Racial Identity Profiles Among Suicidal Black Women: A Replication and Extension Study

Abstract

Despite increasing rates of suicidality among African American women, relatively little is known about culturally-specific factors relevant to their suicidality. Thus, our objectives were to: (1) determine whether previously-identified racial identity profiles replicated in a clinical sample of African American women and (2) examine whether profiles differed on suicidal ideation, hopelessness, and depressive symptoms. In a sample of 198 low-income, African American women (M_age = 36), latent profile analysis supported a 5-class solution: Undifferentiated (average on all subscales), Detached (lower than the average on most subscales), Afrocentric (low public regard, high nationalism), Multiculturalist (high public regard, private regard, centrality), and Alienated (markedly lower than average on all subscales). Subgroups with higher racial group identification and more positive feelings about being African American endorsed less suicidal ideation and hopelessness than other subgroups. This study characterizes patterns of racial identity among a clinical sample and offers insights into how subgroups of individuals with different combinations of racial identity may be more likely to experience suicidality.

Keywords

racial identity suicide depression Black women latent profile analysis

Suicide rates have been increasing among Black women (Curtin et al., 2016); yet, little is known about relevant factors for this population because they are underrepresented in the literature. Some factors (e.g., faith-based beliefs, social support) have been shown to protect against the correlates of suicidality in Black women (e.g., hopelessness, suicidal ideation, depression; Spates & Slatton, 2017; Walker et al., 2018). However, little is known about whether race-specific constructs, like racial identity, play a similar function for Black individuals (Yip, 2019). Black racial identity is comprised of attitudes and beliefs about the significance and meaning of being Black (Sellers & Shelton, 2003), which can inform their beliefs about themselves and others in ways that are relevant to psychopathology (Hunn & Craig, 2009). Therefore, focusing on the impact of racial identity on individuals’ psychological functioning is consistent with multiculturally-informed clinical-science and has the potential to enhance our understanding of suicidal behavior in underserved and understudied populations (Neblett, 2019).

One approach to conceptualizing racial identity for Black individuals is the Multidimensional Model of Racial Identity (MMRI), which describes the current status of one’s racial identity (Sellers et al., 1997). The MMRI is based on several assumptions, including: (1) people have hierarchically ordered identities, of which race is only one; (2) peoples’ perception of their racial identity is the most valid indicator of their identity; and (3) there is not just one way to define what it means to be African American (Sellers et al., 1997). The MMRI consists of four dimensions of Black racial identity: salience, centrality, regard, and ideology. Salience refers to the relevance of racial identity to people’s self-concept at a particular point in time or situation (i.e., how much an individual thinks about their race at a given time). Centrality is the degree to which race is central to people’s self-definition. An individual low in centrality may deprioritize race as part of their identity, whereas a person high in centrality might rank race as being an important part of their identity. Regard pertains to judgment about people’s own racial group and is comprised of two sub-dimensions: private and public. Private regard refers to people’s positive or negative feelings toward their racial group and about being Black (i.e., how much they personally like being Black), whereas public regard refers to people’s perceptions of mainstream society’s evaluations of their racial group (i.e., how much they believe others value Black individuals). Lastly, ideology is defined as peoples’ beliefs, attitudes, and opinions about how Black individuals should live, think, and act in the United States. There are four main ideologies: (1) assimilationist—highlights similarities between Black people and mainstream society (i.e., emphasis on Black people fitting in); (2) humanist—attends to the similarities among all humans (i.e., deemphasis on race/ethnicity); (3) nationalist—stresses the uniqueness of being Black (i.e., emphasis on Black culture and history); and (4) oppressed minority—emphasizes similarities in oppression faced by Black people and other minority groups (i.e., highlighting how Black individuals experience similar oppression as other racial groups).

