The Crisis Being Kept On The Low
What Suicide Awareness Month Needs to Say to Black Women
September is Suicide Awareness Month.
And there is a number that every Black woman, and everyone who loves a Black woman, needs to know.
169%.
That is how much firearm suicide rates among Black women rose from 2015 to 2024, according to the Johns Hopkins Center for Gun Violence Solutions, using Centers for Disease Control (CDC) mortality data released in 2026.
During that same period, and to put this number in perspective;
- The rate for Hispanic/Latina women rose by 57%
- The rate for Asian or Pacific Islander women rose by 51%
- The rate for Native American or Alaska Native women rose by 19%
The rate for white women rose by 4%!
These aren’t simply statistics! This is a crisis happening inside the minds of go-getters, high achievers, leaders, executives, entrepreneurs, educators, physicians, wives, moms, etc. These are the women who show up every single day, all while the world continues to hype up grit, stoicism, being ‘strong’, not asking for help, getting things done, logic over emotions, etc.
We have been so busy calling Black women strong, which is true, but we forgot to ask if they were okay, and the same Black women likely also forgot to stop and ask themselves if they were okay, too!
Why Is This Happening?
There is no single answer. What I see in my practice is a collision of forces that isn’t new, and has been going on for way too long.
Persistent ongoing (di)stress has a direct objective impact on your mind, brain, and body.
Racial (di)stress is not just emotional. It activates and then keeps your body’s internal survival system turned on, weakens vagal nerve tone, raises or depletes cortisol, drives inflammation, depletes the brain chemicals that protect your mood and emotional resilience, etc. Researcher Dr. Arline Geronimus described this as “weathering,” the biological aging that occurs when the body remains under persistent racial (di)stress for years…and generations. This is not a feeling or hyperbole.
It is showing up in bloodwork and as chronic illness, disease, and premature death!
The care has been incomplete.
Most Black women seeking mental health care are offered a diagnosis (and too often a misdiagnosis) and a prescription. What they are not offered is consideration and a thorough investigation. Biological drivers, like low vitamin D, inflammation, hormonal shifts, and nutrient depletion, can go untested. That is uninvestigated. Check out my 🧪12 Critical Labs for Black Women’s Mental & Physical Health.
The culture and the times have no room for “I’m not okay.”
Dr. Cheryl Woods-Giscombé at the University of North Carolina developed the Superwoman Schema framework, a documented pattern in which Black women internalize the expectation to be strong, suppress vulnerability, and never ask for help. (Qualitative Health Research, 2010).
When there is no permission (or time) to not be okay, when it has become one’s identity, or when generations and your very life, aka survival, depend on it…mental and/or physical pain does not disappear. It goes under the radar. But the truth always comes to light, and in this case, it is a matter of life and death!
What the Warning Signs May Actually Look Like
Suicidal crisis in these Black women rarely looks the way people expect.
Here are a few things to watch for:
- Waking up and not being able to go back to sleep…a signal that the brain’s regulatory systems are under serious strain and attack.
- Emotional flatness…not sadness, but numbness or nothing (behind the eyes). Phrases like “I just don’t care anymore” or “I feel like I’m watching my life from the outside,” “it is what it is,” “oh well,” “I’m here (but said flippantly),” “I don’t want to be here,” “Dang, I woke up again,” etc…
- Low-key pulling away; going ghost, not going to church, skipping plans, not returning calls she would normally return immediately, isolating, not doing things that she once loved or was heavily involved in, etc…
- A sudden calm (or burst of energy) after a period of visible struggle; in psychiatry, an unexplained peace after distress or depressed mood can mean, amongst other things, that a decision has been made…
- Unexplained physical symptoms: persistent fatigue and exhaustion, headaches, migraines, change in appetite, increased heart rate, frequent illness, etc. When the nervous system is in crisis, the body speaks even when the mouth stays silent
- History of childhood trauma: increasing the risk of chronic disease, mood disorders, insomnia, disordered eating, obesity, substance abuse and/or addiction, suicidal ideation and attempts, etc.
