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.     

Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality

The influence of complicated grief (CG) on suicidality among bereaved adults was examined. The Yale Evaluation of Suicidality scale and the Inventory of Complicated Grief-Revised were administered to 309 bereaved adults in face-to-face interviews conducted at baseline (6.2 months post-loss) and at follow-up (10.8 months post-loss). Cross-sectionally, CG was associated with a 6.58 (95% CI: 1.74-18.0) times greater likelihood of "high suicidality" at baseline, and an 11.30 (95% CI: 3.33-38.10) times greater risk of high suicidality at follow-up, after controlling for gender, race, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and social support. Longitudinally, CG at baseline was associated with an 8.21 (95% CI: 2.49-27.0) times greater likelihood of high suicidality at follow-up, controlling for the above confounders. The study results indicate that CG substantially heightened the risk of suicidality after controlling for important confounders such as MDD and PTSD, suggesting that CG poses an independent psychiatric risk for suicidal thoughts and actions.     

Potential Moderators of Racial Differences in Responses to Traumatic Events

Research regarding the influence of race on outcomes after trauma has been mixed, and we aimed to identify potential moderators of the relation between race and posttraumatic stress disorder (PTSD)–related outcomes. We conducted a secondary analysis of data from 477 participants in the Collaborative Psychiatric Epidemiology Surveys. African American individuals reported a shorter duration of and less frequent PTSD symptoms than Caucasian individuals, and also endorsed a greater number of reexperiencing and avoidance symptoms. Education, socioeconomic status, and social support did not significantly moderate relations between age of worst trauma and PTSD-related outcomes. Clinical and research implications are discussed.     

Hostility predicts metabolic syndrome risk factors in children and adolescents.

The authors tested in 134 African American and European American children whether hostility measured at study entry predicted the metabolic syndrome risk factors an average of 3 years later. Hostility was measured with the Cook-Medley Hostility Scale (W. W. Cook & D. M. Medley, 1954) and with ratings of Potential for Hostility from interview responses. Metabolic syndrome was based on having at least 2 of the following risk factors above the 75th percentile of scores for their age, race, and gender group: body mass index, insulin resistance index, ratio of triglycerides to high-density lipoprotein cholesterol, and mean arterial blood pressure. Children who exhibited high hostility scores at baseline were likely to exhibit the metabolic syndrome at the follow-up. The results highlight the potential importance of early prevention and intervention of behavioral risk factors for cardiovascular disease.     

Attachment Disruptions,IQ, and PTSD in African American Adolescents: A Traumatology Perspective

Attachment disruptions, other traumas, posttraumatic stress disorder (PTSD), and intelligence quotient (IQ) were measured in a sample of 181 African American adolescents. Path analysis was utilized to test the effects of different types of attachment disruptions on IQ and PTSD. Findings supported that mother and father abandonments and being in foster care are associated with decreased perceptual reasoning, processing speed, and working memory, and increased discrepancy between perceptual and verbal toward decreased perceptual reasoning. Such suppression and discrepancy contribute to poor academic achievement. Results validated the traumatology perspective on attachment disruptions as traumas that are associated with PTSD, suppression of most IQ potentials, and with potential brain hemispheric desynchronization. The ramifications of these results for helping African American adolescents are discussed.     

Social anxiety disorder in veterans affairs primary care clinics

To examine the prevalence and correlates of social anxiety disorder (SAD) in veterans, 733 veterans from four VA primary care clinics were evaluated using self-report questionnaires, telephone interviews, and a 12-month retrospective review of primary care charts. We also tested the concordance between primary care providers’ detection of anxiety problems and diagnoses of SAD from psychiatric interviews. For the multi-site sample, 3.6% met criteria for SAD. A greater rate of SAD was found in veterans with than without post-traumatic stress disorder (PTSD) (22.0% vs. 1.1%), and primary care providers detected anxiety problems in only 58% of veterans with SAD. The elevated rate of comorbid psychiatric diagnoses and suicidal risk associated with SAD was not attributable to PTSD symptom severity. Moreover, even after controlling for the presence of major depressive disorder, SAD retained unique, adverse effects on PTSD diagnoses and severity, the presence of other psychiatric conditions, and suicidal risk. These results attest to strong relations between SAD and PTSD, the inadequate recognition of SAD in primary care settings, and the significant distress and impairment associated with SAD in veterans.     