In contrast to conceptualizing racial identity as a unitary construct and examining whether “high” or “low” racial identity correlates with psychological factors, the MMRI framework allows researchers to study how the nuanced facets of racial identity relate to outcomes (Smith & Silva, 2011). Within this model, individuals are conceptualized as having complex racial identities such that scores from all subscales work in tandem and individuals are not labeled as pure “subtypes” (e.g., nationalist, assimilationist). Because tools to assess racial identity (e.g., Multidimensional Inventory of Black Identity; Sellers et al., 1998) reflect the complexity of the construct and account for several dimensions that can vary within individuals, a person-centered analytic approach may be optimal for examining this construct (Rosato & Baer, 2012). Rather than understanding how separate racial identity subscales relate directly to correlates of suicide (e.g., how individual subscales are associated with suicidal ideation), person-centered analyses allow individuals’ scores on each subscale to be considered in aggregate (e.g., how subgroups of individuals with a particular pattern of scores on all subscales differ in terms of suicidality). Thus, we can estimate an individual’s profile or pattern of racial identity beliefs and attitudes and understand how the total complexity of their racial identity is associated with various outcomes, such as the correlates of suicidal behavior.

Using a person-centered approach, subgroups have emerged in the literature based on endorsement of racial identity dimensions, including: Afrocentric (or race-focused, buffering/defensive), characterized by high racial centrality/nationalism and low public regard; multiculturalist (or idealized), characterized by high racial centrality and high public regard; undifferentiated, characterized by average scores; detached (or alienated), characterized by low centrality and public regard; and integrationist (or humanist, pluralist), characterized by low centrality and high humanism. These studies reveal that subgroups report different levels of psychological distress (Bernard et al., 2018) and depressive symptoms (Banks & Kohn-Wood, 2007). To date, however, these studies have been conducted with college-aged populations (Neville & Lilly, 2000) and have not examined suicidality or its correlates. This limitation obfuscates our understanding of racial identity among clinical populations who are at risk for a variety of severe mental health outcomes (Walker et al., 2018).

The Current Study

Although the research on suicidal behavior and its key correlates (e.g., hopelessness, depressive symptoms; Klonsky et al., 2017; Ribeiro et al., 2019), increasingly has attended to gender, race, and ethnicity (Chu et al., 2019), only recently has attention been paid to the relevance of cultural constructs, such as racial identity. Further, when racial identity has been considered, rarely has it been the focus of investigation with a clinical sample (Street et al., 2012). To advance our understanding of characteristics of racial identity profiles and differential associations with suicidal behavior and its correlates in a clinical sample of low-income Black women, the goals of this study were to (1) examine whether we could replicate racial identity profiles found in the extant literature with a clinical sample; and (2) ascertain if suicidal ideation, hopelessness, and depressive symptoms differed based on profile membership.

With regard to the replicability of racial identity profiles with a clinical sample, we examined the current literature and identified the most reliably found racial identity profiles. On this basis, we hypothesized that we would uncover at least two profiles, Afrocentric (high racial centrality/nationalism and low public regard) and multiculturalist (high racial centrality and high public regard). We also expected to detect at least one of the often-identified profiles: detached (low centrality and public/private regard); undifferentiated (average scores on most subscales); and integrationist (low centrality and high humanism). In terms of the link between racial identity profiles and the manifestation of suicidal behavior, we expected that racial identity profiles characterized by detachment and negative racial regard would be associated with higher levels of suicidal ideation, hopelessness, and depressive symptoms than would those profiles characterized by attachment and positive racial regard.

Methods

Participants

A sample of 198 Black women (M_age = 36.12; Table 1) were recruited from a large, university-affiliated level-1 trauma public hospital in a Southern urban city during the baseline session of a randomized controlled trial focused on providing group therapy for women with a history of suicidality and intimate partner violence. Inclusion criteria included identifying as a Black woman, between 18 and 64 years old, with both a history of intimate partner violence and a suicide attempt within the last year. Exclusion criteria included an inability to complete the assessment protocol due to psychosis or cognitive impairment. The majority (97.9%) of participants reported low socioeconomic status (i.e., <$2,000/month; U.S. Department of Health & Human Services [USDHHS], 2019).

