(PS13-69) Why Do Black Adults Deny Suicidality?: An Exploration of Factors Associated with Non-disclosure of Suicidal Thoughts

Disclosure is a key component to identifying and treating those most at risk for suicide. However, when suicidal thoughts and behaviors (STBs) are denied, risk goes undetected and these individuals not only remain at high risk for suicide, but they are more susceptible to psychological distress and lower well-being. While few research studies has broadly investigated factors associated with denial of STBs, those specific to Black individuals have yet to be examined. Thus, the present mixed-methods study aimed to examine characteristics associated with STB denial among Black adults, as well as reasons for this denial. 

Participants recruited via Prime Panels included 275 Black adults (M= 31.1), with a recent history of suicide ideation who had never disclosed their STBs (44.9% suicide plan; 63.6% suicide attempt). Participants were majority cis-gendered women (56.7%), heterosexual (79.3%), and African American (85.5%). They completed online self-report measures of demographic characteristics, history of STBs, prior opportunities to disclose, suicide risk factors, stigma, thwarted belongingness, perceived burdensomeness, and attitudes toward coping with stress, as well as completed an open-ended question regarding reasons for denying suicidality when asked.

Majority (71.7%) of participants reported having been previously asked if they had thoughts of suicide but denied it. Participants reported a diverse range of individuals who inquired about their suicidal thoughts – 26.8% were asked by a friend, 21.2% by a medical professional, 15.7% by their mother, and 14.1% a mental health professional. Other inquirers included a significant other or spouse, father, sibling, extended family member, member of religious community, and other professionals. Regarding reasons for denial, participants expressed fear of being judged, not feeling ready or comfortable to disclose, fear of hospitalization, shame and embarrassment, fear of burdening others, not wanting to be perceived as weak, disinterest in talking about their STB history, and low risk perception. 

When compared with those who had never been asked, participants who denied suicidality did not differ based on age (t(274)=-1.85, p=.07), gender (𝜒²(1)=3.74, p=.05), sexual orientation (𝜒²(1)=1.21, p=.27), ethnicity (𝜒² (1)=.06, p=.81), history of suicide attempt (𝜒²(1)=2.34, p=.13), history of suicide planning (𝜒² (1)=.38, p=.54), or prior mental health treatment use (𝜒² (1)=3.68, p=.06). Perceived burdensomeness (OR=.98, p=.06), thwarted belongingness (OR=.98, p=.21), STB stigma (OR=.61, p=.07), stigma of mental health help seeking (OR=1.00, p=.95), problem-focused coping (OR=.99, p=.97), emotion-focused coping (OR=.98, p=.39), nor avoidant coping (OR=.99, p=.82) were associated with STB denial. 

As the first study to highlight why Black adults deny suicidality, these findings offer valuable insight into the prevalence of, and reasons for, STB denial among this group. Furthermore, these findings offer integral information beyond traditional risk factors, considering no differences on traditional self-report factors were observed. This elucidates targets for culturally sensitive suicide prevention and psychoeducation efforts among this at-risk group.