Direct and moderating effects of community context on the psychological well-being of African American women

The effects of community characteristics on well-being were examined among 709 African American women. Direct and moderating effects of neighborhood characteristics on distress were tested. Aggregate-level ratings of neighborhood cohesion and disorder were significantly related to distress, although the relation between cohesion and distress became nonsignificant when individual risk factors were statistically controlled. Aggregate-level neighborhood variables interacted significantly with individual risk and resource variables in the prediction of distress, consistent with trait-situation interaction theories (D. Magnusson & N. S. Endler, 1977). Community cohesion intensified the benefits of a positive life outlook. Community disorder intensified both the benefits of personal resources and the detrimental effects of personal risk factors. Results showed evidence of resilience among African American women.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.     

Childhood Maltreatment and PTSD: Spiritual Well-Being and Intimate Partner Violence as Mediators

Childhood maltreatment places individuals, including African American women who are undereducated and economically disadvantaged, at risk for developing posttraumatic stress disorder (PTSD) symptoms. Participants were 192 African American women with a history in the prior year of both a suicide attempt and intimate partner violence (IPV) exposure. They were recruited from a public hospital that provides medical and mental health treatment to mostly low-income patients. A simple mediator model was used to examine if (a) existential well-being (sense of purpose) or religious well-being (relationship with God) mediated the link between childhood maltreatment and adult PTSD symptoms. Sequential multiple mediator models determined if physical and nonphysical IPV enhanced our understanding of the mediational association among the aforementioned variables. Findings suggest that existential well-being mediated the association between childhood maltreatment and adult PTSD symptoms in a simple mediator model, and existential well-being and recent nonphysical IPV served as sequential multiple mediators of this link. However, religious well-being and physical IPV were not significant mediators. Findings underscore the importance of enhancing existential well-being in the treatment of suicidal African American women with a history of childhood maltreatment and IPV.     

Racial/ethnic differences moderate associations of coping strategies and posttraumatic stress disorder symptom clusters among women experiencing partner violence: a multigroup path analysis

Background: Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).

Methods: Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.

Results: The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.

Conclusion: Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.     

Subjective Well-Being of Older African Americans with DSM IV Psychiatric Disorders

This study examined demographic and mental health correlates of subjective well-being (i.e., life satisfaction, happiness) using a national sample of older African Americans with psychiatric disorders. We used a subsample of 185 African Americans, 55 and older with at least one of thirteen lifetime psychiatric disorders from The National Survey of American Life: Coping with Stress in the Twenty-first Century. The findings indicated that among this population of older adults who had a lifetime psychiatric disorder, having a lifetime suicidal ideation was associated with life satisfaction but not happiness. Further, having a 12-month anxiety disorder or a lifetime suicidal ideation was not associated with happiness. Having a 12-month mood disorder, however, was negatively associated with an individual’s level of happiness, as well as their life satisfaction. Additionally, there were two significant interactions. Among men, employment was positively associated with life satisfaction, and marriage was associated with higher levels of happiness among men but not women. The overall pattern of findings reflects both similarities and departures from prior research confirming that well-being evaluations are associated with multiple factors.     

