ACEs and Suicidal Behavior in African American Women: Assessment and Prevention

Principal Investigators:

Nadine Kaslow, PhD |  Emory School of Medicine

Dorian Lamis, PhD, ABPP |Emory School of Medicine

Co-Investigators:

Sarah Dunn, PhD, ABPP |Emory School of Medicine

Sheryl Heron, MD, MPH |Emory School of Medicine

Collaborators:

Grady Health System 

Research Gap:

African Americans are experiencing rising rates, and ACEs are associated with suicide risk in this population. Science has lagged behind this increase as little is known about factors that might influence the ACEs suicide relationship, and few interventions seek to prevent future suicide attempts among African Americans who have previously attempted suicide.

Description:

There is mounting empirical evidence that there is a strong link between particular forms of ACEs and later suicidal behavior, and this association appears to be especially significant in low-income populations, including low-income African Americans. Yet, very little is known about the link between the range of ACEs and later suicidal behavior in this at-risk population, and more importantly there is a dearth of information about the risk and resilience factors that may be modifiable in individuals exposed to child abuse and neglect and other ACEs, and that if targeted in a preventive intervention may result in better behavioral health outcomes, such as a reduced risk for suicidal behavior. Further, no preventive interventions have been designed to reduce the risk of suicidal behavior in individuals with a history of significant exposure to ACEs. Therefore, it is important to conduct randomized clinical trials (RCTs) that compare preventive interventions to determine which interventions are associated in low-income African Americans with the most significant reductions of suicidal behavior and the greatest increases in coping, connection, and community engagement. Ideally, the preventive interventions to be evaluated will be culturally relevant and capitalize on current interventions, such as the inclusion of suicide prevention mobile applications (apps). To improve upon these preventive interventions, it is important to ascertain the risk and resilience factors that mediate the link between intervention condition assignment and later suicidal behavior, coping, connection, and community engagement, as these factors can serve as critical targets for modified interventions in the future.  

Aims:

1. Compare individual-, relationship-, and community- level risk and resilience factors that differentiate African American women who attempt suicide who are low versus high on ACEs; ​
2. Evaluate the efficacy of treatment-as-usual plus an award-winning suicide prevention app (app) versus treatment-as-usual plus the suicide prevention app plus an innovative and culturally-informed empowerment group intervention (app + empower) that targets modifiable individual-, relationship-, and community- level factors in decreasing suicidal behavior (ideation, attempts; primary outcome) and increasing coping, connection, and community engagement (secondary outcomes) in recent suicide attempters high on ACEs; ​
3. Determine the individual-, relationship-, and community- level risk and resilience factors that mediate (i.e., explain the relation between) the intervention effects (app versus app + empower, both of which include treatment-as-usual) on the primary and secondary outcomes for African American women suicide attempters high on ACEs 

Why is this study important?

Currently, it is the only ICRC funded suicide prevention study designed for African Americans, and the study will provide data toward seeking additional funding (NIMH). Identifying the risk and protective factors, and a multilevel suicide prevention intervention for those African Americans who have previously attempted suicide could serve as a model for state and national efforts to reduce suicide.

This investigation systematically examines the link between two major violence-related public health concerns in low-income African Americans. It also offers an innovative preventive-intervention approach that has the potential to reduce risk factors and increase resilience factors associated with the individual, relationship, and community levels of ecological influence in this population.