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Journal of Affective Disorders 289 (2021) 74–80

Contents lists available at ScienceDirect

Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

Research paper

Anxiety sensitivity and suicide risk: Mindfulness as a psychological buffer

for Black adults
*
Jasmin R. Brooks, Antoine Lebeaut, Maya Zegel, Rheeda L. Walker, Anka A. Vujanovic
Department of Psychology, University of Houston, Houston, TX

ARTICLE INFO ABSTRACT

Keywords: Background: Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased
Anxiety Sensitivity risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White
Mindfulness
men and women and with limited attention to clinically relevant underlying factors.
Suicide
Methods: The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and
Black Americans
elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; Mage = 22.4, SD = 5.6).
Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation,
and elevated suicide risk.
Results: After controlling for age and gender, results indicated that AS was directly and indirectly associated with
suicide ideation and elevated suicide risk via lower levels of mindfulness.
Limitations: Limitations include using a cross-sectional methodological design and exclusive reliance on self-report
measures.
Conclusions: These findings provide preliminary insight into novel risk and protective factors that influence suicide
ideation and elevated suicide risk among Black Americans.

Among Black young adults 15-24 years of age, suicide is the third leading
cause of death and a major public health concern (Centers for Disease Control
and Prevention Web Based Injury Statistics Query and Reporting System [CDC
WISQARS], 2018). Black Americans are exposed to an inordinate amount of
painful and provocative life events via racial discrimination, persistent poverty,
social isolation, and decreased access to community resources (Gibbs, 1997).
Black college students, as compared to their White counterparts, have been
shown to attempt suicide more often (Wang, Lightsey, Tran, & Bonaparte, 2013)
but disclose suicide ideation less readily (Morrison & Downey, 2000). In a sample
of university students, Brooks, Hong, Cheref, and Walker (2020) found that
perceived discrimination was associated with suicide capa-bility for Black but not
White adults. To date, however, investigations of suicide vulnerability for Black
Americans remain limited, and thus an investigation of novel risk and protective
factors is warranted.
An emerging body of literature has demonstrated that anxiety sensitivity (AS),
non-Hispanic White samples (Allan, Norr, Boffa, Durmaz, Raines, & Schmidt,
2015; Oglesby, Capron, Medley, Raines, & Schmidt, 2015; Capron, Norr,
Zvolensky, & Schmidt, 2012; Capron, Fitch, Medley, Blagg, Mallott, & Joiner,
2012). AS is conceptualized as a general, “global”, factor that comprises three
lower-order dimensions: cognitive (i.e., fear of mentally losing control), physical
(i.e., fear of physical symptoms associated with anxiety) and social (i.e., fear of
experiencing publicly observable symptoms) (Taylor et al., 2007; Stanley et al.,
2018). Stanley et al.’s (2018) review of 33 study samples revealed that AS has a
significant negative effect on suicide and related behavior. In analyses of lower-
order dimensions of AS, AS cognitive concerns demonstrated the most robust
association with suicide ideation and suicide attempt history (Allan et al., 2015;
Capron, Cougle, Ribeiro, et al., 2012; Oglesby et al., 2015). Importantly, recent
examinations of racial and ethnic group differences in the prevalence of AS
suggest that Black adults report higher levels of AS compared to non-Hispanic
White adults (Alcantara, Cosenzo, Fan, Doyle, & Shaffer, 2017). However, only
a few studies have investigated the potential effects of AS on psycho-logical
´

defined as the fear of anxiety-related sensations (McNally, 2002), is a robust risk
factor for suicide ideation and elevated suicide risk. AS has been linked to
negative mental health outcomes for Black adults (Reitzel, Childress, Obasi, et
al., 2017), and specifically to increased suicide ideation and elevated suicide risk
for primarily
difficulty for Black Americans, documenting relations of heightened AS and lower
social status with anxiety symptomatology (Reitzel et al., 2017) as well as
positive concurrent associations between

* Corresponding author.

