Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.     

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.     

Multicultural perspectives on suicide

Cultural differences exist as to suicide rates, suicide attempts, suicide attitudes such as acceptability, and appropriate treatment of suicide. Although suicide has been studied cross-nationally to highlight cross-cultural differences, the nuances of suicide among racioethnic groups within the United States have been at times been overlooked. The present article discusses suicide among the four (African American, Hispanic American, Native American, Asian American) most populous minority sociopolitical groups in the United States, and makes culture-specific recommendations for treatment and research.     

Fertility Behavior of Immigrants in Canada: Converging Trends

Using data from the 2002 Ethnic Diversity Survey, this paper compares fertility behavior across three immigrant generations: foreign born, second generation, the population of third or more generations. Several important findings emerge from this study. First, consistent with previous studies, we have documented higher fertility for the foreign born and lowest for the second generation, but these differences are no longer statistically significant after controls for sociodemographic factors. The differentials by age, with higher fertility for those who arrived after age 15, also disappear after controls. These findings support the hypothesis that it is the sociodemographic characteristics of the immigrant generations that matter rather than the generational status itself. The controls did not eliminate the differentials by visible minority status, which show highest fertility in the Black population and lowest in the Chinese population. Consistent with the finding that lowest fertility occurs among persons who are least acculturated, we suggest that the relative opportunity structures of given minority groups may be part of the explanation.     

Suicidal behavior in Italy: data, trends and guidelines for a suicide intervention/prevention policy.

Even though in Italy, as in the majority of Mediterranean countries, the increase in suicide rates is not among the highest in Europe, between 1969 and 1989 it showed a sharp upswing (+43% among males and +31% among females). In terms of geographical differences, the regions with the highest suicide rate are the northern ones (up to twice the national average). The age groups with the highest suicide risk are those over 74 years (in 1989 the rate among males over 65 was the highest of all: 31.3 per 100,000). The differences in the between-sexes distribution show that among females over 65 years old the suicide rate rose by 70% between 1974 and 1989, versus 77% for males of the same age. The preliminary epidemiological results of one of two Italian centers are presented. These centers are collaborating with the WHO/EURO Multicenter Study on Parasuicide; parasuicide rates are higher for females than for males (55.9 per 100,000, as against 38.1 for males), while the age group at highest risk is seen to be young women (15-24 years), with a specific rate of 115.6.     

The State of the Union: Contemporary Interminority Attitudes in the United States

An emerging body of work examines relations among marginalized groups, presupposing that interminority interactions display increased levels of animosity or compassion as compared to majority–minority processes. The current article compares interminority and majority–minority attitudes in a nationally representative data set, finding that racial, sexual, and gender minority groups express similar or more favorable attitudes and political support toward a minority outgroup. Experimental follow-ups explore conditions leading to more positive interminority interactions, finding that primes of similarity facilitate increased support toward a minority outgroup. A final minimal-pairs design explores the role of comparative disadvantage in these processes, suggesting that increased interminority support does not extend to a minority target group that is more privileged than the ingroup. Theoretical and empirical implications are addressed.     

The Effect of Cancer on Suicide among Elderly Holocaust Survivors

Jewish‐Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish‐European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60–1.19; women: 0.95, 95% CI 0.55–1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.     

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.     

The Effect of a Majority Group’s Perspective-Taking on Minority Helping

The current study examines how perspective-taking impacts on a majority group’s support for the governmental actions to help minority groups. The contextual background of the current study is tense relations between Sunnis representing a Muslim majority and Ahmadis and Shiites representing Muslim minorities in Indonesia, the world’s largest Muslim population. The results (N = 200) demonstrated that strong perspective-taking than weak perspective-taking triggered a greater minority helping, but only among the majority who strongly identified with their nation, but not with Sunnis. Moreover, participants in the strong perspective-taking condition than those in the weak perspective-taking condition demonstrated a greater willingness to perceptually include minorities as a representative group of national citizens, but not as Muslims, and in turn this perceived inclusion mediated the effect of perspective-taking on minority helping. We also hypothesised and found that such a mediating role of perceived inclusion of minorities as national citizens was more pronounced when the national identification and not Sunni identification was high. Finally, the inclusion of Muslim minorities as national citizens and minority helping increased identity enhancement of national identity, but these effects were more pronounced when the majority strongly identified with their nation, but not with Sunnis. These findings suggest that the merits of perspective-taking in promoting help on behalf of minority groups is not generic, but limited to a specific domain of superordinate category to which these minority groups are included, and to the nature of group identification.     

