Change Pathways in Indigenous and Nonindigenous Youth Suicide

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help‐seeking were examined across time in Native Hawaiian and non‐Hawaiian adolescents, using data from a 5‐year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non‐Hawaiian peers. There were also significant differences between groups in hope and help‐seeking, with Native Hawaiian youth increasing help‐seeking and decreasing hope to a greater degree. Youth‐centered, cultural approaches to suicide prevention are essential in enhancing well‐being in indigenous communities.     

Suicidality Among Adolescent Alberta Indians

A high rate of suicide attempts and suicide ideation characterized a sample of 229 grade 7 to 9 adolescents resident on seven reserves in central Alberta. The prevalence of suicidality for these adolescent Indians was very similar to rates reported for Navajo youth and for 8th- and 10th-grade American non-Indian students. Comparison of Indian and non-Indian suicidality risk factors showed somewhat elevated levels of family disruption and psychological problems among Indian adolescents. Compared to Canadian nonadolescents, substance abuse levels were high, and conditions necessary to modeling were virtually omnipresent. Suicide ideation was significantly elevated for Indian adolescents with low psychological well-being, no father in the home, and a prior suicide in the household. Controlling for age, risk factors for suicide attempts were heavy alcohol use, no father in the home, sleeping problems, and low psychological well-being. The high rates of adolescent Native suicide imply that a much higher proportion of their suicide attempts succeed. Targeted, community-based counselling and educational programs are needed to address these problems.     

Social Network Characteristics,Social Support,and Cigarette Smoking among Asian/Pacific Islander Young Adults

Cigarette smoking may be one of the factors contributing to the high levels of cancer‐related mortality experienced by certain Asian/Pacific Islander (A/PI) subgroups (e.g., Native Hawaiian). Given the collectivist cultural orientation attributed to A/PI groups, social strategies are recommended for substance abuse or smoking cessation treatment among A/PI. However, research examining how social network characteristics and social support relate to smoking across A/PI subgroups has been lacking. This study investigated the associations between social network characteristics (e.g., size, composition), perceived social support, and recent cigarette use across Native Hawaiian, Filipino, and East Asian (e.g., Japanese, Chinese) young adults (18–35 year old). Cross‐sectional, self‐report data were collected from N = 435 participants (M age = 25.6, SD = 8.3; 61% women). Ethnic differences were found in a number of pathways linking social network characteristics, perceived social support, and cigarette smoking. Larger network size was strongly associated with higher perceived social support and lower recent cigarette smoking among Native Hawaiians but not Filipinos or East Asians. Higher perceived social support was associated with lower recent smoking among East Asians and Filipinos but not Native Hawaiians. Implications are discussed with regard to smoking prevention and cessation among A/PI.     

Suicide attempts among adolescent Mexican American students enrolled in special education classes

Suicide is the second leading cause of death among school-aged students between the ages of 15 and 19. There is an increasing frequency of suicide and other self-destructive behaviors among Mexican American youth and students in special education classrooms for emotional and behavioral disabilities. Recognizing Mexican American youth in special education classes as a separate risk group, this study (a) identifies factors that contribute to suicide, (b) reviews the signs and characteristics associated with these factors, (c) interviews Mexican American students in special education who have either exhibited various characteristics of suicidal thoughts and/or have attempted suicide, (d) explores effective prevention programs, and (e) provides suggestions for school personnel. Interviews with five adolescent Mexican American special education students support previous research findings that depression, substance abuse, social and interpersonal conflict, family distress, and school stress are primary characteristics related to suicidal minority youth.     

Assessment of awareness of connectedness as a culturally-based protective factor for Alaska native youth

Research with Native Americans has identified connectedness as a culturally based protective factor against substance abuse and suicide. Connectedness refers to the interrelated welfare of the individual, one's family, one's community, and the natural environment. We developed an 18-item quantitative assessment of awareness of connectedness and tested it with 284 Alaska Native youth. Evaluation with confirmatory factor analysis and item response theory identified a 12-item subset that functions satisfactorily in a second-order four-factor model. The proposed Awareness of Connectedness Scale (ACS) displays good convergent and discriminant validity, and correlates positively with hypothesized protective factors such as reasons for living and communal mastery. The measure has utility in the study of culture-specific protective factors and as an outcomes measure for behavioral health programs with Native American youth.     

Gender Roles,Suicide Attempts,and Substance Abuse

In this article, the focus is on a comparison of suicide attempts and substance abuse in the United States. It is argued that suicide attempts and substance abuse may function as psychologically equivalent but gender-specialized forms of self-injurious behaviors. Possible explanations for the gender segregation of suicide attempts and substance abuse are reviewed, and the benefits of crossover theories and treatments are presented.     

Age‐Specific Characteristics of Serious Suicide Attempters in China

Characteristics of four age groups of patients with medically serious suicide attempts from nine general hospitals in China (N = 617) were compared. There were no significant age‐group differences by residence (rural vs. urban), method of attempt, proportion with prior attempts, or level of family functioning. Attempters <20 years of age were less likely to use alcohol at the time of the attempt. Attempters age 20–44 years had less regular contact with family members but were more likely to make the attempt in the presence of someone else. And attempters ≥ 45 years were more likely to have high suicidal intent, lower quality of life, mood disorders, and substance abuse disorders. These results highlight the need for age‐specific intervention programs for suicide attempters.     

