Project Summary
Suicide is a significant public health problem among youth. Data indicate suicidal behaviors were increasing
among youth even before the COVID-19 pandemic began and have likely increased even more since its onset.
This R16 proposed research seeks to address the urgent mental health crisis and respond to the recent
advisories from the US Surgeon General that highlight the need for a better understanding of the impact of the
pandemic on youth. We will meet this objective by pursuing the following specific aims: (1) Identifying the
trajectory of suicide risk among youth across the pandemic period and testing if there have been differential
changes based on demographics; (2) Determining how social determinants of health are related to suicide risk
among youth; and (3) Characterizing the moderating and mediating roles of social determinants of health in the
association between COVID-19 burden and suicide risk among youth. This research is innovative in several
ways. First, it will apply a Social Determinants of Health framework and thus will widen the investigation of
suicidal behavior risk factors beyond individual-level factors to include relevant social, economic, education,
physical infrastructure, and healthcare risk factors, which have often been overlooked in COVID-19 mental
health research with youth. Second, it will use real-time crisis response data to determine how suicide risk has
changed over the course of the pandemic, an important asset given the reporting time lag involved with other
data sources. Third, it will link data from large national databases (SDOH, Crisis Text Line, USAFacts) that
each provides important and unique strengths (e.g., national, real-time, explores sexual orientation and race
identity) to assess the direct, indirect, and interactive effects of social determinants of health and COVID-19
burden on suicidal behavior among youth. Our research team is particularly poised to undertake this
investigation. The PI has extensive experience in suicide research, secondary data analysis, and mentoring
students, and the Co-Investigators have experience using several of the proposed data sources and similar
data analytic approaches as proposed. Further, Appalachian State University is an ideal institution to receive
this award because Pell grants support 28% of its undergraduate students, it awards degrees in biomedical
sciences, and has received only one NIH grant in the past two years.