Racial Differences in Posttraumatic Stress Disorder in Military Personnel: Intergenerational Transmission of Trauma as a Theoretical Lens

Various theorists have explored how intergenerational transmission of trauma impacts minority groups. Intergenerational trauma theories suggest that trauma(s) endured by a community have long-standing effects that can be passed on through generations. However, much of the research has focused on indigenous populations or Holocaust survivors despite the historical experiences of the African American community. The minority stress model adds support to intergenerational trauma theories, in that racial minority groups might suffer worse health due to a variety of stressors. Racial minorities are also at greater risk of developing posttraumatic stress disorder (PTSD). Within military populations, PTSD is one of many mental health issues and has been labeled one of the signature injuries of the recent wars in Iraq and Afghanistan. However, the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for PTSD do not take into account the effects of intergenerational trauma, discrimination, or racism. This article proposes that intergenerational trauma theories and the minority stress model provide explanations for why many studies have found that African American military personnel have higher rates of PTSD compared to their White peers. Indeed, African American military personnel with PTSD might be better understood through more culturally inclusive frameworks (e.g., complex trauma, race-based traumatic stress), because the stressors they experience as racial minorities might exacerbate or lead to symptoms of PTSD.     

Does Bullying Victimization Suppress IQ? The Effects of Bullying Victimization on IQ in Iraqi and African American Adolescents: A Traumatology Perspective

This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, on intelligence quotient (IQ), posttraumatic stress disorder (PTSD), and complex PTSD symptoms. Participants were 390 African American and Iraqi refugee adolescents. Measures of BV, cumulative life trauma, PTSD, discrimination, and IQ were administered. Correlational, multilevel regression, and path analyses were conducted. BV, independent of cumulative trauma, and discrimination were found to have significant direct effects on increased PTSD symptoms and significant direct and indirect negative effects on perceptual reasoning, processing speed, and working memory. BV was also associated with increases in the discrepancy between perceptual reasoning and verbal comprehension. The implications of these results for the prevention and treatment of bullying victims are discussed.     

The impact of mental health problems and religiosity on African-American girls' HIV-risk

We investigated the relationship between religiosity, mental health problems, and two sexual risk behaviors-condom use and number of partners. Participants were 80 sexually active African American girls in psychiatric care and their caregivers. Results indicated differential relationships, depending on parent versus youth report. Mother's religiosity was positively related to girls' condom use and not to girls' number of partners. Controlling for other predictors in the models, mother's religiosity explained as much as 15% of the variance in girls' condom use. Whereas parent and adolescent reports of girls' depression/anxiety and rule-breaking were positively associated with number of partners, reports of aggression were associated with having fewer partners. Neither parent nor youth reports of girls' mental health problems were associated with condom use. Controlling for other predictors in the models, girls' mental health problems accounted for as much as 31% of the variance in number of partners. Findings underscore the importance of adopting an ecological framework to understand both the risk and promotive factors for sexual risk taking among troubled girls. The roles of specific aspects of psychopathology and religiosity in relation to sexual risk behavior among African American girls in psychiatric care are discussed.     

A comparison of African American and White American veteran MMPI-2 profiles

The present study compared a matched sample of 180 African American and 180 White American veterans who completed the MMPI-2 as a part of their evaluation while receiving inpatient psychiatric treatment. Findings indicated no significant multivariate or univariate effects associated with race on the basic validity and clinical scales, a significant multivariate effect but no significant univariate effects associated with race across the supplementary scales. Overall the two groups had very similar mean profiles across the basic validity, clinical, and supplementary scales. Comparison of the two groups on the content scales yielded a significant multivariate and significant univariate effects with African Americans scoring higher on the FRS, BIZ, CYN, and ASP scales. Because the two groups differed in terms of frequency and type of drug abuse, follow-up 2 x 2 univariate analyses of variance were conducted for the FRS, BIZ, CYN, and ASP content scales comparing participants classified in terms of presence or absence of a primary or secondary drug abuse diagnosis by race. A significant main effect associated with drug abuse was obtained for ASP. Results are discussed and considered in light of earlier research on the MMPI-2 and race. Content scale differences are also discussed in terms of possible differences in worldview.     

