Depressive Symptoms and Suicide Attempts Among Black Adolescents: Moderating Role of Parental Mental Illness

Background and Purpose: Suicide rates among Black adolescents have increased over the past two decades. This rise is tied to unequal exposure to depression, family instability, and an inequitable mental health system. National surveillance data highlight the need to understand how caregiver mental health challenges intersect with youth depressive symptoms to shape suicide risk among Black students. Few studies have examined these dynamics using the 2023 National Youth Risk Behavior Surveillance System (YRBSS) or tested parental mental illness as a moderator of the depression-attempt association in this population. This study examined whether depressive symptoms were associated with suicide attempts among Black high school students and whether living with a parent or guardian with severe mental illness changed this association.

Methods: Cross-sectional secondary data from the 2023 national YRBSS, a three-stage cluster sample of U.S. students in grades 9-12 were used. The analytic sample was restricted to students identifying as Black or African American (N = 1,488). A binary logistic regression with moderation was conducted in SPSS v31 using PROCESS v5 (Model 1), with depressive symptoms as the focal predictor, parental mental illness as the moderator, and suicide attempts in the past 12 months as the outcome, adjusting for sex.

Results: In the analytic sample, 9% of students reported at least one suicide attempt in the past 12 months, 39.4% reported depressive symptoms, and 20.4% reported living with a parent or guardian with a severe mental illness. The moderation model was statistically significant (-2LL = 748.9, p <.001, Nagelkerke R² = .21), indicating that at least one predictor was associated with suicide attempt. Results revealed that depressive symptoms were associated with substantially higher odds of suicide attempts (b=2.23, p<.001, OR=9.29), and parental mental illness was associated with higher odds of suicide attempts (b=1.17, p<.001, OR=1.17. The interaction between depressive symptoms and parental mental illness was also significant (p = .041), indicating that the association between depressive symptoms and suicide attempts is moderated by parental mental illness. The association between depressive symptoms and suicide attempts was stronger among individuals without parent mental illness (OR=11.54, p<.001) than among those with parent mental illness (OR=4.04, p=.001).

Conclusions and Implications: Both depressive symptoms and parental mental illness were associated with higher odds of suicide attempts among Black high school students. Parental mental illness weakened rather than amplified the association between depressive symptoms and attempts suggesting that Black adolescents living with a parent or guardian with a serious mental illness may represent a subgroup with complex family dynamics and service barriers not captured by depressive symptoms alone. This study highlights the need for social work research and practice that focuses on Black youth and families living with mental illness, including family-focused, culturally responsive suicide prevention strategies and policies that expand access to supportive services for both caregivers and adolescents. Future studies should incorporate racialized school experiences and bullying to clarify how family adversity and school contexts intersect to influence suicidal behavior among Black youth and inform policies that promote equity and safety.