Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.     

Qualitative Study of Suicidality and Help-Seeking Behaviors in African American Adolescents

This qualitative study explores adolescents’ perceptions of help-seeking behaviors in the context of a hypothetical suicide crisis. Cauce and colleague’s (2002, Journal of Consulting and Clinical Psychology, 70, 44–55) model was used to examine help-seeking behaviors in 3 domains: problem recognition, decision to seek help, and selection of helpers. Forty-two church-going African American adolescents participated in 1 of 6 focus groups that discussed ways to help a hypothetically suicidal student in a vignette. Findings suggest that although the majority of youth had been exposed to a suicidal peer (76%), they were unsure of the seriousness of suicide as a problem in the African American community. The findings suggest that youth were less comfortable with formal interventions in school, religious institutions or traditional mental health settings. However, youth were open to community-based programs that could be located in school, church or community settings if helpers were: young adults, empathic listeners, non-judgmental, maintained confidentiality, and viewed as “natural helpers”. Implications for developing church-based suicide interventions are discussed. This study was supported by a K-01 Career Development Award from NIMH     

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.     

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.     

Women in Cultural Transition: Suicidal Behavior in South African Indian Women

Young South African Indian women are a population with relatively high rates of suicidal behavior. This article presents three illustrative case studies of nonfatal suicidal behavior by South African Indian women. The cases are discussed in relation to a review of epidemiological, historical, and sociocultural perspectives on South African Indian women. It is argued that suicidal behaviors in this group can be understood in the context of sociocultural transition. Transitional tensions between traditional Indian culture and Westernization have an impact on traditional gendered power relations and generate conflicts that have intrapsychic and interpersonal consequences for women and for men. These in turn may have adverse effects on marital functioning, quality of life, and specific aspects of emotional functioning, which have been identified as precursors of suicidal behavior. The case studies are discussed with reference to gender narratives. Implications for prevention, intervention, and future research are discussed.     

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.     

African American women—education for what?

The article examines the long commitment of the black community to the education of its women as a tool toward liberation and the resulting emergence of a new genre of American intellectualism. The article explores the role of women as carriers and creditors of African American culture in the community, while distinguishing between intellect workers (those who distribute and apply culture) and intellectuals (those who create culture). In addition, the article explores how African American women, while providing a perspective of their own, have been uniquely able to bridge the concerns of black men and white women. It is the emergence of this new American radical intellectualism, as represented by African American women, that potentially comprises a significant and critical force within the American ideology. This new intelligentsia, the article surmises, is only limited by the prejudices and discrimination present in a racist, sexist, and classist society.     

Mediators of the Daily Hassles–Suicidal Ideation Link in African American Women

Depressive symptoms and hopelessness as mediators of the daily hassles–suicidal ideation link in low‐income African American women exposed to intimate partner violence (n = 100) were investigated. As hypothesized, daily hassles, depressive symptoms, and hopelessness were each significantly and positively associated with suicidal ideation. Moreover, the relation between daily hassles and suicidal ideation was, in part, accounted for by depressive symptoms and hopelessness. This study demonstrates the importance of assessing for the presence of these risk factors when determining the likelihood that an abused African American woman will consider suicide. The findings further highlight the value of designing and implementing interventions that target the reduction in depressive symptoms and hopelessness in abused African American women exposed to daily hassles to reduce their suicide risk.     

The prevalence of suicidal behaviors among Northern Plains American Indians

This study examined the prevalence of suicidal behaviors among 1,638 Northern Plains American Indians ages 15-57. Age and gender patterns were investigated as was comorbidity with psychiatric and substance use disorders. Data from a population-based survey indicated that suicidal behaviors were more frequently reported among females than males and among younger respondents than older respondents. In addition, suicidal behaviors were associated with depressive disorders, PTSD, substance abuse/dependence, and violent ideation/aggression. Results underscore the importance of effective and acceptable alcohol, drug, and mental health services in reducing the rates of suicidal behaviors in American Indian communities.     

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.     

Community and Christianity in the Black Church

The authors explore the experience of Christian religion for many African Americans. In response to racial discrimination and prejudice within churches, African Americans developed a Christian tradition with distinct meanings, beliefs and practices. This tradition provides a foundation for social activism within the church, community and American society, as well as community among church members. The recent Black church burnings are discussed with respect to the more traditional Christian African American view of religion. Implications for incorporating the religious traditions of Christian African Americans into counseling practice are explored. (The authors use the term Black church or African American church as a surrogate for Christian African American church throughout the article. The terms Black and African American will also be used interchangeably).     

An empirical investigation of acculturative stress and ethnic identity as moderators for depression and suicidal ideation in college students

The purpose of this study was to explore the relationships of acculturative stress and ethnic identity to depressive symptomatology and suicidal ideation in college students. The SAFE Acculturative Stress Scale, Multi-Group Ethnic Identity Measure, Beck Depression Inventory, and Beck Suicide Scale were administered to 452 college students. The authors found that acculturative stress and ethnic identity moderated the depression-suicide ideation relationship for African American but not European American college students. Given that vulnerability toward suicidal thoughts is increased for African American college students who report symptoms of depression accompanied by either high-acculturative stress or poor group identity, these culturally relevant factors should be included in protocol for suicide risk assessment.     