Suicide attempts among drug abusers.

The relationship between substance abuse and suicide is indicated by the high rate of attempted suicide among alcoholics and drug abusers as well as the increased likelihood of repeated attempts in these populations. This study reports on the psychological characteristics of male drug suicide attempters who are in treatment for their addiction problem. Data collected from 166 veterans included background information, symptoms, mood, social functioning, and attitude measures. Of the drug abuse patients, 26 percent reported having made a suicide attempt. These subjects were found to be significantly more depressed, angry, insecure, and anxious than the nonsuicide-attempt drug abusers. Treatment staff need to be sensitized to the possibility of repeated suicide attempts among substance abuse patients.     

Differences in risk factors for suicidality between African American and White patients vulnerable to suicide

Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty. In adjusted analyses, social support was significantly associated with suicidality in African American patients, while younger age and the presence of an anxiety disorder were significantly associated with suicidality in White patients. The results suggest that race/ethnicity-specific risk profiles may improve the detection of suicidality in vulnerable populations.     

African American children's reports of depressed mood, hopelessness, and suicidal ideation and later suicide attempts

This study attempted to assess whether family demographic characteristics and child aggressive behavior are equal to or better than child self-reported depressive symptoms in predicting suicidal behavior. Participants were a community population of African Americans first recruited at age 6 and followed periodically through age 19-20. Measures included child self-reports of depressed mood, hopelessness, and suicidal ideation, teacher reported child aggression in grades 4-6, 6 th grade caregiver report of family demographic characteristics, and the participants' report at age 19-20 of suicide attempts. Depressed mood proved the most consistent predictor of adolescent/young adult attempts in our logistic regression analyses of the data from the population as a whole and among females. The relationship between depressed mood and suicide attempts in males was in the expected direction, but was not statistically significant. Teacher-reported youth aggressive behavior did prove to be a significant predictor of attempts in 4 th and 5 th grade for the population as a whole, but not in our analyses by gender. The relationships between family demographic characteristics and attempts failed to reach statistical significance, but were, generally, in the expected direction. The study revealed that African American children's self-reports of depressed mood as early as grade 4 may prove useful in predicting adolescent/young adult suicide attempts, particularly among females. Neither family demographics nor teacher-reported child aggressive behavior proved equal to child self-reported depressive symptoms in predicting later suicide attempts.     

Relationship Between Religious Coping and Suicidal Behaviors Among African American Adolescents

This study investigated whether hopelessness and depression were risk factors for suicidal thoughts and behaviors in African American adolescents and looked at whether religious participation and religious coping protected these students from suicidality. Participants were 212 African American high school students (133 females, 79 males). The results of multiple and logistic regression analyses found that hopelessness and depression were risk factors for suicidal ideation and attempts. Religious coping style was significantly related to suicidal behaviors: Self-directed coping was related to increased hopelessness, depression, and suicide attempts, and collaborative coping was related to increased reasons for living. Gender differences were found in symptoms of depression, religious coping style and religious participation. Results provide additional support for suicide interventions to target hopelessness and depressive symptoms and highlight the importance of examining the role of culturally salient variables, such as religious participation and religious coping style, when developing intervention programs for suicide.     

Factors associated with suicide attempts in female inmates: the hegemony of hopelessness

In this study factors associated with past suicide attempts in female inmates were examined. Female inmate participants (N = 105) were given structured diagnostic assessments of antisocial and borderline personality disorders and substance dependence, as well as measures of depression, hopelessness, problem-focused coping styles, and reasons for living. There was a high lifetime prevalence of past suicide attempts (38.1%). Suicide attempts were positively associated with personality disorders, hopelessness, depression, childhood physical/emotional abuse, and family history of suicide and mood disorders, and negatively associated with income, reasons for living, and problem-focused coping. Controlling for hopelessness, borderline personality disorder and family history of suicide attempts were the only variables that remained uniquely associated with suicide attempts.     

The Relationship between Cultural Identification,Family Socialization and Adolescent Alcohol Use among Native American Families

The enculturation or teaching of Native American traditions to Native American adolescents has been incorporated into substance-use prevention interventions in recent decades; yet, little is known about how enculturation may impact substance use through family socialization. The current study aimed to test the relationship between family identification with Native American culture and alcohol use among Native American families residing on or near a reservation, and determine if this relationship was mediated by family socialization practices. To achieve this aim, data (n? =?2368) collected as part of the NIDA-funded Drug Use among Young American Indians was used. No direct relationship was found between identification with Native American culture and alcohol use. Native American culture had an indirect effect on substance use through family communication and parental monitoring, such that a higher identification with Native American culture was associated with more communication and less monitoring, which were associated with drinking behavior. Findings reveal that identification with Native American culture may be related to family socialization, a relationship that could be important to address when designing alcohol-use prevention interventions for this population.     

