How Discrimination Gets Under the Skin: Pathways to Suicidal Thoughts and Behaviors Among Racial/Ethnic Minority Adolescents

Objective: Adolescent suicide remains a major public health concern in the United States, with disproportionate burdens observed among racial and ethnic minority youth. Increasing evidence suggests that structural and interpersonal stressors, particularly racial discrimination, play a critical role in shaping mental health outcomes among adolescents. However, less is known about the mechanisms through which perceived racial discrimination (PRD) contributes to suicidal thoughts and behaviors (STBs). This study examined the association between PRD and STBs among U.S. racial/ethnic minority adolescents and assessed whether persistent sadness/hopelessness and electronic vapor product (vaping) use mediate these relationships after adjusting for demographic characteristics.

Methods: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative, school-based survey of high school students in the United States. The analytic sample included 8,054 racial/ethnic minority adolescents aged 14–18 years (50.8% male). Multivariable logistic regression models were used to examine associations between PRD and suicidal ideation, suicide planning, and suicide attempts. Mediation analyses were conducted to assess whether persistent sadness/hopelessness and vaping explained these associations while controlling for age, sex, and other relevant covariates. All analyses accounted for the complex survey design using appropriate weighting procedures.

Results: Approximately 43% of racial/ethnic minority adolescents reported experiencing PRD, highlighting the widespread nature of discrimination in the lives of young people. Adolescents who reported PRD had significantly higher odds of suicidal ideation (AOR=1.44, 95% CI=1.20–1.73), suicide planning (AOR=1.26, 95% CI=1.02–1.57), and suicide attempts (AOR=1.49, 95% CI=1.16–1.93). Mediation analyses indicated that persistent sadness or hopelessness was a substantial pathway linking PRD to STBs, accounting for 47.2% of the total effect for suicidal ideation, 44.0% for suicide planning, and 42.3% for suicide attempts. Vaping also functioned as a mediator, though to a lesser extent, explaining 18.1%, 17.1%, and 19.0% of the associations across outcomes, respectively. These findings suggest that emotional distress is a primary mechanism through which discrimination translates into suicide risk, while maladaptive coping behaviors such as vaping may further compound vulnerability.

Conclusions and Implications for Social Work: Findings underscore that racial discrimination—rather than racial or ethnic identity itself—is a key driver of suicide risk among minority adolescents. For social work practice, integrating trauma-informed and culturally responsive approaches is essential, including routine screening for discrimination and associated emotional distress in schools, healthcare, and community settings. Interventions should prioritize addressing depressive symptoms and strengthening adaptive coping strategies while reducing maladaptive behaviors such as vaping. At the policy level, efforts to reduce structural racism and promote inclusive, supportive environments are critical. For social work research, these findings highlight the importance of examining structural determinants of mental health and identifying mechanisms that can inform targeted, equity-driven interventions to reduce adolescent suicide risk.