Suicidal behavior inLatinas: explanatory cultural factors and implications for intervention

We posit that the high rates of suicidal behavior by teenage Hispanic females reported in large-scale surveys can be understood as a cultural phenomenon, a product of specific elements of the history, tradition, ideology, or social norms of a particular society, and that treatment interventions must take family and cultural factors into consideration. For over a decade, surveys have reported that among ethnic and racial minority youth in the United States, Latinas have the highest rates of suicidal behavior compared to African American and non-Hispanic White adolescent females. However, other research shows that the psychological profiles of suicidal Latina adolescent girls and the risk factors for Latina suicidal behavior may not be that different from non-Hispanic suicidal adolescent females. The unique situation of adolescent Latinas involves the convergence of cultural and familial factors (i.e., familism, acculturation, relatedness, autonomy, etc.) with the developmental, social, and individual factors frequently associated with suicidal behaviors. Based on this background, family-oriented interventions appear to be the most appropriate approach to the prevention and treatment of Hispanic suicidal girls. Factors implicated in Latina suicidal behavior and community-based interventions that include the adolescent and her family are suggested.     

Race, Culture, and Ethnicity: Implications for a Community Intervention

We present an overview of research on African American families and emphasize in this discussion limitations of approaches used in the past to study African American families. We also discuss and identify challenges for designing and implementing community, family-based programs targeting competence-promoting behaviors in African American families. In addition, we attempt to accomplish the following objectives: (1) identify themes in studies of African American families, including bias in prior research; (2) discuss ways in which prior approaches and conceptual models guiding studies of African Americans have created challenges for the development and implementation of community-based intervention and research programs; and (3) present the Parents Matter! Program as an example of a community-based prevention effort that attempted to overcome many of the challenges created by prior research efforts.     

Conceptualizations of Social Class in Afrtican American Women:

This article addresses the multiple definitions of social class in African American people and how the therapist's understanding of these definitions is important in therapeutic interventions with African American women. The article discusses: (a) the traditional ways in which social class has been defined in social science and the limits of these conceptualizations; (b) the multiple definitions of class within the African American community; and (c) treatment concerns for African American women based on class issues. Clinicians working with African American and other women who vary by class should be able to assess how class variables influence their therapeutic interventions with these women.     

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.     

A Family Strengths Model of Adjustment to Disability for African American Clients

Sociocultural factors germane to African American families need to be recognized and incorporated into the counseling process of African Americans with disabilities. It is imperative that counseling professionals develop a thorough understanding of the family, community, and cultural ecologies of African Americans who are disabled. This article includes an analysis of the African American family system and its inherent strengths. A family strengths model of adjustment to disability for African American clients is presented, and potential applications of the model to the adjustment process are provided.     

Validity of the Self-Harm Behavior Questionnaire with Diverse Adolescents

Suicide and non-suicidal self-injurious behavior (NSSI) continue to be significant health problems for adolescents. Although there are many instruments available to assess self-harm behaviors, few have been validated for use with adolescents, and even fewer have been validated for use with different racial/ethnic groups. The Self-Harm Behavior Questionnaire (SHBQ) assesses NSSI, suicidal ideation, suicide threats, and past suicide attempts. Data from 1,386 racially/ethnically diverse adolescents (57.5% minority) were collected to examine the validity of the SHBQ in this age group. Analyses supported the four-factor structure, revealed the SHBQ is internally consistent, and provided evidence for convergent validity within Caucasian, African American, and Hispanic adolescents. However, slight differences were noted. Overall, the findings suggest the SHBQ is a useful assessment tool appropriate for use with Caucasian, African American, and Hispanic adolescents.     

Empowerment,Leadership, and Sustainability in a Faith-Based Partnership to Improve Health

Community-based participatory research is a noted approach for improving community health and reducing health disparities. Community partnerships can serve as a catalyst for change in public health efforts. This article will apply empowerment theory and sustainability principles to an existing faith-based partnership. BRANCH Out is a partnership among 13 African American churches, the City of Milwaukee Health Department—Community Nutrition, and the Medical College of Wisconsin. The partnership goal was to change inaccurate perceptions, knowledge and negative attitudes, and behaviors about chronic disease and promote healthy youth leadership. Faith-based empowerment can occur at the individual, organizational, and community level. BRANCH Out demonstrates how partnerships can be sustained in multiple ways. The partnership also highlights the unique contributions of churches to community health outcomes.     

Implications of an Africentric Worldview in Reducing Stress for African American Women

Despite the extensive research on stress in recent decades, including the emphasis on stress mediation and reduction, epidemiological studies indicate that African American women continue to experience high rates of morbidity and mortality because of stress and stress-related diseases. With growth in the conceptualization and articulation of an Africentric perspective for defining the functioning of African American people, in this article the authors explore the idea of an Africentric worldview as a means for reducing stress among African American women. Considering that cognitive appraisals define the situations that individuals experience and considering that worldview is the lens through which experience is viewed, restructuring worldview can alter the cognitive appraisals of potential stressful situations. Africentric worldview provides a framework for affirming African American and women's beliefs and behaviors. The authors propose that the framework has the potential to counter the negative images that often result in stressful appraisals of an oppressive and hostile environment.