- Take this free ACEs Questionnaire to see where you fall!
Sometimes, it isn’t the woman who is obviously going through it, but the woman who looks good on the outside, still going, while telling no one what’s happening inside.
What May Be Happening Inside the Body
A suicidal crisis is not only a psychological(mental) event. It can have biological roots, too. And when those roots go uninvestigated, we are responding to a fire while the gas line is still on.
Here is what I look for during patient visits that aren’t always evaluated:
Neuroinflammation.
Research published in peer-reviewed journals shows that elevated inflammatory markers, including C-reactive protein (CRP), are associated with suicidal ideation independently of how depressed someone is. Black women living under chronic racial (di)stress, amongst other types of stress, often have elevated inflammation, but it rarely gets tested.
Critically low Vitamin D.
Melanin reduces the amount of vitamin D the skin produces from sunlight, making deficiency significantly more common in Black women. Severely low vitamin D affects how the brain processes things like (di)stress and its ability to see a way forward. Vitamin D is testable, and deficiency is treatable.
Cortisol dysfunction.
After years of chronic (di)stress, the body’s cortisol system can go from overactive to exhausted. When that happens, the brain’s capacity for resilience and perspective is compromised at a biological level.
Thyroid dysfunction.
Even levels within the “normal” range can be suboptimal. Poor thyroid function produces profound fatigue and exhaustion, emotional blunting, sleep disturbance, appetite changes, depression, and anxiety, and many women are told their thyroid is ‘fine’ when it is not functioning optimally for brain or body health.
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Nutrient depletion.
Magnesium, zinc, B12, folate, and omega-3 fatty acids are raw materials the brain uses to regulate mood. Chronic (di)stress, as well as many prescription medications, depletes them. When they are low, the biological foundation for mental health stability is compromised.
MTHFR gene variant.
This genetic variation affects how the body processes folate, which plays a direct role in the production of serotonin and dopamine. Research suggests it may also contribute to antidepressant non-response in some patients, though evidence is still emerging. Identifying it early on allows for more targeted nutritional support alongside psychiatric treatment.
Low total cholesterol, low LDL, and the brain connection.
Your brain is heavily composed of fat. Cholesterol is not just a number historically linked to heart health; it is a structural building material for every brain cell and neurotransmitter receptor. The research on low cholesterol, low LDL, and mood and suicide risk and/or attempts is consistent and spans decades.
This matters because many Black women are placed on cholesterol-lowering medications for heart attack and stroke prevention, often appropriately per standard of care. But the psychiatric implications of very low total cholesterol and LDL are almost never part of that same conversation. If you are on a cholesterol lowering medication and have noticed a shift in your mood, emotional flatness, or a deepening sense of hopelessness, that is worth investigating. Please note that this is not an argument against statins, as they save lives. However, this is an argument for due diligence and always considering and assessing the complete picture of both mental AND physical health.
This Part Is for You
Maybe something in this post is resonating. Maybe you haven’t told anyone. Maybe you’ve convinced yourself it isn’t bad enough because you’re still functioning, as in you’re still going and getting things done. That’s what bosses do, right?
BUT, being able to show up is not the same as being okay. For many women, it could be the only warning sign that went unnoticed.
You do not have to have a plan. You do not have to have hit a wall.
You are not too strong for this to be real.
You are not weak for needing or asking for help.
You are not a burden for needing someone or something.
My practice and my passion is not to diagnose and then send you on your way. It is to investigate what is actually happening in your mind, brain, and body, at the same time; the inflammation, the hormones, the nutrients (fat, protein, complex carbs, vitamins, minerals, fatty acids, amino acids, glucose), the genetics, while also considering your lived experiences, your family history, your race and cultural context, and your faith.
You have probably been seen by people who looked at part of you. I am interested in the wholeness of you.
The threshold for reaching out after you’ve hit rock bottom. The threshold is ALWAYS now.
What Real Prevention Looks Like
Prevention is not only a hotline number. It is what happens when we stop waiting for the crisis and start investigating the conditions that make a crisis pending.
