal behaviors, are complex and may vary by specific populations. Asian, Black, Indigenous, Hispanic, and LGBTQ+ youth may exhibit risk factors that are overlooked in general youth suicide prevention and promotion-focused efforts. For example, recent research has shown that racial discrimination increases the risk of suicidal ideation for African American youth, while navigating acculturation may act as a risk factor for Asian American youth. Inupiat youth note that loss of culture may have implications for the youth suicide rates of Indigenous youth while, on a more interpersonal level, familial conflict serves as a particularly salient risk factor of youth suicide to Mexican-origin youth. Exposure to bullying and a negative school experience, in addition to family rejection, are risk factors of youth suicide for LGBTQ+ youth. While these examples are not exhaustive, they highlight the need to recognize that the same risk factors may have varying degrees of salience for different groups of youth.
Conversely, protective factors are attributes associated with enhancing well-being in the face of adversity. While CBOs must be aware of communities’ most salient risk factors, their work should lead with a strengths-based approach, meaning they should integrate protective factors and cultural strengths/assets when promoting targeted suicide prevention efforts. For example, in some Hispanic communities, promoting familism (i.e., a tendency to strongly value the family unit) may be effective, whereas promoting cultural and spiritual beliefs may be a vital component for Yup’ik Alaska Native youth. Emphasizing these cultural protective factors can help buffer the effects of risk factors to prevent youth suicide behaviors. Notably, risk and protective factors within racial/ethnic and LGBTQ+ groups may present differently based on lived experiences, especially regarding the circumstances of those with multiple marginalized identities. To avoid generalizations and simplistic approaches, ask youth to help identify risk and protective factors across singular and intersecting identities.
CBOs should host youth-led listening sessions to identify risk and protective factors that are most salient to the groups they serve. Ask youth to identify which aspects of their communities help them feel safe and loved and which leave them feeling scared or alone. Use these answers to identify strategies to address youth suicide and to find potential partner organizations.
CBOs should collaborate with local partners to maximize their efforts to reduce youth suicide risk and promote protective factors. Community partnerships are essential when implementing suicide prevention efforts at the community level. Asian, Black, Indigenous, Hispanic, and LGBTQ+ youth are impacted by community-level risk and protective factors that require interventions with contributions from many groups across a community. Many communities may have untapped resources or benefit from better-coordinated efforts.
Relative to interventions that are implemented in isolation, collaboration requires relationship building, communication of shared interest, and commitment from all involved parties to result in larger-scale change. For example, in the Somerville Cares About Prevention community coalition, the mayor of Somerville, Massachusetts was able to help a community coalition effectively respond to the youth suicide crisis by leveraging existing resources from community partners, community activists, and a research organization. This partnership ultimately reduced youth suicide and overdose rates in Somerville.
CBOs engaged in youth suicide prevention should invite other youth-serving CBOs, elected officials, local activists, etc., to brainstorm on youth suicide prevention. After identifying opportunities for collaboration, they should form community coalitions that employ a youth-led, strength-based approach to address risk factors and promote protective factors of youth suicide.
 There is a clear distinction between reporting on suicide deaths for racial and ethnic groups and reporting on suicide attempts for LGBTQ+ youth. National data on suicide rates for LGBTQ+ youth are nonexistent due to the lack of sexual orientation and gender identity questions on national surveys and their exclusion from reporting criteria on death certificates.
 In the survey, students were asked which of the following terms best describes them: “heterosexual (straight),” “gay or lesbian,” “bisexual,” “questioning,” or “I describe my sexual identity in some other way.” Students were not asked questions pertaining to gender identity.
Winston, J., Wilkinson, A., Stratford, B., Ramos-Olazagasti, M., & Around Him, D. (2023). Communities must tailor youth suicide prevention efforts to those who need them most. Child Trends. https://doi.org/10.56417/7301w7147l
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