https://doi.org/10.1016/j.jad.2021.04.012
Received 22 September 2020; Received in revised form 18 March 2021; Accepted 12 April 2021
Available online 17 April 2021
0165-0327/© 2021 Elsevier B.V. All rights reserved.
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JR Brooks et al.
high AS and panic symptoms among Black youth (Ginsburg & Drake, 2002).
Given the robust association between AS and negative mental health
outcomes in Black Americans, expanded AS investigations may shed light on
whether AS contributes to suicide vulnerability in this population.
Mindfulness, a potential protective factor in the AS-suicide risk as-
sociation, is generally defined as purposeful awareness of and focus to the
present moment, and the non-judgmental acceptance of interocep-tive
sensations, cognitions, and/or adverse emotional circumstances (Baer et al.,
2006). Mindfulness has demonstrated congruence to spiri-tuality/religiosity,
a robust coping mechanism among people of African descent (Taylor,
Chatters, & Joe, 2011; Taylor, Chatters, & Jackson, 2007; Woods-Giscombe
& Gaylord, 2014; Walker, Salami, Carter, & Flowers, 2014). Specifically,
Woods-Giscombe and Gaylord (2014) found that the core tenets of
mindfulness are similar to messages pro-moted in Christian hymns and text.
Mindfulness-based interventions are increasingly demonstrating utility for
symptom reduction across a broad spectrum of psychopathology (Williams,
Crane, Barnhofer, et al., 2008; Rodrigues, Nardi, & Levitan, 2017; King,
Erickson, Giardino, et al., 2013). Heightened mindfulness is associated with
lower anxiety symp-toms and emotional distress and reactivity (Arch &
Craske, 2006; Bishop et al., 2017; Vujanovic, Zvolensky, Bernstein, Feldner,
& McLe-ish, 2007). Among Black Americans, heightened mindfulness has
repeatedly been associated with positive health outcomes, including increased
psychological well-being (Masuda, Anderson, & Seehan, 2009), decreased
suicide ideation and depressive symptomatology (Watson-Singleton, Walker,
LoParo, Mack, & Kaslow, 2018; Chesin & Jeglic, 2016; LoParo, Mack,
Patterson, Negi, & Kaslow, 2018), lower levels of substance use (Bowen et
al., 2006), and lower levels of psy-chological distress (Coffey & Hartman,
2008; Masuda & Tully, 2012).
Mindfulness has also been shown to buffer the impact of racism on anxiety
symptomatology (Graham, West, & Roemer, 2013) and mod-erate the effect
of discriminatory experiences on behavioral health outcomes for Black
Americans (Zapolski, Faidley, & Beutlich, 2018). A growing body of literature
suggests that increased AS is related to a more limited use of mindfulness-
based strategies (Mahoney, Segal, & Cool-idge, 2015; Zvolensky et al.,
2015; Gonzalez, Zvolensky, Grover, & Parent, 2012; Schoorl, Mil-Klinkenberg,
& Van Der Does, 2015; McKee, Zvolensky, Solomon, Bernstein, & Leen-
Feldner, 2007). As McKee et al. (2007) elucidates, if an individual is
hypersensitive to bodily sensations, such as heart palpitations or racing
thoughts, they may be less able to place non-judgmental attention and
awareness to the present moment or observe cognitions, emotions, and
sensations. In sum, given the positive effect of mindfulness on psychological
well-being for Black Americans, as well as the established relation between
AS and suicide risk among other racial and ethnic groups, it is imperative to
examine whether mindfulness can serve as a mediator between AS and
suicide risk for Black Americans.
To address this gap in the literature, the purpose of the current study was
to examine the association between AS, mindfulness, suicide idea-tion, and
elevated suicide risk, among Black adults. To the best of our knowledge, the
current study is the first to examine the indirect effect of AS on suicide ideation
and elevated suicide risk via mindfulness among Black adults. The explicit
hypotheses were that among Black adults: (1) higher levels of AS (global AS)
would be associated with higher levels of both suicide ideation and elevated
suicide risk, (2) higher self-reported mindfulness would be inversely associated
with suicide ideation and elevated suicide risk, and (3) AS (global AS) would
be indirectly asso-ciated with both suicide ideation and elevated suicide risk
through mindfulness. Given differences in observed correlates and effects
across the three lower-level dimensions of AS, subsequent analyses stratified
