The number of black teens who have attempted suicide increased from 1991 to 2017, while attempts by teens of other racial groups fell during the same time period, according to a study published by the American Academy of Pediatrics this week.

The new study, which analyzed data from 198,540 high school students collected by the U.S. Centers for Disease Control and Prevention’s Youth Risk Behavior Survey, also found that almost one in five high school students had thoughts about suicide. About one in 10 had a suicide plan.

While disparities in suicidal behavior based on sex and race have been observed before, researchers wanted to see if certain racial subgroups of adolescents are more likely to engage in suicidal behaviors over time.

They looked at four suicide-related rates: suicidal thoughts, suicide plans, suicide attempts, and injury by attempt. (Injury by attempt refers to any injuries, poisonings, or overdoses that had to be treated by a medical professional as a result of an attempt.)

Researchers found that rates of suicidal thoughts and suicide plans have decreased across all groups.

Black teens of both sexes reported an increase of 73% in suicide attempts from 1991 to 2017, with black male adolescents reporting an increase in injury by attempt as well.

“Ideation and plans represent a less serious form of suicide behavior, but attempts are potentially more caustic in terms of outcomes,” said Michael Lindsey, a professor of poverty studies at New York University who led the study. “It suggests that black kids might be engaged in more impulsive behavior around suicide. And for black boys, the increase in injury by attempt means that they’re engaging in more lethal means to attempt suicide.”

Lindsey said that the increase in injury by attempt could be because black boys are using weapons to attempt suicide, which is more dangerous than taking pills.

The increase in suicide-attempt rates for black teens is in line with earlier research that found that black children between ages 5 and 12 died by suicide at twice the rate of white children in the same age group. Black boys, in particular, have experienced an increase in the rate of suicide deaths.

Previous research has pointed to disparities in mental health treatment for black adolescents compared with white adolescents. Some are reluctant to seek help or acknowledge mental illness symptoms, while others are skeptical of mental health treatment. But research has shown that the social issues black adolescents face, such as racial discrimination and poverty, have been linked to suicidal behaviors.

Jaynay Johnson, a family therapist who works with black teens in the Philadelphia area, said she wasn’t surprised by the results of this study. Johnson said that black teens don’t have a lot of outlets to just “let their emotions be,” so living with mental illness can become very taxing.

“As we have pushed for more awareness around mental health and anxiety and depression, we have a lot more teens willing to share their experiences,” she said. “But as they do that, they realize how much they don’t have support.”

Johnson also identified social media as a potential stressor for black girls, who increasingly absorb what the standards of beauty are through photos they see on Instagram. Johnson discusses these issues with black girls in group therapy sessions.

“When you’re on social media all day long, all you’re seeing are models who have a certain hair texture and certain skin,” she said. “If you don’t fit that mold, a lot of self-esteem issues start to creep in, along with self-doubt. And because black girls are at the bottom of the totem pole, no one’s having these conversations with them about how to beat these issues.”

As for young black men, Johnson said exposure to violence and racism that happens in their communities plays a bigger role in their mental health. Trauma from shootings in their families, communities, and even of black people they don’t know can cause stress, anxiety, and depression. A study published last year by researchers from the University of Pennsylvania, Boston University, and Harvard University found that when police kill an unarmed black American, other black Americans who did not know the victim experience an emotional impact so severe that it is comparable to the stress caused by a chronic illness like diabetes.

In 2018, another study from Penn’s School of Nursing found that when black men are shot, they rarely get treated for psychological symptoms. Of the men interviewed for the study, 68% said that they experienced depression in the three months after their injuries, and a little over half said they suffered from post-traumatic stress disorder.

Lead study author Lindsey said that it’s important for researchers to look into why increasing numbers of black teens are attempting suicide.

“We need to provide all schools with mental health services proportional to the number of students who are there,” he said. “Proximity and colocation of services is really important to getting kids identified early and connected to treatment.”

Johnson agreed, saying that figuring out how to provide mental health services in schools is key to preventing suicide and related behaviors. She said that black students often find schools to be traumatic places because of ostracizing and lack of resources. Johnson said parents of teens should keep an eye out for mood swings and erratic behavior. A drastic break from normal routines or hobbies can indicate that something is wrong.

Overall, Johnson said that the biggest hurdle the black community faces with treatment for mental health is the stigma associated with it.

“We need to continue to diminish that so we can build programs tailored for youth,” she said. “In other communities, they’ve accepted mental health. They’re the ones writing the books. For us, we are behind the ball with that.”

If you or someone you know is thinking of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.