Suicide, negative interaction and emotional support among black Americans

Chronic stress exposure, social support, and sleep quality among African Americans: findings from the National Survey of American Life-Reinterview

OBJECTIVE

The purpose of this study was to determine whether social support from extended family and church members moderate the association between chronic stress exposure and sleep quality in a nationally representative sample of African American adults.

DESIGN

Data from African American respondents aged 18 and older were drawn from the National Survey of American Life-Reinterview. The analytic sample for this study included 1,372 African American adults who attended religious services at least a few times a year, as the church-based relationship measures were only assessed for these individuals. Self-reported sleep quality was assessed by sleep satisfaction, trouble falling asleep, and restless sleep. Chronic stress exposure was measured by a nine-item index. OLS and logistic regression were used to estimate the relationship between chronic stress exposure, extended family and church relationships, and sleep quality.

RESULTS

The data indicated that chronic stress exposure was associated with decreased sleep satisfaction, increased likelihood of trouble falling asleep and restless sleep. Receiving emotional support from family and more frequent contact with church members were associated with decreased restless sleep. Emotional family support moderated the associations between chronic stress exposure and trouble falling asleep and restless sleep. The positive associations between chronic stress exposure and these two sleep quality measures were attenuated among respondents who received high levels of emotional support from their family.

CONCLUSIONS

Together, these findings underscore the detriment of chronic stress exposure to African Americans' sleep quality and suggest that extended family members are effective stress coping resources and play an important role in this population's sleep quality.

Do We Belong? Examining the Associations Between Adolescents' Perceptions of School Belonging, Teacher Discrimination, Peer Prejudice and Suicide

In the USA, suicide is a leading cause of death for adolescents ages 12 to 18 (National Institute of Mental Health (NIMH), 2019). Given the urgency of this public health crisis, this paper aims to explore the impact of a sense of school belonging and teacher-based discrimination and peer-based prejudice on suicidal ideation and attempts among Black youth. This secondary analysis used a sample of Black youth (N = 4229; Mage = 16) from the National Longitudinal Study of Adolescents to Adult Health data. Independent variables included a sense of school belonging, school-based teacher discrimination, and school-based peer prejudice; the dependent variable was suicidal thoughts and behaviors. The results of multinomial regression analyses revealed that as Black adolescents' sense of school belonging decreased, they were 35% more likely to be at risk for suicidal ideation and attempts. Findings from our study support the assertion that the school microsystem plays a substantial role in modifying the risk of suicidal behavior among Black youth.

Religion and Suicide in Black Emerging Adults: Examining Pathways Through Hope and Meaning in Life

While suicide persists as a leading cause of death for Black emerging adults in the U.S., few studies identify specific positive psychological mechanisms that can be leveraged to reduce future risk. The current study, therefore, explores whether religion is related to suicidal ideation via hope and meaning in life among a sample of n = 375 Black emerging adults ages 18-25-years-old (M = 20.79, SD = 2.22). Structural equation modeling techniques were used to measure direct and indirect associations. Primary results indicate that non-organizational religiosity (e.g., reading religious texts, listening to religious music, prayer) was positively associated with hope, presence of meaning in life, and search for meaning in life. Presence of meaning in life was the strongest contributor to decreased suicidal ideation. Further, non-organizational religiosity was indirectly associated with less suicidal ideation via hope and presence of meaning in life. Personal forms of religious involvement, and not service attendance, appear to be the most salient aspects of religion to consider when exploring pathways between religion and suicidality during this particular developmental stage.

Peer-Written Caring Letters for Veterans after a Suicidal Crisis

OBJECTIVE

In the evidence-based suicide prevention intervention, Caring Letters, healthcare providers send brief, caring messages to patients following psychiatric inpatient care, a time of elevated suicide risk. However, recent studies with military populations have found mixed results. An adaptation of Caring Letters employed a peer framework in which veterans from the community wrote brief caring messages to veterans discharging from psychiatric inpatient treatment after a suicidal crisis.