by AS subfactors (i.e., physical, cognitive, and social concerns) were
conducted.
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Journal of Affective Disorders 289 (2021) 74–80
1. Method
1.1. Participants
The data employed in the current study are based upon a subsample
from a larger study of stress and health behaviors among college stu-dents.
To test the present study hypotheses, only data for participants who completed
all measures of interest and identified as Black and non-Hispanic/Latinx were
included in the present study. Among this sub-sample of students (N = 461),
154 were removed due to invalid responding, for a final sample size of 307.
Responses were considered invalid if participants endorsed the wrong
response option for three validation questions (e.g., “When I am paying
attention, I select very much”) included in the primary measures of interest.
Participants included 307 Black college students (79.2% female; Mage =
22.4, SD =
5.6) recruited from a large public university in the southern United States.
Students who were 18 years of age or older and proficient in English were
considered eligible. All participants identified as non-Hispanic/Latinx. The
sample consisted of freshmen (11.4%), sopho-more (24.8%), junior (30.9%),
senior (30.9%), and post-baccalaureate (2.0%) students. Regarding marital
status, most of the sample (93.5%) indicated that they had never been
married, 4.6% indicated that they were married, and 2.0% reported that they
were divorced.
1.2. Measures
Demographics questionnaire. Participants provided demographic in-
formation, including age, gender, race, ethnicity, and academic classi-
fication. Age and gender were included as covariates.
Anxiety Sensitivity Index – 3 (ASI-3; Taylor et al., 2007). The ASI-3 is an
18-item self-report measure of fear of anxiety-related sensations. The ASI-3
is comprised of three subscales: physical concerns (e.g., “It scares me when
my heart beats rapidly”), cognitive concerns (e.g., “When my thoughts seems
to speed up, I worry that I might be going crazy”), and social concerns (e.g.,
“It is important for me not to appear nervous”).
Higher scores indicate greater AS. The ASI-3 has demonstrated strong
psychometric properties (Jardin et al., 2018; Taylor et al., 2007) and has been
examined among nonclinical samples (Osman et al., 2010). For the present
study, the ASI-3 total score showed excellent internal consis-tency (ÿ = .93)
and was used as a predictor. The cognitive concerns subscale demonstrated
excellent internal consistency (ÿ = .90), and good internal consistencies were
observed for the physical concerns and social concerns subscales (ÿ = .80,
respectively). For post hoc analyses in which ASI-3 subscales were examined
as predictors, the remaining two subscales were included as covariates.
Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins,
Krietemeyer, & Toney, 2006). The FFMQ is a 39-item self-report mea-sure
that assesses five facets of mindfulness, including observing, describing,
acting with awareness, non-judging of experience, and non-reactivity to inner
experience. The average of the items is calculated and higher mean scores
indicate greater self-reported mindfulness. The FFMQ demonstrates good
psychometric properties (Baer et al., 2008; Christopher, Neuser, Michael, &
Baitmangalkar, 2012). In the present sample, the internal consistency of the
FFMQ was good (ÿ = 0.86). The FFMQ total score was examined as a
statistical mediator.
Beck Scale for Suicide Ideation – 5 (BSS-5; Beck & Steer, 1991). The
BSS-5 is a 5-item self-report measure designed to help identify in-dividuals
at risk for suicide by assessing the intensity of past-week sui-cide ideation.
Higher total scores indicate more severe suicide ideation.
The BSS has demonstrated strong psychometric properties among adult
populations (Batterham et al., 2015), as well as university students (Chioqueta
& Stiles, 2006). In the current sample, the internal consis-tency of the BSS-5
was acceptable (ÿ = 0.75). The BSS-5 was used to measures suicide ideation
severity, a criterion variable.
Suicide Behaviors Questionnaire – Revised (SBQ-R; Osman et al., 2001).
The SBQ-R is a 4-item self-report measure of elevated suicide risk
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JR Brooks et al. Journal of Affective Disorders 289 (2021) 74–80

