SERVICE UTILIZATION AMONG ADOLESCENTS FROM RACIAL AND ETHNIC MINORITY GROUPS WITH ELEVATED SUICIDE RISK: EXPLORING THE ROLES OF TRAUMA EXPOSURE AND RELATED SYMPTOMOLOGY

Background: Suicide is the second leading cause of death among adolescents in the United States. Among adolescents from a racial and ethnic minority group, rates of suicide attempts increased over the past decade. Early detection of suicide risk is complicated by low rates of mental health service utilization among adolescents from racial and ethnic minority groups who present with self-harm types (i.e., suicidal ideation, attempts, non-suicidal self-injury). Characterization of and identification of factors associated to utilization have been under-investigated. Method: A descriptive, three-paper dissertation guided by Andersen’s behavioral model of health service utilization for vulnerable populations was completed. Paper one is a scoping review synthesizing empirical literature on service utilization characteristics and factors associated with utilization for adolescents from racial and ethnic minority groups with a self-harm type. Paper two is a cross-sectional, secondary analysis using the National Child Traumatic Stress Network’s (NCTSN) Core Data Set (CDS), examining the role of self-harm, race, ethnicity, and gender on service utilization characteristics among a trauma-exposed, treatment-seeking adolescent sample. Utilizing the subsample who reported self-harm types, paper three includes an investigation of trauma-related pathways to service utilization within racial and ethnic groups. Results: NH White adolescents utilized services with greater frequency compared to Black adolescents. Black adolescents who had histories of self-harm were not more likely to receive mental health services than other Black adolescents. Medical healthcare services were more likely to be accessed among all racial and ethnic groups presenting with self-harm. Factors associated to service utilization were significantly different across groups. Hispanic and NH White adolescents had psychiatric symptoms (e.g., externalizing, hyperarousal) associate with service utilization. For NH Black adolescents, symptoms were not associated with service utilization. However, trauma exposure was associated with service utilization across all groups.Conclusion: Trauma exposure assessment may facilitate access to services among adolescents at risk for suicide, particularly those from racial and ethnic minority groups. While the identification of individual-level factors such as trauma exposure are necessary for referral to services, future research should focus on identifying structural and culture-specific factors associated with service utilization.Doctor of Philosoph