Understanding Protective Factors That Impact Adolescent Suicidal Behaviors Across Race/Ethnicity and Sex

Rising suicide rates disproportionately affect youth across racial, ethnic, and sex groups, highlighting the need to identify protective factors associated with specific suicidal behaviors in diverse populations. This study aimed to estimate and compare the effects of protective factors among youth with suicidal ideation only (SI+) and youth with suicide attempts (SA+) across race/ethnicity and sex.

Data from the New Mexico Youth Risk and Resiliency Survey (N = 50,887) from 2005 to 2021 were analyzed. Using a causal inference framework, doubly robust adjusted risk ratios (aRRs) of protective factors on SI and SA were estimated through inverse probability of treatment weighting, weighted logistic regression, and G-computation.

Protective factors significantly reduced suicidality with stronger effects for SA (aRRs = 0.59 [95% CI 0.54-0.64] to 0.93 [95% CI 0.85-1.01]) compared with SI (aRRs = 0.74 [95% CI 0.69-0.79] to 0.94 [95% CI 0.86-1.01]). Overall, 3 factors effectively distinguished between outcomes. There were race/ethnicity and sex differences; however, differences were more pronounced across race/ethnicity than sex and for SA compared with SI.

Protective factors significantly reduced both SI and SA among adolescents, with stronger effects and more pronounced differences for SA. These findings show that protective factors are not universal, highlighting the importance of culturally and demographically tailored prevention strategies. Whereas most previous work has focused on risk factors for suicidality in adolescents, focusing on protective factors is critical for effective prevention.

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.