(Batterham et al., 2015). Each item assesses a different component of Table 1

suicide, including lifetime suicide ideation and/or suicide attempts; frequency Participant characteristics (N = 307)
of suicide ideation over the past twelve months; threat of suicide attempt; Variable Mean (SD) / n (%)
and self-reported likelihood of suicide-related behavior in the future. Higher
be
total scores indicating greater suicide risk. The total SBQ-R demonstrates Female 243 (79.2%)
good psychometric properties among adult clinical populations (Batterham Male 62 (20.2%)
et al., 2015; Osman et al., 2001). The internal consistency for the SBQ-R in Transgender 2 (0.7%)
the present study was acceptable (ÿ = Race/Ethnicitya
Black/African American 307 (100%)
0.77). The SBQ-R total score was used as a measure of suicide risk, a
Not Hispanic/Latino 307 (100%)
criterion variable.
Birthplacea
Within the United States 202 (65.8%)
1.3. Procedure Outside the United States 35 (0.7%)
In a United States territory 2 (11.4%)
Agea 22.38 (5.57)
The data employed in the current study are based upon a subsample
Academic yeara
from a larger study of stress and health behaviors among college stu-dents. Freshman 35 (11.4%)
Students who consented to participate were directed to an online battery of Sophomore 76 (24.8%)
Junior 95 (30.9%)
self-report measures which was estimated to take 1.5-2 hours to complete.
Senior 95 (30.9%)
Students who completed the survey received university-based credit that Post-baccalaureate 6 (2.0%)
could be allocated to fulfill course requirements or to receive course extra Grade Point Averagea 3.12 (2.71)
credit. To test the present study hypotheses, only data for participants who Marital status
completed all measures of interest and iden-tified as Black and non- Married 14 (4.6%)
Divorced 6 (2.0%)
Hispanic/Latinx were included in the present study. Among this subsample
Never married 287 (93.5%)
of students (N = 461), 154 were removed due to invalid responding, for a
Employmenta
final sample size of 307. Responses were considered invalid if participants Unemployed 110 (35.8%)
endorsed the wrong response option for three validation questions (e.g., Employed part-time 136 (44.3%)
“When I am paying attention, I select very much”) included in the primary Employed full-time 57 (18.6%)
Retired 1 (0.3%)
measures of interest. The study protocol was approved by the relevant
Disability 3 (1.0%)
Institutional Review Board. At-risk for suicideb 60 (19.5%)

