Predictors of Suicide Ideation and Resilience Among Native- and Foreign-Born Adolescents in the United States

Background: Nearly one in five adolescents in the United States have considered suicide. Yet, gaps remain in understanding how the relationship between protective and risk factors influence resilience and suicide risk, especially among populations born outside the U.S. Methods: This study employs a secondary analysis of quantitative data from the Study of Adolescent Lives after Migration to America, pooling survey data from 357 students born in and outside the U.S. from Harrisonburg, Virginia, and Detroit, Michigan. A structural equation model was used to model dual outcomes of resilience and suicide ideation using predictors of hope, sense of school belonging, stressful life events, and being born outside the U.S. Models controlled for age, gender, and city. Outcomes: Suicide ideation and resilience were negatively correlated (s=-0.236[0.069]; P<0.001). Adolescents with greater hope (s=0.367; P<0.001) and school belonging (s=0.407; P<0.001) reported higher resilience, but lower levels of school belonging were associated with higher levels of suicide ideation (s=-0.248; P=0.009). More stressful life events predicted suicide ideation (s=0.243; P<0.001), while fewer stressful life events predicted resilience (s=-0.106; P=0.003). Being born outside the U.S. was associated with suicide ideation (s=0.186; P=0.015). Being born in the Middle East and North Africa (MENA) was predictive of suicide ideation (s=0.169; P=0.036). Interpretations: Findings suggest that adolescents born in the MENA region may represent a vulnerable group needing targeted interventions, which should prioritize culturally responsive programming to destigmatize mental health, boost existing sources of resilience, and encourage help-seeking behaviors. Funding Statement: Funding for this study was provided by Qatar Foundation International. Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: All Harrisonburg research protocols were approved by the Institutional Review Board (IRB) of the Columbia University Medical Center (Protocol #AAAR7830) and the Harrisonburg school district. Study protocols in the DMA were approved by the IRB at Washington University in St. Louis (IRB ID# 201905151), the charter school system, and principals at each of the three schools.