Higher Educational Attainment is Associated with Lower Risk of a Future Suicide Attempt Among Non-Hispanic Whites but not Non-Hispanic Blacks
In a sample of patients presenting to the emergency department (ED), the current study was conducted with two aims: (1) to investigate the protective effects of educational attainment (i.e., completing college) on subsequent risk of suicide attempt/death among patients presenting to the ED and (2) to compare this effect between non-Hispanic Black and non-Hispanic White ED patients.
The current study analyzed data from the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) study, a quasi-experimental, eight-center study of universal suicide screening and follow-up of ED patients presenting for suicidal ideation and behavior. Our sample included 937 non-Hispanic White and 211 non-Hispanic Blacks. The dependent variable was suicide attempt/death during the 52-week follow-up. The independent variable was completing college. Age, gender, lesbian/gay/bisexual status, psychiatric history, and previous suicide attempts at baseline were covariates. Race/ethnicity was the focal effect modifier. Logistic regression models were used to test the protective effects of educational attainment on suicide risk in the overall sample and by race/ethnicity.
In the overall sample, educational attainment was not associated with suicide risk over the follow-up period. A significant interaction was found between race/ethnicity and educational attainment on suicide risk, suggesting a larger protective effect for non-Hispanic Whites compared with non-Hispanic Blacks. In race/ethnicity-specific models, completing college was associated with decreased future suicide risk for non-Hispanic Whites but not Blacks.
Consistent with the Minorities’ Diminished Return theory, educational attainment better protected non-Hispanic White than non-Hispanic Blacks against future suicide attempt/death. While Whites who have not completed college may be at an increased risk of suicide, risk of suicide seems to be independent of educational attainment for non-Hispanic Blacks.
KeywordsSocioeconomic status Ethnic health disparities Race Ethnicity Blacks Suicide
SA analyzed the data and prepared the first draft of this paper. All other authors contributed to the interpretation of the findings and revision of the draft and approved the final paper.
This project was supported by Award Number U01MH088278 from the National Institute of Mental Health. Shervin Assari is partially supported by the Assari is supported by the Center for Medicare and Medicaid Services (CMS) Grant 1H0CMS331621 as well as the NIH Awards 54MD008149”, R25 MD007610, 2U54MD007598, and U54 TR001627. Heather Schatten is supported by Award Numbers R01MH112674, R01MH108610, and R01NR014540 from the National Institute of Mental Health.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The institutional review boards (IRBs) at each site approved the study protocol. All ED participants signed an informed written consent. As SOs in the intervention phase were only contacted via telephone, they gave verbal consent. The Data and Safety Monitoring Board (DSMB) of the National Institute of Mental Health (NIMH) conducted the overall study oversight and monitoring.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.
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