1.4. Analytic Strategy
Analyses were conducted using IBM SPSS version 26.0. First, the data
were examined for normality and missingness. Little’s missing completely
at random (MCAR) test was non-significant (ÿ2 (5) = 7.83, p = .166),
suggesting it was reasonable to treat the data as missing completely at
random. Therefore, list-wise deletion was employed for missing data.
Second, descriptive statistics and zero-order correlations among study
variables were examined. Third, indirect effect analyses were conducted
using 10,000 bootstrap sampling, using the PROCESS Macro for SPSS
(Hayes, 2017). A bootstrapped confidence interval (CI) that does not include
zero provides evidence of a significant indirect effect (Preacher & Hayes,
2008). Specifically, mediation analyses were conducted to detect the indirect
effect of AS on suicide ideation and elevated suicide risk via mindfulness.
Covariates included age and gender. A Bonferroni correction (alpha = .05/2
= .025) was applied to control for Type I error rate. Lastly, post hoc
exploratory analyses were conducted to examine the indirect effects of each
AS subscale (i.e., physical, cognitive, and social concerns) on suicide
ideation and elevated suicide risk through mindfulness. Exploratory indirect
effect analyses were conducted utilizing the same data analytic procedures
described above. Covariates for the exploratory analyses included age and
gender, as well as the remaining two AS subscales that were not used as
the predictor in each particular model.
2. Results
2.1. Descriptive Statistics
No missing values were identified across all study variables. Exam-
ination of collinearity diagnostics did not reveal evidence of excess
multicollinearity (variance inflation index [VIF] < 1.2) as VIF values did not
exceed 10.0 (Mason & Perreault, 1991). Distributions for study variables
approximated normality (skewness < |2.25|; George & Mal-lery, 2003). A
summary of sample characteristics is presented in Table 1 and zero-order
correlations for all study-related variables are presented in Table 2.
Participants reported an average ASI-3 total score of 19.87
Note.
a
Demographics questionnaire;
b
Suicide Behaviors Questionnaire – Revised (Osman et al., 2001).
(SD=14.80), indicating clinically significant levels of AS (i.e., moderate to
high) according to current clinical cutoff scores of AS among under-graduate
populations (Allan et al., 2015; Bernstein et al., 2010). The average FFMQ
total score in this sample was 3.27 (SD=0.44), which coincides with previous
work among undergraduate populations (e.g., Bravo, Pearson, & Kelley,
2018; Freligh & Debb, 2019).
2.2. Indirect Effect Analyses: Global AS
A summary of indirect effect analyses is presented in Table 3 and
illustrated in Fig. 1. Controlling for all covariates (i.e., age and gender),
global AS was inversely associated with mindfulness such that higher AS
was associated with lower mindfulness. Mindfulness was inversely
associated with suicide ideation and elevated suicide risk such that re-
spondents reported less suicide risk given higher levels of mindfulness.
Regarding the association between global AS and suicide ideation, the total
effect was statistically significant though the direct effect was not statistically
significant. The indirect effect was statistically significant, indicating that
mindfulness completely mediated the association be-tween global AS and
suicide ideation. Regarding the association be-tween global AS and
elevated suicide risk, neither the total effect nor the direct effect were
statistically significant. However, the indirect effect was statistically
significant, indicating that mindfulness partially mediated the association
between global AS and elevated suicide risk in the current sample of
participants.
2.3. Post Hoc Exploratory Analyses: AS Subscales
Post hoc analyses were conducted to examine the indirect effects of
each AS subscale (i.e., physical, cognitive, and social concerns) on sui-
cide ideation and elevated suicide risk through mindfulness. In addition to
covarying for gender and age, each AS subscale that was not used as a
predictor was included in the indirect effect model in order to ensure

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Table 2
Descriptive Statistics and Bivariate Correlations Between Study Variables
1 2 3 4 5 6 7 8 9

1. Gendera -

2. Agea -.12* -

3. Global ASb 4. -.04 -.09 -

AS physical concernsb 5. AS -.01 -.04 .90** -

cognitive concernsb 6. AS social -.05 -.10 .92** .78** -

concernsb 7. Mindfulnessc -.04 -.09 .86** .64** .69** -

8. Suicide ideationd -.05 .21** -.41** -.33** -.43** -.34** -

9. Elevated suicide riske .08 .02 .16** .11* .19** .12* -.29** -

.13* -.01 .11 .05 .15** .08 -.23** .57** -

Mean -
22.38 19.87 5.99 5.48 8.4 3.27 .57 4.92
Standard Deviation -
5.57 14.8 5.61 5.49 5.44 0.44 1.24 2.64

Range 0-3 18-60 0-72 0-24 0-24 0-24 1-5 0-6 3-15

Note. *p <.05, **p <.01.

a
Demographics questionnaire (0=male; 1=female);
b
Anxiety Sensitivity Index-3 total score or total subscale score (ASI-3; Taylor et al., 2007); Five
c
Facet Mindfulness Questionnaire average score (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006); Beck
d
Scale for Suicidal Ideation total score of first five items (Beck & Steer, 1991); Suicide
Behaviors Questionnaire – Revised (Osman et al., 2001); Global AS = ASI-3 total score; AS Physical Concerns = ASI-3 physical concerns subscale total score;
It is

AS Cognitive Concerns = ASI-3 cognitive concerns subscale total score; AS Social Concerns = ASI-3 social concerns subscale total score.