Examining the impact of psychiatric diagnosis and comorbidity on the medical lethality of adolescent suicide attempts

Specific psychiatric diagnoses and comorbidity patterns were examined to determine if they were related to the medical lethality of suicide attempts among adolescents presenting to an urban general hospital (N=375). Bivariate analysis showed that attempters with substance abuse disorders had higher levels of lethality than attempters without substance abuse. Regression results indicated having depression comorbid with any other diagnosis was not associated with medical lethality. However, having a substance abuse disorder was associated with higher suicide attempt lethality, highlighting the importance of substance abuse as a risk factor for lethal suicide attempts in adolescents. This finding stimulates critical thinking around the understanding of suicidal behavior in youth and the development and implementation of treatment strategies for suicidal adolescents with substance abuse disorders.     

Characteristics of suicide attempters in a Slovenian high school population

The study was carried out on a representative sample of Slovenian high school students (n = 3687) of whom 238 (137 girls and 101 boys) have already attempted suicide. Both suicide attempters and nonattempters were assessed by a questionnaire consisting of Zung's (1965) Depression Scale, Rosenberg's (1965) Self-Esteem Scale, sociodemographic data, information on suicide attempt, suicide ideation, family relations, and substance abuse. Statistical analyses indicated that groups differed in the levels of self-esteem, emotional reaction to family problems, running away from home, and substance abuse. The differences in the level of depression, frequency of suicide ideation, family suicide occurrence, smoking, and alcohol use were significant.     

African American and Caucasian attempters compared for suicide risk factors: a preliminary study

The aim of the study was to compare African American and Caucasian substance dependent suicide attempters for risk factors for suicidal behavior. One hundred and fifty-eight African American and 95 Caucasian substance dependent patients who had attempted suicide were interviewed and their family history of suicidal behavior recorded. Patients completed the Childhood Trauma Questionnaire, the Eysenck Personality Questionnaire, and the Foulds Hostility and Direction of Hostility Questionnaire. The results revealed that there were no significant differences between the African American and Caucasian suicide attempters for marital status, age, childhood abuse, or for personality scores for neuroticism, extraversion, psychoticism, or hostility. However, the African American attempters had significantly lower childhood emotional neglect scores. Also, significantly more of the Caucasian attempters had a family history of suicide and current legal problems. Further studies seem warranted examining for differences between African Americans and Caucasians for risk factors for suicidal behavior.     

Prevention Programs to Augment Family and Child Resilience Can Have Lasting Effects on Suicidal Risk

In this commentary, the effects of four family‐based preventive interventions designed to augment parent and child resilience, originally designed to prevent mental health and substance abuse, on suicide ideation and attempts are reviewed. Three of the preventive interventions showed a beneficial effect either on child suicide ideation or attempts, and one found a beneficial effect on parental suicidal ideation. The duration of effects in two of these studies was well longer than a decade. These studies suggest that interventions to augment family and child resiliency originally designed to prevent mental health and substance abuse disorders can also have beneficial, often long‐term, effects on suicidal ideation and behavior.     

Gender in Suicide Attempt Rates and Childhood Sexual Abuse Rates: Is There an Interaction?

Two competing explanations for higher rates of attempted suicide in women than men were compared. Because childhood sexual abuse is more prevalent in girls than boys, one explanation of higher rates of suicide attempts in women is that it is a direct result of the higher incidence of sexual abuse in girls. Alternatively, higher rates of suicide attempts might result from gender differences in the impact of childhood sexual abuse on suicidal behavior. To compare these theories, data from 1,889 abstinent, substance-dependent patients who completed the Childhood Trauma Questionnaire (CTQ) and who were interviewed about suicide attempts was examined. Scores on each scale of the CTQ were examined as a function of gender and attempter status. Results showed higher rates of suicide attempts in women than in men, higher CTQ scores in women than men, and a higher CTQ score in attempters than nonattempters. However, logistic regression indicated that gender and abuse did not interact to determine attempter status. Thus, the data support the first hypothesis that the greater frequency of suicide attempts in women may be partly attributed to the higher prevalence of childhood sexual abuse in girls. The generalizability of these results to the general population and to other diagnostic groups requires further study.     

Predicting the suicide attempts of lesbian, gay, and bisexual youth

In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths' sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths' openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population.     

Suicide and African American teenagers: risk factors and coping mechanisms

In this study we investigated whether locus of control, hopelessness, and depression were primary risk factors for suicide ideation and attempts in African American youth, and whether congruency between locus of control and religious coping style reduced suicide risk. The sample consisted of 176 African American high school students (115 females; 61 males). Multiple and logistic regression were used to determine relationships among study variables. Depression was found to mediate the relationship between hopelessness and suicidal behaviors. External locus of control led to greater risk for hopelessness and depression, with a trend in the predicted direction for suicide attempts. Religious coping style alone was not always associated with reduction of risk of suicidal behaviors, yet some evidence suggests that congruency between locus of control and religious coping style reduces risk. Results provide additional support for suicide interventions to target depressive symptoms. Results also highlight the importance of examining the role of culturally salient variables such as fatalism and religious coping style when developing intervention programs for suicide.