Table 1.

Demographics of Full Sample and by Latent Profiles.

	Total (n = 198)	Undifferentiated (n = 108)	Detached (n = 41)	Afrocentric (n = 25)	Multiculturalist (n = 19)	Alienated (n = 5)
Mean age (SD)	36.34 (11.37)	36.61	38.27	29.46	34.88	44.2
Employed (%)	13.2	10.2	14.6	20	21.1	0
Have children (%)	67.7	74.1	68.3	48	63.2	40
Monthly income (%)
$0 to $249	55.6	60.2	61	28	36.8	100
$250 to $499	9.7	9.3	7.3	16	10.5	0
$500 to $999	27	22.2	22	48	42.1	0
$1,000 to $1,999	5.6	5.6	4.9	4	10.5	0
$2,000+	1.5	1.9	0	4	0	0
Household income (%)
$0 to $249	36.9	37	48.8	24	21.1	60
$250 to $499	6.1	5.6	2.4	8	15.8	0
$500 to $999	21.2	19.4	17.1	28	31.6	20
$1,000 to $1,999	11.6	13	7.3	20	5.3	0
$2,000+	9.6	11.1	7.3	8	10.5	0
Education (%)
Less than 12th grade	46	44.4	53.7	36	47.4	60
High school or GED	29.8	33.4	19.5	36	31.6	0
Some college or technical school	15.7	16.6	21.9	24	15.8	40
College or tech school graduate	8	5.6	2.4	4	5.3	0
Graduate school	0	0	0	0	0	0
Psychiatric hospitalization (%)	78.3	75.9	80.5	84	84.2	60

Procedures

This study was approved by the university institutional review board and hospital research ethics board committees. Participants were recruited in person in hospital waiting rooms or referred by healthcare providers. Due to participants’ literacy levels and length of the assessments, trained research assistants administered the measures as an interview. Participants received $25 as compensation for their time.

Measures

Racial identity

To assess racial identity dimensions, we used the 27-item Multidimensional Inventory of Black Identity-Short Form (MIBI-S; Martin et al., 2005). Participants rated each item on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The MIBI-S is comprised of seven subscales that map on to the MMRI, including: centrality (e.g., “Being Black is an important reflection of who I am,” α = .63), private regard (e.g., “I feel good about Black people,” α = .83), public regard (e.g., “Overall, Blacks are considered good by others,” α = .85), assimilationist (e.g., “Blacks should try to work within the system to achieve their political and economic goals,” α = 0.82), humanist (e.g., “Blacks would be better off if they were more concerned with the problems facing all people rather than just focusing on Black issues,” α = .66), oppressed minority (e.g., “The same forces which have led to the oppression of Blacks have also led to the oppression of other groups,” α = .66), and nationalist (e.g., “It is important for Black people to surround their children with Black art, music and literature,” α = .62). All subscales have four items, except for private regard, which has three items. Four of the seven subscales demonstrated acceptable alpha coefficients (.70 or higher) centrality, oppressed minority, and nationalist were lower than ideal. Previous studies demonstrated the construct validity of the MIBI-S (Bernard et al., 2018).

Suicidal ideation

To assess suicidal ideation, we used the 21-item Beck Scale for Suicide Ideation (BSS; Beck et al., 1979). Respondents rated the degree to which items described their suicidal ideation in the past week on a 3-point Likert scale ranging from 0 to 2; with higher scores indicating more ideation (e.g., “I have brief periods of thinking about killing myself which pass quickly”). An overall sum score of intensity of current ideation was used. The BSS has shown good construct validity in similar samples of low-income African American women (Zhang et al., 2013) and reliability in this sample was good (α = .86).

Hopelessness

To assess hopelessness, we used the 20-item Beck Hopelessness Scale (BHS; Beck & Steer, 1993). Participants were asked if an item was true or false for them on items such as “I look forward to the future with hope and enthusiasm,” and scores were summed. The BHS demonstrates construct validity in racially diverse clinical and community samples (Thompson et al., 2002) and reliability in this sample was excellent (α = .93).

