Explaining the Race Gap in Adolescent Suicide: Impacts of Childhood Rape and Implications for Policy

Suicide is the third leading cause of death among youths in the U.S., with rates varying markedly by race. While few studies have examined the drivers behind this racial variation, a large body of research demonstrates associations between childhood sexual abuse and adolescent suicidal ideation. This paper considers the extent to which differentials in childhood sexual assault explain the race-gaps in high risk suicide attempts among teenagers.

Using data on 13 to 17 year olds from the 2001-2013 Youth Risk Behavior Surveillance System, we focus on high risk suicide attempts—suicide attempts resulting in an injury that required professional medical treatment— occurring in the 12 months before interview. Survey-weighted linear probability models estimate adjusted race effects by gender, controlling for age, state, and year fixed effects. To consider the contribution of childhood sexual assault, a second specification adds three different rape variables: ever “physically forced to have sexual intercourse when you did not want to” (i.e. forced sex), first sex occurring prior to age 12 (i.e., early statutory rape), and an interaction between the two to capture early childhood rape. Using early childhood measures establishes directionality, as such events predated the suicide attempt.

For boys, all but one of the non-white race variables has a statistically significant positive impact on high risk suicide attempts, with magnitudes ranging from 1 to 2 percentage points. Adding the rape-controls reduces the size of every race effect. Coefficients suggest that high risk suicide attempts rise 9 percentage points in response to forced sex, 4 percentage points with childhood statutory rape, and 16 percentage points from the interacted effect, experiencing forced sex prior to age 12. Simulations indicate that, for boys, eliminating early childhood rape (i.e., both statutory and physically forced) would lower the gap in high risk suicide attempts by 10 percent for Native Americans, 18 percent for Hispanics, and about 30 percent for both Black and multi-racial teens.

Among girls, the corresponding effects are also substantive, though somewhat smaller. High risk suicide attempts are 10 percentage points more likely in response to forced sex, 7 percentage points with childhood statutory rape, and 4 percentage points from forced sex prior to age 12. Simulations suggest that eliminating both forms of early childhood rape would lower the race gap in female adolescents’ high risk suicide attempts by 4 percent among Native Americans, 6 percent among Hispanics, and 9 percent for multi-racial teens.

These findings suggest that childhood rape is not only a substantive contributor to suicide attempts among teens, but also a key driver of race differentials in such attempts, particularly for boys. Youth suicide prevention should prioritize screening and support for victims of childhood sexual abuse and rape, as well as rape prevention efforts. Such interventions have the potential to improve targeting of suicide prevention efforts, narrow the race gap in teen suicide rates, and reduce these rates overall.