Academic performance differences among ethnic groups: do the daily use and management of time offer explanations?

This explorative study describes time use and time management behaviour of ethnic minority and ethnic majority students as possible explanations for the poorer study results of ethnic minority students compared to those of majority students. We used a diary approach in a small sample to examine students’ daily time use in both a lecture week and an exam week. Time management behaviour was measured in a questionnaire, as were demographic variables. The sample consisted of 48 full-time first-year university students of Business Administration of which 24 students belonged to a non-Western ethnic minority group. Student pairs (ethnic majority vs. non-Western ethnic minority) were fully matched by gender, socio-economic status, living situation and type of secondary education. Results showed that ethnic majority students earned higher grades compared to ethnic minority students. As regards time management behaviour, ethnic majority students appeared to have a stronger preference for organisation (e.g., leaving a clear study space at the end of a study day) than ethnic minority students. No differences between ethnic groups were revealed in setting goals and priorities (e.g., setting deadlines) and mechanics of time management (e.g., making to-do lists). Daily time use also appeared to be the same for both ethnic groups.     

Minority status,access to information,and individual performance

With growing nationality diversity in organizations, the question under which circumstances differences in nationality background between team members affect individual performance increases in importance. Research showed that dissimilarity may negatively affect individual performance and that the status difference between nationality majority and nationality minority moderates this effect. We take this analysis an important step further by recognizing that not all nationality minorities are low status and propose that status differences among nationality minority groups influence the extent to which nationality minority background affects individual performance. We identify the elaboration of distributed information in the team as a mediator and process accountability as a moderator in this effect. Results of a multilevel team experiment in which we manipulated team nationality composition and process accountability supported our hypotheses, testifying to the value of status-based distinctions between minority groups in the study of relational demography effects. The mediating role of the elaboration of distributed information also provides an important bridge to team diversity research inviting further conceptual integration.     

Relationships between intergroup contact and prejudice among minority and majority status groups

Considerable research has shown that greater intergroup contact corresponds with lower intergroup prejudice, yet little is known regarding how the relationships between contact and prejudice may vary for members of minority and majority status groups. The present research examined differences in contact-prejudice relationships among members of minority and majority status groups, using data from a larger meta-analytic study of the effects of intergroup contact. Results indicate that the relationships between contact and prejudice tend to be weaker among members of minority status groups than among members of majority status groups. Moreover, establishing Allport's (1954) proposed conditions for optimal intergroup contact significantly predicts stronger contact-prejudice relationships among members of majority status groups, but not among members of minority status groups. Implications of these findings for future research on contact between minority and majority status groups are discussed.     

Ethnocultural Differences in Prevalence of Adolescent Suicidal Behaviors

Data from an ethnically diverse sample of middle school students (grades 6–8; n = 5,423) are analyzed for ethnic differences in suicidal ideation, thoughts about suicide in the past 2 weeks, suicide plans, and suicide attempts. Ideation was examined using a four-item scale and a single item on suicidal thoughts. Ideation was higher among females, older youths, and lower status youths. The same general pattern held for recent suicidal plans and attempts, with the exception of gender, where the trend was for males to report more attempts. Lifetime plans and attempts were higher for females, older youths, and lower status youths. Data were sufficient to compare nine ethnic groups. Multivariate logistic regression analyses, adjusting for the effects of age, gender, and socioeconomic status, yielded significant odds ratios using the Anglo group as the reference, for suicidal ideation for the Mexican (OR = 1.76, p < .001), Pakistani (OR = 2.0, p < .01), and Vietnamese (OR = 1.48, p < .05) American groups. For thoughts about suicide in the past 2 weeks, only Pakistani and Mixed Ancestry youths had elevated risk. For suicidal plans in the past 2 weeks, Mixed Ancestry youths (OR = 2.02, p < .05) and Pakistani youths (OR = 3.20, p < .01) had elevated risk. For recent attempts, only the Pakistani American youths had elevated risk (OR = 3.19, p < .01). Future research needs to address whether these results hold in other ethnically diverse communities and, if so, what factors contribute to increased risk among some minority youth and not others.     

