Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Suicidal Ideation,Depressive Symptomatology,and Self‐Concept: A Comparison Between Mexican Institutionalized and Noninstitutionalized Children

Previous research reports a significant prevalence of child depression worldwide and self‐concept as a predictor of depression and suicide behavior. Although suicide in children is an increasing problem in Mexico, there are scarce studies reporting risk factors and none of children in foster care institutions. This was a comparative, ex post facto study whose aim was to analyze associations between suicidal ideation, depression, and self‐concept in two paired samples of Mexican children (83 institutionalized and 83 noninstitutionalized). Results show 16% of the children reported suicidal ideation and statistically significant differences among variables in both samples. Suggestions are made to address this problem from early ages.     

Sociocultural determinants of suicide ideation: a comparison between American and Ghanaian college samples

This study investigated the role of gender, family cohesion, religiosity, and negative suicide attitudes as potential determinants of cultural differences in suicide ideation among 375 college students from Ghana and the United States. Significant cultural differences were found for suicide ideation, family closeness, religiosity, and negative suicide attitudes. Family cohesion and negative attitudes were significant predictors for both cultural groups. Gender was a significant determinant for suicide ideation among Ghanaians, but not Americans; religiosity was not a significant determinant for either group. More extensive research on sociocultural influences on suicide, especially among countries in which suicide is underreported or not documented, is encouraged.     

Perceived burdensomeness, familism, and suicidal ideation among Mexican women: enhancing understanding of risk and protective factors

The interpersonal-psychological theory of suicide and a culturally-relevant construct, familism, was used to examine predictors of suicidal ideation among Mexican and Mexican American women in the United States. A sense of perceived burdensomeness toward others was expected to significantly predict suicidal ideation, especially among women who endorsed high levels of familism. Mexican and Mexican American outpatient women (N = 73) completed self-report measures and an interview measure of suicidal ideation. Main and interactive effects of perceived burdensomeness and familism were examined. Perceived burdensomeness, but not familism, significantly predicted suicidal ideation. The interaction hypothesis was not supported. These findings highlight perceived burdensomeness as a risk factor for suicidal behavior in Mexican and Mexican American women.     

Sex differences in developmental trends of suicide ideation, plans, and attempts among European American adolescents

Although suicide ideation, plans, and attempts increase during adolescence, it remains unclear whether boys' and girls' risk for these outcomes peaks at different ages. We used longitudinal categorical data (never, once, 2+ times) from the Family Transitions Project (N = 1,248 rural European Americans, ages 11-19) to investigate whether yearly prevalence rates of adolescent suicidal episodes follow different patterns by sex. Multiple-group growth models revealed that peak levels of past-year ideation and plans occurred during mid adolescence for girls, but slowly increased through late adolescence for boys. We found that prevalence patterns for attempts were very similar for boys and girls, with both increasing through mid adolescence and then declining, although girls' risk declined slightly more rapidly. This information may help alert gatekeepers to developmental periods during which boys and girls are particularly vulnerable to suicide-related experiences, and also may help inform the timing of preventive efforts.     

Current and Military‐Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans

Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past‐year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past‐year transgender‐specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past‐year and past 2‐week suicide ideation through past‐year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.     

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus.

Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.     

Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts.

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.     

The effectiveness of family-based cognitive-behavior grief therapy to prevent complicated grief in relatives of suicide victims: the mediating role of suicide ideation

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n = 122) on the effectiveness of cognitive-behavior therapy, the effect of suicide ideation on the effectiveness of grief therapy on the bereavement outcome at 13 months post loss was examined. Results show that suicide ideators more often have a history of mental disorder and suicidal behavior than non-ideators, and suicide ideation indicates a high risk for adverse bereavement outcome. Grief therapy likely reduces the risk of maladaptive grief reactions among suicide ideators. Therefore, suicide ideators may benefit from grief therapy following a loss through suicide.     

The Role of Body Image and Disordered Eating as Risk Factors for Depression and Suicidal Ideation in Adolescents

There is much empirical literature on factors for adolescent suicide risk, but body image and disordered eating are rarely included in these models. In the current study, disordered eating and body image were examined as risk factors for suicide ideation since these factors are prevalent in adolescence, particularly for females. It was hypothesized that disordered eating and body image, in addition to depressive symptoms, would contribute to suicide ideation. It was also hypothesized that these relationships would be stronger for females than for males. Structural equation modeling was used to test a model of risk for suicide ideation incorporating the above factors in a sample of 392 high school students. Results indicated that disordered eating contributed to both suicide ideation and depressive symptoms, while body image only contributed to depressive symptoms. Depressive symptoms contributed to suicide ideation. The model was found to be cross‐validated with males and females, and no gender differences emerged. Implications of these findings and their importance in constructing future models of adolescent suicide risk are discussed.     

