Youth Suicide Trends in California: An Examination of Immigrant and Ethnic Group Risk

Although immigrants are in better health than the U.S.-born population according to a variety of indicators, little research has investigated current foreign-born/U.S.-born differentials in suicide. A review of 32,928 California death certificates from 1970 to 1992 indicates that although foreign-born persons are consistently underrepresented in the suicide deaths of 15- to 34-year-olds (risk ratio = 0.60), any foreign- versus U.S.-born difference by ethnicity appears to be decreasing. Specifically, although Hispanics born outside the United States consistently are at significantly lower risk of suicide than U.S.-born Hispanics, the discrepancy between the two groups has diminished over time. And, in a comparable trend, non-Hispanic white persons born outside the United States were at higher risk of suicide than their U.S.-born counterparts until 1990, when their risk became similar. Black and Asian/other foreign- and U.S.-born persons have been at statistically similar risk since 1970. A man using a firearm at home was the typical pattern for both the foreign- and U.S.-born.     

Prevalence of suicide attempts in a Mexican-American population: prevention implications of immigration and cultural issues

Self-reported suicide ideation and suicide attempts were examined among 2,393 Mexican-Americans (706 born in Mexico, 538 born in the United States) and non-Hispanic whites (1,149 born in the United States). Mexican-Americans born in Mexico reported significantly lower age- and gender-adjusted lifetime rates of suicide thoughts (4.5%, 2.7-6.3%) than Mexican-Americans born in the United States (13.0%, 10.0-15.9%), who reported significantly lower rates than non-Hispanic whites born in the United States (19.2%, 17.4-21.0%). Adjusted rates of suicide attempt were lowest among Mexican-Americans born in Mexico (1.6%, 0.6-2.6%) and higher among both Mexican-Americans (4.8%, 2.4-7.2%) and non-Hispanic whites (4.4%, 3.4-5.4%) born in the United States. Rates were not affected by degree of acculturation when immigration status was controlled. High schools and the Catholic church are suggested as sites for programs designed to prevent suicide and suicide attempts among Mexican-Americans.     

Using the Linehan Risk Assessment and Management Protocol With a Chronically Suicidal Patient: A Case Report

The Linehan Risk Assessment and Management Protocol (LRAMP) is an empirically supported, comprehensive framework used to assess suicide risk and protective factors, and provide a guide for the therapist to consider reasonable options for intervening on suicidal behavior. This protocol includes a structured checklist for assessing, managing, and documenting suicide risk. It also structures the documentation to clearly describe the presentation, assessment, in-session interventions, decision-making process, and follow-up to other members of the treatment team. This paper describes a case in which the LRAMP was used to guide the assessment, intervention, and documentation of the suicidal behavior of a patient, “Ann,” being treated with outpatient Dialectical Behavioral Therapy in a community mental health clinic. Each section of the LRAMP is discussed as it was used with this complex patient, who had history of high utilization of acute psychiatric services. Application of the LRAMP included the assessment of risk and protective factors, and the use of an individualized crisis plan that engaged the patient, her family, the therapist, and the clinical team, to decrease acute risk, continue outpatient treatment, and avoid inpatient hospitalization. The considerations for documenting clinical decision-making with chronically suicidal patients are discussed.     

CF carrier testing: Experience of relatives

Consensus exists that genetic counseling and CF carrier testing should be offered to individuals with a positive family history of CF. To learn more about their experience with genetic counseling and testing we conducted a series of structured telephone interviews and focus group discussions with individuals and couples who had undergone genetic counseling and carrier testing because of a family history of CF. Traditional genetic counseling appears to have been effective for this population. Subjects generally report having a positive counseling experience and few difficulties upon learning their carrier status. Subjects were quite knowledgeable about CF and their carrier risk and were highly motivated to seek testing. They may not be representative of all individuals with a family history of CF however. For carriers, concerns about whether and when to have children tested, and concerns about insurance implications of carrier status may emerge sometime after the initial counseling. Strategies for addressing these concerns and for providing efficient and effective education and genetic counseling for people with a family history of CF need to be developed.     

School Counselors and Consultants: Legal Duties and Liabilities

This article provides an overview of legal issues and problems salient to school counselors who provide direct services to students or indirect services through consultation. Among legal issues addressed are privacy, confidentiality, and privilege—conceptually distinct topics that in practice often overlap. Also covered are legal duties pertaining to handling student records, conducting research projects, reporting child abuse, and testing and placing students. Among the legal liabilities discussed are those arising from contract, tort, and criminal law and from violations of federal constitutional and statutory rights.     

Ongoing change in psychoanalytic theory implications for analysis of religious experience

Hans Loewald (1980) once made the distinction between ghosts and ancestors, the former always wanting to return to the land of the living, the latter being able to rest in peace and live forth through their progeny in the present generation. Extending this metaphor, Stephen Mitchell (1991) has noted that the intellectual integrity and vitality of psychoanalysis depends on our shifting our view of Freud from an unburied ghost who haunts us to an honored ancestor. I argue that perhaps nowhere is Freud's enduring presence greater than in psychoanalytic perspectives on religion, and it is often as an unburied ghost. Ongoing change in psychoanalytic theory, however, affords respectful amendment to his work in a way that allows Freud to be a dearly honored ancestor from whom we are all psychoanalytic descendents. Three developments in psychoanalytic theory have special implication for the analysis of religious experience. These areas of change pertain to contemporary understanding of illusion, narrative, and social constructivism. I offer in conclusion seven points for further consideration.     

gang membership,race, and social class: a test of the group hazard and master status hypotheses

This article examines the extent to which gang membership, race, and social class affect a youth's chances of being arrested, independent of their self-reported delinquent behavior. We couple the concepts of group hazard and master status to frame our theoretical predictions. Using data from the Seattle Youth Study (Hindelang, Hirschi, and Weis 1981), we find that the odds of being arrested are roughly similar for gang and nongang members, controlling for the nature and level of self-reported delinquency. While being a gang member does not pose a group hazard to being arrested, a youth's master status based on race and social class is associated with arrest risk. Both being black and lower class increases a youth's odds of being arrested, independent of delinquency. Neither race nor class effects can be accounted for by the frequency with which youth hang out with their best friends. We propose several recommendations for reducing race and class profiling.     

Factor analytic evaluation of differences between black and caucasian emotionally disturbed children on the children's depression inventory

Scores on the Children's Depression Inventory (CDI) for 392 Caucasian and 159 black psychiatric inpatients between 6 and 18 years of age were subjected to principal-components factor extraction with Varimax rotation. Factors not contributing to variance were eliminated using the scree test (Cattell, 1966) and the degree of variance accounted for by remaining factors for both groups was examined through respective squared multiple correlations. A comparison of CDI factors for blacks and Caucasians indicated some differences, with blacks be ing less suicidal yet higher on other behavioral dimensions, such as oppositionality, and Caucasians higher on affective dimensions, such as sadness. The results support research on black-Caucasian differences and suggest the need to validate further the CDI with minority populations.