Table 3 mediates the association between AS cognitive concerns and suicide

Standardized Regression Coefficients: Indirect Effect Models
ideation, above and beyond covariates and the effects of other AS
sub-scales. Regarding the association between AS cognitive concerns
and model Model b p Bootstrapped
R2
and elevated suicide risk, the total (ÿ=.15; p<.01), direct (ÿ=.114;
95% CI
p<.05), and indirect effects (ÿ=.075; CI[.025, .139]) were statistically
Global AS ÿ Mindfulness (a) .20** -.012 <.001 -.015 -.009
1
signifi-cant, indicating that mindfulness partially mediates the
Mindfulness ÿ Suicide .10** -.807 <.001 -1.14 -.469
association be-tween AS cognitive concerns and elevated suicide risk,
ideation (b) above and beyond covariates and the effects of other AS subscales.
Global AS ÿ Suicide .04* .014 .004 .005 .023 Neither AS physical nor social concerns were significantly
ideation (c) associated with mindfulness (ÿ=.001, p=.842; ÿ=-.006; p=.303,
Global AS ÿ Suicide .004 .384 -.006 .014
respectively). The indirect effect models for mindfulness were not
ideation (c’)
Global AS ÿ Mindfulness ÿ .114 .070 .162 statistically significant with regard to AS physical on suicide ideation
Suicide ideation (a*b) (ÿ=-.005; CI[-.049, .038]) and elevated suicide risk (ÿ=-.003; CI[-.038,
2 Global AS ÿ Mindfulness (a) .20** -.012 <.001 -.015 -.009 .028]) and AS social con-cerns on suicide ideation (ÿ=.02; CI[-.015,
.060]) and elevated suicide risk (ÿ=.015; CI[-.013, .046]).
Mindfulness ÿ Elevated .07** -1.32 <.001 -2.05 -.588
suicide risk (b)
Global AS ÿ Elevated .03* .020 .051 -.0001 .040
3. Discussion
suicide risk (c)
Global AS ÿ Elevated .004 .698 -.017 .026 The current study sought to investigate, among a sample of Black
suicide risk (c’)
adults, the direct effects of AS and mindfulness on suicide ideation and
Global AS ÿ Mindfulness ÿ .088 .039 .142
Elevated suicide risk (a*b)
elevated suicide risk. In addition, this study examined the indirect ef-
fects of AS on suicide ideation and elevated suicide risk through mind-
Note. *p <.05, **p <.01. The standard error and 95% CI for a*b is obtained via
fulness. As hypothesized, and consistent with well-established literature
bootstrapping with 10,000 resamples. Global AS = Anxiety Sensitivity Index-3 total
among non-Hispanic, White adults (e.g., Allan et al., 2015; Boffa et al.,
score (ASI-3; Taylor et al., 2007); Mindfulness = Five Facet Mindfulness
Questionnaire average score (Baer et al., 2006); Suicide ideation = Beck Scale for
2018; Capron, Blumenthal, et al., 2012; Capron, Cougle, Ribeiro, et
Suicidal Ideation total score of first five items (Beck & Steer, 1991); Elevated al., 2012; Hames, Ribeiro, Smith, & Joiner, 2012; McLaughlin, McLeish,
suicide risk = Suicidal Behaviors Questionnaire – Revised (Osman et al., 2001); & O’Bryan, 2016), global AS (i.e., the total score for the ASI-3) was
CI (lower) is the lower bound of a 95% CI; CI (upper) is the upper bound of a 95% posi-tively associated with suicide ideation and elevated suicide risk.
CI. Path a indicates effect of X on M; b, effect of M on Y; c, effect of X on Y; c’, These findings suggest that increased AS may be associated with
direct effect of X on Y, controlling for M. All total, direct, and indirect paths are elevated suicide vulnerability among Black adults. Also, consistent
noted after controlling for the variance accounted for by theoretically relevant with hy-potheses, mindfulness was inversely associated with suicide
covariates, including gender and age. ideation and elevated suicide risk in the current sample. This finding is
consistent with extant literature that suggests mindfulness may be a
that any unique effect of one of the AS subscales (e.g., AS physical buffer for suicide risk among Black Americans (Chesin & Jeglic, 2016;
concerns) was separable and independent from the variance accounted Watson--Singleton, Black, & Spivey, 2019).
for by the other AS subscales (e.g., AS cognitive and social concerns). Our second hypothesis was also supported, as the association be-
Results indicated that AS cognitive concerns was negatively associated tween AS and suicide ideation was accounted for by low mindfulness,
with mindfulness (ÿ=-.03; p<.001) and mindfulness was negatively or a decreased ability to place non-judgmental attention and awareness
associated with suicide ideation (ÿ=-.77; p<.001) and elevated suicide to the present moment. Furthermore, analyses revealed that the
risk (ÿ=-1.18; p<.01). Regarding the association between AS cognitive associa-tion between AS and elevated suicide risk was partially
concerns and suicide ideation, the total effect (ÿ=.061; p<.01) was accounted for by low mindfulness. Future studies might examine the
statistically significant while the direct effect was not statistically sig- effects of mindful-ness on other known predictors of suicide and
nificant (ÿ=.038; p=.093). The indirect effect was statistically signifi- elevated suicide risk, including capability for suicide (Van Orden et al.,
cant (ÿ=.103; CI[.052, .163]), indicating that mindfulness completely 2008), impulsivity (Bender et al., 2011), or substance use (Borges, Walters, & Kes