Depressive symptoms

To assess severity of depressive symptoms, we used the well-established 21-item Beck Depression Inventory-II (BDI-II; Beck et al., 1996). Participants were asked how present each item was for them on a scale of 0 (not present) to 3 (severe) with items such as, “I don’t feel I am being punished” and “I feel I am being punished.” The total score was constructed by adding item scores; higher scores reflect more severe symptoms. There is psychometric support for using the BDI in racially diverse samples (Carr et al., 2013) and reliability in this sample was excellent (α = .92).

Data Analytic Plan

To address aim 1, related to the replicability of the MIBI-S profiles in this clinical sample, we used MPlus 8 (Muthén & Muthén, 2017) to conduct a series of latent profile analyses (LPA) using the seven subscales of the MIBI-S as indicators. LPA provides a parsimonious strategy for classifying people into profiles using theoretically meaningful and established constructs (Gabriel et al., 2018). It identifies within-person patterns across many variables, rather than individual associations between variables and allows patterns to emerge from the data without a priori assumptions (Stanley et al., 2017). Based on previous literature on optimal class solutions, we used Maximum Likelihood Estimation with robust standard errors (MLR) to examine 2 to 6 class models (Nylund et al., 2007). The optimal class solution was based on superior fit indices and theoretical rationale. We examined the Akaike information criterion (AIC), Bayesian Information Criterion (BIC), quality of classification (entropy), Lo–Mendell–Rubin Adjusted Likelihood Ratio Test value (LMR), and Bootstrapped Likelihood Ratio Test (BLRT) p value. Lower AIC and BIC values indicate better fitting models, higher entropy values indicate higher classification quality, significant LMR values suggest improvement in fit between neighboring nested class models, and significant BLRT p values indicate increased model fit between the k–1 and k class models (Nylund et al., 2007). To characterize the five profiles, we first examined the subscale scores and reviewed them in the context of the literature. Second, given the unique sample, we solicited the perspectives of individuals from this intersection of identities (race, gender, socioeconomic status) regarding the profiles that emerged. One opportunity to glean such information was through an ongoing woman of color exploration therapy group (created and led by the first four authors) at the hospital where the data were collected. As part of a module for the group on racial identity, we introduced the MIBI-SF items and subscales, explained the basic goals of LPAs, and presented the profiles across two group sessions. We asked group members to share thoughts and feedback about each of the profiles. We therefore characterized the profiles by integrating the pertinent literature, discussions among group members, and dialogue among research team members.

To address study aim 2, focused on the link between racial identity profiles and endorsement of the correlates of suicidal behavior, we conducted separate one-way analyses of variance (ANOVA) tests with LPA profiles as the independent variable and scores on each outcome measures (suicidal ideation, hopelessness, and depressive symptoms).

Results

Descriptive Analyses

Correlations among study variables are summarized in Table 2. Significant correlations emerged between many racial identity dimensions and the suicidal behavior correlates.

Table 2.

Correlations Among Study Variables.

	α	M (SD)	1	2	3	4	5	6	7	8	9	10
1. Centrality	0.63	5.27 (1.23)	—
2. Private regard	0.83	5.83 (1.21)	.63*	—
3. Public regard	0.85	4.07 (1.48)	.33*	.38*	—
4. Assimilationist	0.82	5.74 (1.11)	.28*	.33*	.12	—
5. Humanist	0.66	5.59 (1.24)	.31*	.35*	.27*	.38*	—
6. Oppressed minority	0.66	4.91 (1.21)	.17*	.26**	.16*	.30*	.36*	—
7. Nationalist	0.62	4.26 (1.27)	.24*	.19*	−.01	.26*	.07	.20*	−
8. Beck suicidal ideation	0.86	11.94 (11.38)	−.12	−.21*	−.16*	−.09	−.16*	−.11	−.07	—
9. Beck hopelessness scale	0.93	7.90 (5.99)	−.22*	−.19*	−.24*	−.12	−.23*	−.14	−.07	.48*	—
10. Beck depression inventory-II	0.92	30.01 (18.07)	−.17*	−.13	−.21*	−.13	−.16*	−.04	−.16*	.39*	.51*	—

Note. *p < .05.

