(PS13-53) The Relationship Between Race, Family Connectedness, and Suicide Risk in Youth Presenting to the Emergency Department

Background: Suicide is a major public health concern and the second leading cause of death among youth ages 12-17 years. There are significant racial disparities in youth suicide rates, with increasing rates among African American/Black youth and highest rates among American Indians and Alaska Natives (AI/AN). Previous research has identified family connection as a strong protective factor against suicide. Family connectedness for youth can be described as feeling cared for and understood by parents/family and being able to discuss one’s problems. Nevertheless, the role of family in youth mental health may vary based on cultural factors such as stigma and parental views on mental health. Few studies have described the relationship between suicide risk and family connectedness across racial groups.

Aim: To evaluate how race moderates the association between suicide risk and family connectedness in youth presenting to the emergency department (ED)

Methods: This is a secondary analysis of the ED Screen for Teens at Risk for Suicide (EDSTARS) Study 1. Youth aged 12-17 years with data for the following variables were included: 1) race/ethnicity, 2) family connectedness (‘How much do people in your family understand you?’ and ‘How much does your family pay attention to you?’) and 3) questions from the Ask Suicide-Screening Questions (ASQ) tool. Participants rated family connectedness on a Likert scale of 1 (not at all) to 5 (very much). Based on prior research, a family connectedness score was derived by calculating the sum of the two questions (range: 2(low) to 10 (high)). Binary logistic regression assessed the relationship between family connectedness and positive ASQ screen, using race as a moderator.

Results: Data were analyzed from 5514 participants (50.9% Female, 45.8% Non-Hispanic White, mean age [SD] = 15.0 years [1.7]). Of the total sample, 23.5% (1293/5514) of participants screened positive for suicide risk. Overall, participants reported high levels of family connectedness with an average of 8.2 out of 10 (SD = 1.74). AI/AN and Asian American Native Hawaiian Pacific Islander (AANHPI) youth had the highest average sum of family connectedness (8.53 and 8.46 out of 10, respectively). Comparing racial groups, multiracial participants had the lowest average family connectedness (7.93 out of 10) and the highest screen positive rate for suicide risk (28.5% (178/249)). Every 1-unit increase in family connectedness decreased the odds of a positive suicide risk screen by 54% (OR = 0.46, 95% CI: 0.42 – 0.49) for White youth and 47% (OR = 0.53, 95% CI: 0.49 – 0.59) for African American/Black youth (b = -0.62, z = -3.17, p = 0.001).  Small cell sizes limited the ability to detect a difference between White participants and other racial groups.

Conclusion: In this sample of youth presenting to the ED, the relationship between a positive suicide risk screen and family connectedness varied by race, highlighting the importance of cultural considerations in suicide prevention research/interventions. A more diverse sample is needed to further understand the role race plays in the intersection of family connectedness and suicide risk.