Are UN Peacekeepers at Risk for Suicide?

Media reports connecting UN peacekeeping duties by Canadian soldiers to their subsequent suicide prompted this study of peacekeeping as suicide risk. In a case-control design we retrospectively compared 66 suicides in the Canadian military between 1990 and 1995 with two control groups: (a) 2,601 controls randomly selected from the electronic military database and (b) 66 matched controls with complete personnel and medical data. We found no increased risk of suicide in peacekeepers except among a subgroup of air force personnel. Here confounding individual factors, isolation from supports, and possibly inadequate preparation for deployment elucidated their suicides. Theater of deployment (e.g., Bosnia) did not affect the suicide rate. Military suicides experienced psychosocial stresses and psychiatric illness more often than their matched controls. We conclude that although peacekeeping per se does not increase overall suicide risk, military life-styles may strain interpersonal relationships, encourage alcohol abuse, and contribute to psychiatric illness and suicide in a minority of vulnerable individuals irrespective of peacekeeping assignment. Careful selection, and preparatory military training that encourages intragroup bonding and mutual support, may protect against suicide risk.     

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.     

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M _age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.     

Rescuers and the Rescued

ABSTRACT: There is a fairly widespread but unverified belief that persons working on certain taboo areas may be similar to the population they serve and drawn to such work by their own personal problems in these areas. Two groups, 51 suicide prevention volunteers and 31 suicide attempters, were compared with respect to demographic characteristics and for psychological attitudes and experiences pertaining to suicide, death, and mental status by means of a death questionnaire developed by Shneidman. Comparative analysis revealed substantial differences between volunteers and clients. Demographically, the volunteers were older, better educated, more affluent, and contained a greater proportion of Protestants. Psychologically, the volunteers were distinctly different in regard to suicide. In contrast to their clients, the volunteers reported greater emotional stability, much less fantasy about suicide, almost no actual suicide attempts, and a disinclination to consider suicide as a justifiable problem-solving option.     

Perceptions of ethnic discrimination by minority and majority early adolescents in the Netherlands

This research investigates perceptions of discrimination among ethnic majority and minority group early adolescents (aged between 10 and 12 years) living in the multi‐ethnic context of the Netherlands. In two studies (N = 679 and N = 2630), personal and group discrimination was examined in terms of name‐calling and social exclusion, and in relation to ethnic identity and family allocentrism. All early adolescents reported more group than personal discrimination. The personal‐group discrimination discrepancy (PGDD) was found independently of ethnic group, gender, allocentrism, and ethnic identity. Hence, the PGDD seems a more general phenomenon that already exists among early adolescents and across different domains. However, minority group participants perceived far more discrimination overall than majority group early adolescents, and the Turkish participants reported more discrimination than the Moroccan and Surinamese early adolescents. Furthermore, family allocentrism was positively related to perceived discrimination among all ethnic groups in Study 2 and among the Dutch in Study 1. In agreement with ethnic identity development models, strength of ethnic identity was not related to perceived discrimination. Ethnic identity was, however, positively related to allocentrism. In both studies, ethnic minority group participants had higher scores for allocentrism and for ethnic identity than majority group participants. In addition, boys had stronger ethnic identity than girls and ethnic identity was negatively associated with perceived discrimination for the boys but not for the girls. It is concluded that in order to understand early adolescents' perception of discrimination it is necessary to pay attention to basic (cognitive) tendencies that cross ethnic lines, to cultural and status differences between the majority group and ethnic minorities as a category and between ethnic minority groups, and to within‐group differences or individual level variables.     

Precipitating Circumstances of Suicide among Active Duty U.S. Army Personnel Versus U.S. Civilians, 2005–2010

To help understand suicide among soldiers, we compared suicide events between active duty U.S. Army versus civilian decedents to identify differences and inform military prevention efforts. We linked 141 Army suicide records from 2005 to 2010 to National Violent Death Reporting System (NVDRS) data. We described the decedents’ military background and compared their precipitators of death captured in NVDRS to those of demographically matched civilian suicide decedents. Both groups commonly had mental health and intimate partner precipitating circumstances, but soldier decedents less commonly disclosed suicide intent.