Aim 1: Profile Replicability

Table 3 summarizes goodness-of-fit indices yielded from the LPAs, including the BIC, AIC, LMR, BLRT, and entropy. The entropy values increased going from the 2-, 3-, and 4-class solution, and were slightly lower for the 5- and 6-class solutions. However, although there was a relatively higher entropy and lower BIC for the 4-class than the 5-class solution, when other goodness-of-fit indicators were taken into consideration, the optimal number of profiles shifted. Specifically, the 5-class solution had a lower AIC and a profile distribution more closely aligned with previous literature. In addition, the significant BLRT value for the 5-class solution suggested that it was a superior fit compared to the 4-class solution, resulting in our decision to choose the 5-class solution over the 4-class solution. For completeness, we ran a 6-class solution and determined based on the comparable entropy value and non-significant BLRT p value that it was not a superior fit. Thus, the 5-class solution was retained (see Figure 1).

Table 3.

Summary Statistics Describing Latent Profile Analysis Fit Indices.

	2-Class	3-Class	4-Class	5-Class	6-Class
Entropy	0.88	0.89	0.90	0.85	0.86
Log likelihood	−2,143.80	−2,101.09	−2,072.22	−2,054.77	−2,037.24
Free parameters	22	30	38	46	54
AIC	4,331.59	4,262.19	4,220.43	4,201.55	4,182.48
BIC	4,403.93	4,360.83	4,345.39	4,352.81	4,360.05
LMR (p)	180.67 (.15)	83.43 (.04)*	56.42 (.14)	34.08 (.29)	23.3 (.49)
BLRT p	<.001*	<.001*	<.001*	.013*	.13
Class 1 n	34	5	5	5	9
Class 2 n	164	47	85	108	37
Class 3 n		146	30	19	108
Class 4 n			78	41	5
Class 5 n				25	18
Class 6 n					21

Note. AIC = Akaike information criterion; BIC = Bayesian information criterion; LMR = Lo–Mendell–Rubin Adjusted Likelihood Ratio Test; BLRT = Bootstrapped Likelihood Ratio Test.

Figure 1.

LPA-derived profiles depicted by standardized MIBI subscale means.

The first and largest subgroup (n = 108; mean age = 36.61) had relatively average scores on all subscales. This subgroup resembled other groups found in LPA papers using the MIBI (Banks & Kohn-Wood, 2007) and consistent with this, were named Undifferentiated.

The second largest subgroup (n = 41; mean age = 38.25) was notably lower than average on all subscales and had particularly low scores on centrality. They had lower private regard compared to public regard—their own attitudes about being Black were more negative than their perception of how others view Black individuals. This was similar to the detached profile found by Seaton (2009) and Thomas et al. (2015). Thus, this subgroup was named Detached.

The third largest subgroup (n = 25; mean age = 29.46) had lower than average scores on public regard and higher scores on nationalism, resembling the race-focused subgroup found by Banks and Kohn-Wood (2007) and the defensive/buffering profile reported by others (Richardson et al., 2015; Seaton, 2009). Particularly in the context of higher than average centrality and private regard, this subgroup appeared to have pro-Black attitudes and was named Afrocentric.

The fourth largest subgroup (n = 19; mean age = 34.88) had the highest oppressed minority and public regard scores, resembling the multiculturalist subgroup reported by Banks and Kohn-Wood (2007) and the idealized subgroup noted by Chavous et al. (2003) and Richardson et al. (2015). In the context of higher private regard and centrality, it appeared that this subgroup had a focus on both Black individuals and other groups, and thus was named Multiculturalist.