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JR Brooks et al.
Fig. 1. Theoretical model, whereby global AS is associated with Suicide ideation and Elevated suicide risk indirectly via mindfulness. Covariates included gender direct effect of X on Y controlling for
(C1) and age (C2). Note: a, direct effect of X on M; b, direct effect of M on Y; c, total effect of X on Y; cÿ
of M.
2000).
Additionally, we sought to demonstrate the indirect effects of each AS
subscale (i.e., physical, cognitive, and social concerns) on suicide ideation and
elevated suicide risk through mindfulness. Post hoc exploratory analyses
revealed that mindfulness completely mediated the association between AS
cognitive concerns and suicide ideation, and partially mediated the association
between AS cognitive concerns and elevated suicide risk, above and beyond
the effects of other AS subscales (i.e., physical and social concerns). AS
cognitive concerns reflect the tendency to believe that cognitive difficulties,
such as difficulty concentrating or racing thoughts, are indicative of severe
cognitive dysfunction (Taylor et al., 2007). As the association between AS and
suicide vulnerability is primarily theorized to be driven by AS cognitive concerns
(Capron et al., 2012; Capron et al., 2014; Oglesby et al., 2015; Stanley et al.,
2018), these findings further denote the significant role of mindfulness in
psychological well-being for Black Americans.
To our knowledge, this is the first study to examine the indirect effect of AS
on suicide ideation and elevated suicide risk through mindfulness within a
predominantly Black adult sample. Black adults with height-ened AS may be
more likely to report lower mindfulness, which in turn, is associated with greater
suicide risk. Thus, AS may drive lower mindfulness levels (and vice versa); and
both heightened AS and lower mindfulness are associated with suicide risk.
Importantly, this also suggests that despite the aversive psychological
consequences of AS, heightened mindfulness can be adaptive for Black adults.
These findings are consistent with available theories which postulate that for
Black adults, mindfulness, or the ability to place non-judgmental attention and
awareness to the present moment, may be a protective factor that buffers
against negative mental health outcomes (Adams et al., 2014; Masuda et al.,
2009; LoParo et al., 2018; Woods-Giscomb´e, & Gaylord, 2014).
Importantly, the adaptive role of mindfulness may be attributable to its
congruence to religiosity, a robust cultural protective factor for Black Americans
(e.g., Spears et al., 2017; Walker & Bishop, 2005). Future studies should aim
to further explicate the similarities and differences of mindfulness and religiosity,
particularly within the context of suicide risk and resilience.
The present study provides important insights regarding the adverse effects
of AS on suicide vulnerability among Black adults. Study limi-tations, however,
should be noted. One limitation of the study is the cross-sectional methodological
design, which hinders our capacity to infer causality about the role of AS in
activating suicide ideation and elevated suicide risk, or the role of mindfulness
in mitigating this asso-ciation. Future prospective studies might employ
longitudinal and experimental designs to more reliably predict AS as a direct