Catching critically low vitamin D before flatness becomes hopelessness. Identifying hormone dysfunction before exhaustion becomes collapse. Recognizing that a woman labeled “treatment-resistant” may have biological or trauma drivers that have never been addressed, and then addressing them.
Naming the Superwoman Schema patterns as the clinical risk factors they are, not personality traits to admire. Honoring prayer and spiritual identity as real, documented protective factors against despair.
The women I have worked with who came to me at their lowest almost universally had a constellation of addressable biological and contextual drivers that had never been looked at. When those drivers were finally investigated and treated, things shifted.
Not only their mood, but their sense of knowing and believing that they, too, are worth investigating.
Worth understanding.
Worth keeping and being alive!
That shift from invisible to seen is not a side effect of good care. Often, it is the very thing that saves a life.
What You Can Do Right Now
- Name what you see in YOURSELF and in someone you love. “I’ve noticed you seem different. I’m not going anywhere. You don’t have to be okay.”
- Stop waiting for bad enough or worse. The threshold for care is not the crisis; it is often in the subtle.
- Ask for a thorough investigation. “What biological, lifestyle, race & cultural drivers haven’t we considered?” What labs have never been run?”
- Take the ACEs Questionnaire to see how your childhood might be playing a role in your current health status.
- Know the number. 988. Call or text. Free. Confidential. 24/7.
And I need to say this too…in a world where “religion” has become God and taken the place of TRUTH that is God…
- KNOW THE TRUTH: God STILL and will ALWAYS love you (even if, throughout, and when)!
⚠️ In crisis right now? Call or text 988 NOW.
You do not have to be at the bottom. Subtly is more than enough
Ready to find out what may be driving those persistent mental (physical) health-related symptoms, illnesses, and diagnoses?
The 💡Clarity Call Assessment Check is a complimentary 20-minute call to explore whether our boutique, personalized investigative medicine & psychiatry services are ‘right’ for your health and healing journey. Learn more at https://beafya.life/clarityapplication
Frequently Asked Questions
Why is suicide increasing among Black women?
Firearm suicide rates among Black women rose 169% from 2015 to 2024, compared to 4% among white women. There are likely multiple drives that include, but are not limited to, chronic racial (di)stress, minimal investigation of biological contributors, and inability to recognize nuance in cultural patterns and behaviors that make it difficult to seek, accept, or have access to help.
What can suicidal crisis look like in high-functioning Black women?
It often looks like nothing from the outside. Subtle warning signs include sleeping issues, change in appetite, weight gain, weight loss, emotional numbness, irritability, withdrawing from community and faith, unexplained physical symptoms, and sudden calm or a burst of energy after a period of visible struggle.
What biological factors can contribute to suicidal risk that are rarely tested?
Inflammation, low vitamin D, hormone dysfunction, thyroid function, nutrient depletion, MTHFR genetic variants, and low total cholesterol and low LDL, all of which are measurable, and many of which are addressable.
What is 988?
The national Suicide & Crisis Lifeline. Call or text 988, 24/7, free and confidential. You do not need to be in immediate danger to call.
What role does investigative medicine & psychiatry play in suicide prevention?
It identifies potential root biological, cultural, emotional, behavioral, and lifestyle drivers, ideally before a crisis occurs, rather than waiting to respond after one.
About Dr. Devin N. Bailey, FNP-BC, PMHNP-BC, CFFP, DipACLM: Triple board-certified practitioner (FNP-BC, PMHNP-BC, DipACLM) and founder of The AFYA Effect Family Healthcare Services, located in Newport News, Virginia, but serving the entire state of Virginia through telemedicine. Her clinic provides Boutique Personalized Investigative Medicine & Psychiatry services that center Black women who do “everything right” or have been told “everything looks normal” but still don’t feel mentally or physically well.
⚠️If you are in crisis, call or text 988 immediately. This article is for educational purposes only and does not constitute medical advice. ALWAYS speak with your personal healthcare provider!!