Recent suicidal ideation and suicide attempts in a large-scale survey of the U.S. Air Force: prevalences and demographic risk factors

One-year prevalences of self-reported noteworthy suicidal ideation and nonfatal suicide attempts were assessed in a large sample of U.S. Air Force active duty members (N = 52,780). Participants completed the 2006 Community Assessment, which was conducted online. Over 3% of male and 5.5% of female participants reported having experienced noteworthy suicidal ideation during the previous year, and 8.7% of those with ideation reported a recent suicide attempt. Demographic factors predicting significantly increased risk for suicidal ideation included female gender, low rank, and non-Christian religious affiliation; unmarried men were also at increased risk. Groups that were at increased risk for nonfatal suicide attempts included low-ranking men and Hispanic women. Implications for prevention efforts are discussed.     

Suicidality and associated risk factors among lesbian, gay, and bisexual compared to heterosexual Austrian adults

This is the first study in German-speaking countries to compare the suicidality of lesbian, gay, and bisexual adults (n = 358) with matched heterosexual adults (n = 267). The former had significantly elevated incidences of current suicide ideation (28% vs. 13%) and lifetime suicide attempts defined in three ways (14% vs. 1% to 10% vs. 2%), including higher incidences for most suicidality-related risk factors. Increased psychosocial stress and vulnerability is indicated, especially with respect to a lack of family support. Controlling for risk factors in multivariate analysis diminished the association of sexual orientation with current suicide ideation.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Depression, self-defeating, and self-destructive behaviors as predictors of suicide ideation in males and females

Previous studies have implicated depression, self-defeating behaviors, and self-destructive behaviors in suicide ideation. The present research directly compared these three concepts as predictors of both males' (n = 51) and females' (n = 78) suicide ideation. Analysis confirmed sex differences, with depression and self-defeating behaviors predicting females' suicide ideation, and self-destructive behaviors predicting males' suicide ideation. These results suggest that suicide may be related to these subtle yet relevant factors which may not be easily detected by mental health workers.     

The Great Black Hope: Hope and Its Relation to Suicide Risk among African Americans

Positive psychology has garnered considerable scholarly interest recently and has been suggested to hold promise in the application to suicide research and prevention; however, empirical research has lagged behind these suggestions. This is the first study to examine the relationship between hope and a specific theory of suicide in African Americans. It was hypothesized that (1) hope would negatively predict the interpersonal suicide risk factors of burdensomeness and thwarted belongingness; and positively predict acquired capability to enact suicide; (2) hope would negatively predict suicidal ideation; and (3) the interpersonal suicide risk factors would predict suicidal ideation. Results were primarily as predicted. Implications for hope theory and Joiner's theory of suicidal behavior are discussed, as well as implications for clinical practice.     

Relationships of suicide ideation with cause-specific mortality in a longitudinal study of South Koreans

Using 7-year mortality follow-up data (n = 341) from the 1998 National Health and Nutrition Examination Surveys of South Korean individuals (N = 5,414), the authors found that survey participants with suicide ideation were at increased risk of suicide mortality during the follow-up period compared with those without suicide ideation. The cause-specific analyses showed that, in men, suicide ideation was significantly associated with mortality due to cardiovascular disease, external causes, and other causes. However, there was no significant association between suicide ideation and cause-specific mortality in women. The relationship between suicide ideation and cause-specific mortality in men was not fully explained by baseline health status, socioeconomic status, health behavior, or psychosocial factors.     

The Associations of Physical and Sexual Assault with Suicide Risk in Nonclinical Military and Undergraduate Samples

The associations of various forms of sexual and physical assault with a history of suicide attempts and recent suicide ideation were studied in two distinct samples: active duty military and undergraduate students. A total of 273 active duty Air Force personnel and 309 undergraduate students anonymously completed self‐report surveys of assault victimization, emotional distress, belongingness, recent suicide ideation, and previous suicide attempts. Among military personnel, rape, robbery, or violent assault was associated with a nonsignificant trend toward increased risk for suicide attempts, whereas physical abuse or battering as an adult was significantly associated with recent suicide ideation. Among undergraduates, unwanted sexual experiences as an adult and physical or sexual abuse as a child were significantly associated with increased risk for suicide attempt, but only unwanted experiences as an adult was significantly associated with increased risk for suicide ideation. Experiencing multiple forms of assault increased risk for suicide attempts and ideation in both groups. Results suggest that different types of assault contribute differentially to suicide risk in military versus undergraduate populations, but experiencing multiple types of assault is associated with increased risk in both groups.     

The epidemiology of suicide-related outcomes in Mexico

Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age-of-onset (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM-IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM-IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide-related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.