and/or in-direct antecedent of suicide vulnerability. Relatedly, studies comparing
Black adults at high and low suicide risk are necessary to disentangle the roles
of various sociodemographic factors, racial discrimination, and racial trauma
on related factors that may account for levels of cognitive-
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Journal of Affective Disorders 289 (2021) 74–80
, M; a*b, indirect effect
behavioral risk factors, such as AS or mindfulness. Second, results were
obtained from a moderately-sized, urban, southwestern U.S. university setting;
therefore, generalizability of these findings to non-students may be limited.
Future research might next examine mindfulness as a psy-chological buffer of
the adverse effects of AS on suicide vulnerability in first-generation immigrants
as well as international populations. Third, this study relied on self-report
measures of suicide ideation and behavior and as such, participants may have
underreported the severity of their suicidal thoughts or behaviors due, in part,
to suicide stigma (De Leo, 2015). Future studies might examine additional
mediating and/or moderating factors that influence the association between AS
and sui-cide vulnerability, including depression, other forms of mental illness,
substance use, and psychiatric medication use and compliance. Addi-tionally,
future research might incorporate clinical trials of mindfulness-based
interventions for suicide risk reduction. Indeed, mindfulness may have potential
clinical utility as a tool for reducing anxious arousal and distress among Black
Americans. Extant literature supports this assumption, as mindfulness
meditation has been shown to be a viable option for stress management among
Black Americans (Khoury et al., 2013). Furthermore, mindfulness-based
cognitive ther-apy (MBCT), which encompasses core tenets of mindfulness
including moment-to-moment awareness and non-judgmental acceptance of
the present state, has been shown to assist in prevention of the recurrence of
suicide-related behavior among primarily non-Hispanic, White samples
(Williams, Duggan, Crane, & Fennell, 2006; Chesin, Sonmez, Benjamin-Phillips,
Beeler, Brodsky, & Stanley, 2015). To advance this line of inquiry, researchers
are encouraged to consider the effects of mindfulness-based interventions on
suicidal ideation and/or behavior for Black Americans who manifest relevant
risk factors, such as heightened AS.
Overall, this study provides preliminary evidence that, for Black adults, AS
is associated with suicide vulnerability, and mindfulness may account for this
effect. The prevailing body of research remains limited in understanding suicide
risk and protective factors particularly among vulnerable racial and ethnic
minority populations. The current study’s contributions are important in the
context of providing preliminary evidence for the role of AS and culturally-driven
buffers in suicide ideation and elevated suicide risk for an underserved group.
4. Author Statement
Contributors:
Anka A. Vujanovic, Antoine Lebeaut, and Maya Zegel conducted the study.
Jasmin R. Brooks, Antoine Lebeaut, and Maya Zegel analyzed the data and
wrote the manuscript with support from Rheeda L. Walker and Anka A.
Vujanovic. All authors reviewed the manuscript.
Machine Translated by Google

JR Brooks et al. Journal of Affective Disorders 289 (2021) 74–80

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