Our study examined the association between state-level structural racism and past year rates of suicide ideation (SI) and suicide attempts (SA) among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents.

This secondary analysis used state- and individual-level linked data combining multiple years i.e., 2011-2019, of the Youth Risk Behavior Surveys, the 2019 American Community Survey, and the 2019 state-level Structural Racism Index (SRI), a composite measuring state-level Black-White (B-W) and Hispanic-White (H-W) racial inequities across five domains: residential segregation, incarceration rates, educational attainment, economic indicators, and employment status. A series of generalized estimating equations were used to examine the association between structural racism and past-year SI and past-year SA, with race/ethnicity as a moderator, adjusting for state- and individual-level covariates, among U.S. adolescents.

Negative associations were observed between B-W SRI with SI (Adj. b [95% CI] = -0.011 [-0.017, -0.003], p =.004), and SA (-0.011[-0.018, -0.004], p = .002), as well as between H-W SRI with SI (-0.008 [-0.016, -0.0002], p = .044), and SA (-0.011 [-0.018, -0.004], p = .001). These associations were significantly modified by race and ethnicity for both B-W SRI and H-W SRI. Both Black (SI= –0.011 [-0.02, -0.002]; SA= -0.011 [-0.019, -0.004]) and Hispanic (SI = -0.097 [-0.011,-0.004]; SA = -0.011 [-0.018, -0.004]) adolescents living in states with higher structural racism had lower rates of past-year SI and SA relative to White adolescents. Exploratory analyses identified a negative association between the residential segregation index and past-year SI and SA among Black and Hispanic adolescents. Meanwhile, a positive association emerged between B-W incarceration index and past-year SA, though not past-year SI, among Black adolescents.

Adolescents in states with higher SRI were at lower risk for past-year SI and SA. Racial inequities across various institutions may differentially influence suicide-related risk among adolescents. Structural racism may play an important role in conferring risk for SI and SA, and its impact may vary across Black, Hispanic, and White adolescents. Attending to institutional level markers of racism may help improve the cultural responsiveness of youth suicide prevention strategies.