Finally, the smallest subgroup (n = 5, mean age = 44.20) was notably low on all subscales, with particularly deviant scores on the centrality, private regard, and humanist subscales. This subgroup appeared to strongly dislike being Black and perceived others as having negative attitudes toward Black individuals. Consistent with particularly low valuation of being Black as part of their identity and negative feelings about being Black, this subgroup was named Alienated. Given the extreme scores found in this group and consequent concerns about the possibility of data entry error due to the small number of individuals classified within this profile, we examined the original data files and confirmed that the data were entered correctly. Further, we entertained the possibility that this subgroup was better characterized as part of another subgroup, and only emerged in the 5-class solution as a statistical artifact. We therefore examined the profiles developed in the 3-, 4-, 5-, and 6-class solutions (Table 3, bottom panel) and found that the five-person profile found in the 5-class solution contained the same participants as the other solutions. Furthermore, there is evidence that when examining trauma, researchers uncover profiles characterizing a very small segment of the sample (i.e., <5%; Holt et al., 2017), which are reliably found in other samples (Contractor et al., 2018). The removal of smaller profiles prohibits researchers’ ability to determine whether such profiles can be reliably uncovered, which consequently obfuscates our understanding of racial identity and its correlates. Thus, given that the Alienated subgroup reliably emerged across solutions, it was retained.

Subgroup Differences on Clinical Outcomes

A series of ANOVAs revealed significant subgroup differences for suicidal ideation, hopelessness, and depressive symptoms (see Figure 2 and Supplemental Table A). Using Tukey’s post-hoc tests to correct for type I error, we found that the Alienated subgroup had greater levels of suicidal ideation than all other subgroups. In addition, for hopelessness, we found the Detached subgroup had significantly higher scores compared to the Undifferentiated and Multiculturalist subgroups. In terms of depressive symptoms, the Detached subgroup had higher scores (versus Undifferentiated), but the effect only reached marginal significance.

Figure 2.

Group differences on study outcomes depicted by standardized scores.

Discussion

Although racial identity is one of the most widely studied culturally-relevant constructs for Black individuals, few studies have utilized a person-centered approach to understand how its complex and nuanced dimensions work together in ways that are relevant to suicidal behavior in low-income Black women. Thus, this study contributes to the literature in two important ways. First, we uncovered several racial identity profiles in a clinical sample that typically are found in college samples—Afrocentric, Multiculturalist, Undifferentiated, and Detached. We also identified a novel profile, Alienated, characterized by lower scores on all racial identity subscales, especially centrality and private regard. Second, we found that these subgroups differed on suicidal ideation, hopelessness, and depressive symptoms.

Our first goal was to replicate the racial identity profiles found across studies. Four of the previously identified subgroups emerged in this unique clinical population. In addition, a new subgroup appeared that included individuals who scored low on all racial identity measures and worse across indicators of suicidal behavior. These findings suggest that there are meaningful similarities regarding racial identity attitudes and behaviors that result in comparable profile patterns across diverse samples of Black individuals. Results also indicate there may be distinctive experiences associated with being Black and having elevated mental health symptoms and trauma histories that are associated with unique patterns of racial identity. Thus, the use of a person-centered approach allowed us to uncover multiple subgroups and shed light on potential strategies for culturally-responsive approaches to mental health promotion (Petersen et al., 2019).

Our second goal was to clarify whether investigating racial identity from a person-centered approach provided unique insights regarding greatest risk for suicidal ideation, hopelessness, and depressive symptoms. Relative to the other four subgroups, the Alienated subgroup reported greater levels of suicidal ideation. According to prominent theories of suicide, social disconnection (Durkheim, 1966; Spates & Slatton, 2017) and low sense of belongingness (Joiner, 2005; Van Orden et al. 2010) exacerbate risk for suicidal behavior. Because individuals in the Alienated subgroup hold attitudes that reflect dislike for their own racial group (i.e., internalized racism) and do not experience racial belonging, they may be more likely to have poor self-esteem (James, 2017) which may, in turn, increase suicide ideation (Bhar et al., 2008).

