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.     

Effective connectivity hierarchically links temporoparietal and frontal areas of the auditory dorsal stream with the motor cortex lip area during speech perception

A left-hemispheric cortico-cortical network involving areas of the temporoparietal junction (Tpj) and the posterior inferior frontal gyrus (pIFG) is thought to support sensorimotor integration of speech perception into articulatory motor activation, but how this network links with the lip area of the primary motor cortex (M1) during speech perception is unclear. Using paired-coil focal transcranial magnetic stimulation (TMS) in healthy subjects, we demonstrate that Tpj → M1 and pIFG → M1 effective connectivity increased when listening to speech compared to white noise. A virtual lesion induced by continuous theta-burst TMS (cTBS) of the pIFG abolished the task-dependent increase in pIFG → M1 but not Tpj → M1 effective connectivity during speech perception, whereas cTBS of Tpj abolished the task-dependent increase of both effective connectivities. We conclude that speech perception enhances effective connectivity between areas of the auditory dorsal stream and M1. Tpj is situated at a hierarchically high level, integrating speech perception into motor activation through the pIFG.     

Respecting autonomy in difficult medical settings: a questionnaire study in Japan

Some people in Japan are still comfortable with the paternalistic role of doctors, but others wish that their own decisions would receive a greater amount of respect. A total of 747 students of universities and colleges and 114 parents of these students participated in a questionnaire survey. Most of the participants thought that autonomy should be respected in situations involving death with dignity and euthanasia, whereas it should not be respected in attempted suicide and involuntary admission of individuals with mental illness. A cluster analysis revealed that the participants could be divided into the following groups: aid in dying advocates (n=577), complete libertarians (n=109), protectors of the mentally ill (n=90), complete paternalists (n=29), and questionables (n=27). The assertion of independence score of the Scale for Independent and Interdependent Construal of the Self showed a significant difference among the 5 clusters. These findings suggest that the traditional paternalistic relationship between doctor and patient is undergoing a gradual transformation in Japan.     

Health-Related Quality of Life during COVID-19 Pandemic: Assessing Impacts of Job Loss and Financial Support Programs in Japan

This cross-sectional study examined the association between job loss during the coronavirus disease 2019 (COVID-19) pandemic and health-related quality of life (HRQOL) in the Japanese working population and whether universal financial support program has a protective influence on the HRQOL. Two self-reported internet surveys were used to determine job loss during the pandemic: one was conducted between February and March 2020, just before the COVID-19 emergency declaration by the Japanese government (April 2020), and the other was conducted between August and September 2020. For the dependent variable, we used the EQ-5D-5L utility score (QOL utility score), which was assessed between August and September 2020. The independent variables were job loss after the state of emergency was declared and two types of government financial support (either universal support or support targeting child-raising households). The Tobit regression model was applied, adjusting for covariates. Job loss during the pandemic was negatively associated with the QOL utility score in the fully adjusted model; the coefficient (95% confidence interval [CI]) for job loss during the pandemic was −0.07 (−0.11 to −0.03). For the government financial support variables, the universal financial support program was associated with a better QOL utility score of the coefficient (95% CI), 0.05 (0.03 to 0.08). Job loss during the COVID-19 pandemic is negatively associated with HRQOL, while universal financial support is positively associated with HRQOL. Our study results imply that universal financial support during the COVID-19 era has a protective influence on an individual’s HRQOL.