A new survey of black Americans finds that they have about the same rate of attempted suicide as the rest of the U.S. population, according to University of Michigan researchers.

In the past, suicide was seen as a more significant problem for whites, but apparent differences in suicidal ideation may reflect lack of comprehensive data, they said.

A national household probability sample found a lifetime prevalence of 11.7 percent for suicidal ideation and 4.1 percent for suicide attempts among African Americans and Caribbean Americans. About 4.9 percent of all Americans report attempting suicide.

The highest lifetime prevalence for attempts occurred among Caribbean black men, followed by African-American women, wrote Sean Joe, M.S.W., Ph.D., and colleagues in the November 1 Journal of the American Medical Association.

"This kind of study is long overdue," Donna Barnes, Ph.D., a member of the research faculty and an instructor in the psychiatry department at Howard University Medical School in Washington, D.C., told Psychiatric News. "In the past, research had shown low rates of completed suicide but said little about ideation."

Barnes, a sociologist, is also president of the National Organization for People of Color Against Suicide, an advocacy group based in Washington, D.C. (see box).

In the past, strong ties to the church and the interlocking social fabric of segregated black neighborhoods may have been protective factors against suicide among black people, said Barnes.

The University of Michigan researchers used data from the National Survey of American life, which included 3,570 African Americans, 1,621 blacks of Caribbean descent, and 891 non-Hispanic whites, aged 18 or older.

Respondents were initially screened for suicidality by being asked if they had ever seriously thought about committing suicide, if they had attempted suicide, and if so, how serious the attempt was. They were also asked about comorbid mental health conditions. Those with any one of 20 DSM-IV disorders were more than five times as likely to develop ideation and eight times as likely to attempt suicide, compared with persons with no psychiatric disorder. Respondents were also asked whether they had seen a psychiatrist, mental health professional, or a general health provider; used complimentary or alternative treatments; or had sought help from a religious or nonmedical social service.

About 44 percent of those reporting suicidal ideation and 24 percent of those who attempted suicide had never sought treatment for mental health problems.

Among the 11.7 percent who reported suicidal ideation, 34.6 percent had made a suicide plan, and attempts were more likely among women (4.9 percent) than men (3.1 percent). There were other ethnic and gender differences as well.

The highest risk of initial onset of suicidal thinking, planning, or attempts, occurs in the late teens or early 20s. The authors noted that the risk of a suicide attempt is higher than the risk for making a plan, implying that unplanned, impulsive attempts are common in that age group. Within three years of ideation onset, 90 percent of those who attempted suicide had made their attempt. Statistically, risk of ideation or attempts in the entire sample were associated with being younger, having a low education level, and living in the Midwest.

"The prevalence of suicide attempts was highest for Caribbean black men (7.5 percent, followed by African American women (5.0 percent)," wrote Joe and colleagues. "Caribbean black women had the lowest prevalence of attempts (2.7 percent), while attempts were only slightly more prevalent for African-American men."

Further research will be needed to tease out the relative roles of ethnicity, place of origin, and immigration experience, along with race, in establishing risk of suicidality in this population, they said.

"This article from Dr. Joe and colleagues reveals some unexpected subcultural and gender differences among African Americans and people of Caribbean descent in rates of suicide attempt and completion," said Annelle Primm, M.D., M.P.H., APA's director of minority and national affairs." This underscores the fact that when we characterize psychiatric illness or outcomes like suicide, we cannot afford to paint people of African descent or, for that matter, other racial and ethnic groups with a single, broad brush. We must look at the specificity of within-group differences, because one size does not fit all."

African Americans and Caribbean Americans come from two fundamentally different cultural backgrounds, said Barnes. Those born in the United States have grown up being in a minority, while Caribbean immigrants were born into societies in which they were in the majority. While that may boost their confidence in some settings, it is also possible that encounters with discrimination may cause depression or anxiety.

"Much of this suicidality really comes from untreated depression and not getting the help you need," said Barnes. Depression in the black community is still often viewed as a character flaw, not an illness, so people are less likely to seek help.

"Education is really important," she said. "We have to go into other community health organizations and help educate people about suicide prevention."

"Prevalence of and Risk Factors for Lifetime Suicide Attempts Among Blacks in the United States" is posted at<http://jama.ama-assn.org/cgi/content/full/296/17/2112>.▪