The Detached subgroup had higher hopelessness scores compared to the Undifferentiated and Multiculturalist subgroups. Similar to the Alienated subgroup, the Detached subgroup demonstrated low scores on all racial identity subscales, particularly on the centrality subscale. Although these scores were not as extreme as the Alienated subgroup, these lower than average levels of centrality could have contributed to increased hopelessness. Previous research has indicated that among Black individuals for whom race is not central to their identity, their mental health outcomes are worse, especially in the context of racial discrimination (Neblett et al., 2004; Seaton, 2009). This may be because individuals, especially Black women, with low centrality use fewer culturally-relevant coping strategies and/or fewer effective coping practices in response to racism (Lewis et al., 2017). For members of the Detached subgroup, limited access to and use of culturally-relevant coping strategies in the face of multifaceted stressors could engender feelings of hopelessness. Of note, in prior research, the findings on racial centrality have been mixed; some studies have indicated that low centrality may lead to poorer outcomes whereas other work has suggested that lower racial centrality may buffer individuals from being personally affected by society’s negative perceptions of Black individuals and thus protected against adverse health (Volpe et al., 2019). Although additional research is required to shed light on these interrelations, our findings complement the literature by demonstrating how individuals with the lowest centrality may be at greater risk for suicidal behavior and its correlates compared to those with higher centrality, who are at relatively lower risk.

Though the current study advances the existing research on racial identity, several limitations require acknowledgement. First, we used cross-sectional data, which limits our ability to infer causality and assess how these profiles influence suicidal behavior and its correlates over time. Second, participants were low-income women, and we did not use random sampling to recruit them. Thus, it is unclear if the findings are applicable to a nationally representative sample of Black individuals representing a range of gender identities, sexual orientations, socioeconomic backgrounds, and regions of the country (Cole, 2009; Lewis & Van Dyke, 2018). Related to limits of generalizability, all women in the sample had made a suicide attempt and had been exposed to IPV, thus, representing a unique subset of Black individuals with significantly elevated clinical symptomatology and a trauma history. On the one hand, focusing on individuals with past suicide attempts combined with interpersonal trauma is a strength of our study but on the other hand, Black individuals with previous suicide attempts may differ from Black individuals in the general population given notably low base rates of suicides. Therefore, to enhance our ability to offer primary prevention programs (i.e., programs offered before any indication of the target problem), it is essential to explore the associations among racial identity profiles and suicidal behavior correlates among non-suicidal individuals. Third, the study focused solely on risk-related correlates of suicidal behavior. Given racial identity’s function as a protective factor that promotes self-esteem, psychosocial functioning, and adaptive coping, it is crucial to focus on how these racial identity profiles contribute to resiliency outcomes.

Implications

Although myriad factors account for Black women’s underutilization of mental health services, a primary barrier is clinicians’ limited awareness of and competency related to race and culture (Thompson et al., 2004), including minimal attendance to cultural factors in suicide-risk assessments and interventions (Chu et al., 2017). Not only can these factors limit treatment engagement, but they also may mitigate treatment success (Drinane et al., 2018). Therefore, it is important for mental health practitioners to understand cultural factors (e.g., racial identity), and know how to apply culturally-relevant theories in practice in ways that (a) honor group-level cultural values and (b) acknowledge individual-level expressions of those attitudes and beliefs as this can inform culturally-responsive and individualized treatment plans (Carter & Johnson, 2019; Holden et al., 2015). For instance, for Black women in the Alienated and Detached subgroups, treatment goals may include challenging pejorative views of racial group members and promoting healthy social relationships with racial group members. These goals, if achieved, can enhance self-esteem and social support, and ultimately reduce distress in the form of suicidal ideation, hopelessness, and depressive symptoms. For Black women in the Multiculturalist subgroup, treatment goals may include capitalizing upon their positive views of themselves vis-à-vis their racial group and their connection to other people within their racial group.

