The impact of intersectional vulnerabilities on suicide risk, an interview with Dr. Shairi Turner, Chief Health Officer for Crisis Text Line.

“We are losing children of color at rates that are epidemic,” says Shairi Turner, M.D., M.P.H., an internist and pediatrician with a background in trauma. She is Chief Health Officer for Crisis Text Line, a national non-profit providing 24/7 crisis counseling via text in both English and Spanish.

The text conversations with the Crisis Text Line reflect the increasing risk of suicide among adolescents, a leading cause of death for youth 18 years old and under. This vulnerability is compounded if these individuals comprise different marginalized identities. Young people identifying with more than one minoritized group, are at increased risk for suicide, Turner noted.

Intersectionality refers to how individuals and groups are shaped and impacted by multiple social positions in terms of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical abilities.

“Some studies have found that youth with intersecting identities, for example, an LGBTQIA+ youth that is also a woman and also Hispanic, is more likely to report higher suicidality scores [more suicidal thinking],” said Dr. Turner. “It becomes this layering…because of the way you walk through this world, how people treat you is based on what they see, they see you are a person of color or disabled, and the experiences are vastly different than those of other groups. The fact that they have existed in this country in all their intersectionality can be traumatizing.” Inequities can also be amplified by stigma, mistrust of institutions, criminal justice involvement and a scarcity of mental health professionals of color or that speak additional languages.

Turner notes that, especially in communities of color, when trauma experiences contribute to depression, symptoms may manifest as anger, irritability, or distractibility. This may contribute to missed diagnosis or misdiagnosis. In addition, the COVID-19 pandemic complicated vulnerabilities. A national survey by the Centers for Disease Control and Prevention in 2021 found that during the pandemic, approximately one in three high school students experienced poor mental health with 44% experiencing “persistent feelings of sadness or hopelessness.” The prevalence of poor mental health was higher among gay, lesbian, or bisexual students compared to heterosexual students.

Support systems are essential to reducing suicide risk. Support at school and especially at home from family significantly reduce the risk for teens with intersecting marginalized identities. She advises parents and other caregivers to open the conversation with their children. Ask them how they are feeling, save important numbers in their cell phone (such as the Crisis Text Line, 741741, and the national 988 Suicide and Crisis Lifeline) and remove the risk posed by firearms accessibility in the home. The Crisis Text Line has developed toolkits with coping tools, available in English and Spanish, for use by students and families.

When people contact the Crisis Text Line, counselors work to de-escalate situations, addressing the texters’ unique stressors and concerns. They work to build rapport, trust, and connection and identify coping strategies and resources available. “Whatever the crisis is, an overwhelming event, violence, natural disaster or an eating disorder, for example, we reduce the risk.”

Resources

• Mental Health Resources for Diverse Communities from the American Foundation for Suicide Prevention
• Warning Signs of Mental Illness from APA
• Suicidio y autolesión (Suicide and Self-Harm) from APA on La Salud Mental

by Fatima Reynolds, M.P.H.
Division of Diversity and Health Equity,
American Psychiatric Association