State Hospital Reentry Among Youth with Serious Emotional Disturbance: A Longitudinal Analysis

We investigated the demographic, service history, and clinical factors associated with readmission to state operated inpatient psychiatric hospitals by children and adolescents. Using computerized administrative data records for 3,969 consecutive index admissions of individuals between the ages of 7 and 17 inclusive, we examined hospital reentry among youth receiving services at these facilities. The univariate analysis comparing youths who reentered the hospital with those who did not reenter indicated that reentry was more likely to occur among African American youths and among those who were diagnosed with psychotic disorders. Reentry occurred less frequently among youths diagnosed with depressive disorders. Reentry also occurred less frequently among youths living in areas having an organized array of community-based mental health services. Youths who reentered the hospital were significantly older and had longer prior hospitalizations than those not reentering. The proportional hazards model used in the analysis indicated several factors associated with increased likelihood of hospital reentry. African American youths and individuals diagnosed with a psychotic disorder were more likely to reenter the hospital. Younger youths and those having lengthy prior hospitalizations were at increased risk for reentering the hospital. Youths living in urban, white, higher income communities were less likely to reenter the hospital.     

Health-protective effects of attachment among African American girls in psychiatric care

African American girls in psychiatric care are at increased risk for HIV and sexually transmitted infection (STI) through sexual risk taking. Adolescent sexual behavior often reflects peer norms and behavior. Secure attachment patterns with mothers and peers might lessen the effects of negative peer influences and reduce sexual risk taking among African American girls. This study examined the relationships among mother-daughter and peer attachment, peer norms, and sexual-risk behaviors in African American girls seeking outpatient psychiatric care. A group of 12-16-year-old African American girls (N = 262; M age = 14.45 years) reported on their attachment to their mothers and peers, peer risk-taking and dating behaviors, peer pressure, and sexual-risk behaviors (e.g., number of partners, high-risk partners, and condom use). Structural equation modeling examined whether peer attachment and peer norms mediated the relationship between mother attachment and sexual risk. Findings supported peer norms, but not peer attachment, as a mediator of mother attachment and girls' sexual-risk behaviors. Findings revealed important family and peer factors for African American girls in psychiatric care. HIV prevention programs may be strengthened by improving mother-daughter relationships, addressing the importance of peer relationships, and emphasizing how secure mother-daughter relationships can temper the impact of peer norms.     

Psychiatric and substance use disorders as risk factors for attempted suicide among adolescents: a case control study

The objective of this research was to test substance-related and non-substance-related psychiatric disorders as predictors of attempted suicide among adolescents. Ninety-six psychiatrically disordered suicide attempters were matched one-to-one to 96 psychiatrically disordered non-attempters on age, race, gender, and the presence/absence of major depression. Conditional logistic regression was used to test psychiatric risk factors for their power to predict attempted suicide among adolescents. Bipolar disorder, cocaine use disorders, and conduct disorder were found to be predictive of attempted suicide in univariate testing. Bipolar disorder, inhalant use disorders, cocaine use disorders, and hallucinogen use disorders were found to be predictive of attempted suicide, after adjusting for all other covariates. Loglinear analyses revealed high odds ratios associated with the comorbidities of alcohol use disorder with conduct disorder and drug use disorders with conduct disorder in both groups. Higher rates of cocaine use disorder/conduct disorder, hallucinogen use disorder/conduct disorder, and alcohol use disorder/ conduct disorder were found among suicide attempters. Evaluation of these particular comorbid conditions should be part of the adolescent suicide risk assessment.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

The relative contribution of abuse severity and PTSD severity on the psychiatric and social morbidity of battered women in shelters

Intimate partner violence (IPV) is a severe health problem associated with significant distress and impairment in women. The most common psychiatric difficulty in battered women is posttraumatic stress disorder (PTSD); however, no research to date has investigated the relative impact of the severity of IPV and IPV-related PTSD symptoms on battered women's psychosocial functioning. In a sample of 177 sheltered battered women, PTSD severity was associated with considerable psychiatric morbidity, social maladjustment, and personal and social resource loss. Moreover, PTSD severity mediated the relationship between IPV severity and psychiatric severity and loss of personal and social resources. Results highlight the need for the assessment and treatment of IPV-related PTSD in battered women's shelters.