Stigma and suicidal thoughts and behaviors among Black American emerging adults

Background: Recent suicide rates among Black American emerging adults have increased sharply, outpacing other racial groups. Stigma plays a critical role in shaping risk for suicidal thoughts and behaviors; however, little research that has examined the ways in which perceptions of perceived public stigma and self-stigma/prejudice are related to suicidal thoughts and behaviors among Black American emerging adults. Methods: A sample of 1224 Black American emerging adults from the general population aged 18-29 were recruited through Qualtrics Panels. Suicidal ideation and attempts were assessed using adapted items from the World Health Organization's suicide screen. Both public and self-stigma/prejudice were evaluated using modified versions of the Devaluation and Discrimination Scale. We used modified Poisson regression, adjusting for race/ethnicity, age, gender, education, health insurance, and treatment utilization. Results: Among those who perceived needing help for mental health concerns, higher perceived public stigma was associated with greater 12-month suicidal ideation, whereas self-stigma was associated with 12-month suicide attempts. These associations were attenuated or absent among those who did not perceive need, except for a pronounced association between prejudice and suicide attempts in sensitivity models. Discussion: Our findings underscore the importance of addressing both perceived public stigma alongside self-stigma/prejudice in prevention efforts to reduce suicide risk in Black emerging adults. Future research is needed to explore mechanisms underlying these associations and to develop targeted prevention strategies.