Taken together, these findings underscore the relevance of cultural factors to suicidal behavior and support the utility of examining culturally-specific factors when assessing suicide risk and its correlates. Furthermore, these results add to a growing body of evidence suggesting that assessment of culturally-specific variables may inform culturally-responsive suicide prevention and intervention efforts.

Supplemental Material

MIBI_LPA_Supplementary_Materials_4_20_2020 – Supplemental material for Racial Identity Profiles Among Suicidal Black Women: A Replication and Extension Study

Supplemental material, MIBI_LPA_Supplementary_Materials_4_20_2020 for Racial Identity Profiles Among Suicidal Black Women: A Replication and Extension Study by Yara Mekawi, Ciera B. Lewis, Natalie N. Watson-Singleton, Isatou F. Jatta, llana Ander, Dorian Lamis, Sarah E. Dunn and Nadine J. Kaslow in Journal of Black Studies

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Natalie N. Watson-Singleton was supported by funding from the National Institute on Minority Health and Health Disparities (R43MD012284) during the writing of this manuscript. This research was supported by a grant from the National Institute of Mental Health (1R01MH078002-01A2, Group interventions for abused, suicidal Black women) awarded to the last author (Kaslow).

ORCID iD

Yara Mekawi

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Yara Mekawi, PhD, is a postdoctoral resident at the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine, Atlanta, GA. Her research focuses on examining racial discrimination and racial prejudice at the intersection of affect and cognition. Specifically, her research focuses on examining the cognitive and affective mechanisms through which racial discrimination is associated with mental health in marginalized groups, as well as the cognitive and affective factors that maintain racially-prejudiced behavior and attitudes among privileged groups.

Ciera B. Lewis, MA, is a doctoral student in the Clinical-Community Psychology PhD program at Georgia State University. Her research explores the utility of culturally-specific constructs like Black racial identity and racial socialization as resilience factors in promoting psychological well-being among Black American emerging adults. Ciera’s clinical interests include helping Black Americans navigate emerging adulthood with a particular focus on racial identity exploration, redefining the strong Black woman schema, and reducing stigma against mental health help-seeking in the Black community.

Natalie N. Watson-Singleton, PhD, is an assistant professor in the Department of Psychology at Spelman College. Her research interests include African American women’s health disparities and barriers to psychological help-seeking among African American women. Her program of research also encompasses cultural adaptations to evidence-based treatments, especially mind-body interventions, for racial/ethnic minorities.

Isatou F. Jatta is a senior community researcher at Georgia State University’s Psychology Department for the Georgia Department of Education 21st Century Community Learning Centers. She graduated Cum Laude with a Bachelor of Arts in Psychology and Sociology. Her research interest includes migration experiences of West Africans within the United States, mental health outcomes of Black organizers, and protective factors against suicidality for Black women.

llana Ander, BA, is currently a clinical research coordinator at the Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program at Massachusetts General Hospital. She manages studies on the etiology and treatment of anxiety disorders, specifically psychiatric interventions for PTSD and GAD. Her independent research focuses on the early risk factors and socioemotional experience of Complicated Grief. She holds a Bachelors degree from Emory University.

Dorian Lamis, PhD, ABPP, is a board certified licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine, Atlanta, GA. His research focuses on mood disorders, substance use, and suicidal behaviors in a variety of populations. He has published over 150 peer-reviewed articles and book chapters on these topics.

Sarah E. Dunn, PhD, ABPP is an assistant professor in the Emory School of Medicine Department of Psychiatry and Behavioral Sciences and is board certified in Clinical Psychology. With a strong integrative orientation, working primarily with low income, marginalized, minority populations, her particular research and clinical interests include: suicidal behavior; domestic violence; severe and persistent mental health problems, especially personality disorders; and the intersection of mental and medical illnesses.

Nadine J. Kaslow, PhD, ABPP is professor and vice chair for Faculty Development, Diversity, Equity, and Inclusion, Emory School of Medicine Department of Psychiatry and Behavioral Sciences. The past president of the American Psychological Association, she is also the director of the Atlanta Trauma Alliance and the Nia Project.

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