METHODS

The present study utilized content analysis to assess 90 caring messages generated by 15 peer veterans recruited from veteran service organizations (e.g., American Legion).

RESULTS

Three themes emerged: (1) Shared Military Service, (2) Care, and (3) Overcoming Adversity. Peer-generated content varied in how the coded themes were expressed in the messages.

CONCLUSION

These veteran-to-veteran caring messages may bolster belongingness, social support, and destigmatize mental health struggles, and have the potential to augment existing Caring Letters effects and interventions.

Building stronger bonds: The impact of family support and communication on suicidal behaviors among Black men who have sex with men

INTRODUCTION

It has been well documented that men who identify with a sexual orientation other than heterosexual are at a greater risk for suicide-related outcomes. What is less known are the protective factors that can reduce such negative outcomes and contribute to their resilience.

METHODS

This study used data collected between December 1, 2021, and January 2022 to understand how family factors contribute to or prevent depression symptoms and suicide outcomes among young Black men who have sex with men (BMSM) ages 18 to 29 (N = 400). A path analysis was conducted to explore the direct and indirect effects of suicide attempts.

RESULTS

Surprisingly, there were nuanced findings that showed having a family member or friend die by suicide was indirectly associated with suicide planning and suicide attempts. It was also unexpectedly noted that there was a positive relationship between higher rates of depressive symptoms and higher levels of support from family members.

CONCLUSIONS

The population focused on in this study is understudied and has unique needs. Identifying familial support may not automatically reduce the thoughts and plans of young BMSM, which is an example of why their intersecting marginalized identities must be considered when conducting further research, creating interventions, and providing therapeutic services.

Associations Between Family Factors, Social Integration, and Suicidal Ideation Across the Life Course of an Urban African American Cohort

Suicide is a problem on the rise but not studied extensively among African Americans. It is critical to identify risk factors for suicidal ideation to reduce risk. This study examines whether family and social factors over the life course predict suicidal ideation among African American adults in midlife. We conducted multiple logistic regression analyses on data from a longitudinal cohort of African Americans first assessed in childhood to identify associations with suicidal ideation in midlife (ages 33-42). Findings suggested living without one's mother in childhood (vs. living with mother alone; aOR = 3.69, p = .017) and parental rule-setting in adolescence (aOR = 0.79, p = .047) were associated with suicidal ideation. Having a lifetime drug disorder (aOR = 2.19, p = .046) or major depression by young adulthood (aOR = 3.58, p < .001) was also associated with an increased risk of suicidal ideation. Findings highlight the importance of intervention for children in mother-absent homes for improving mental health outcomes. Family interventions that promote parental rule-setting and addressing drug problems and depressive symptoms early in the life course offer an area for intervention to reduce suicide over the long term.

Family and peer support moderates the relationship between distress tolerance and suicide risk in black college students

ObjectivesThe relationship between distress tolerance and suicide risk was examined in black college students, as well as the moderating role of family and peer support in this relationship. Parent and peer support were studied separately in their relationship to overall suicidality.MethodOne-hundred twenty-five Black undergraduate students completed self-report measures that assessed study variables.ResultsUsing moderation analyses, distress tolerance was significantly associated with overall suicidality, such that increased tolerance was associated with decreased risk. Higher family support was significantly associated with decreased suicide risk, while peer support was not. However, both family and peer support significantly moderated the relationship between distress tolerance and suicide risk. For both types of support, the relationship between distress tolerance and suicide risk was significant when support was low.ConclusionsSocial support appears to be an important protective factor for suicide risk in black college students.

The Role of Church Support Networks in the Relationship between Discrimination and Psychiatric Disorders among Older African Americans

BACKGROUND

Few studies have examined the effects of discrimination on mental health specifically among older African Americans despite it being a common experience in this population. Further, knowledge on social resources, such as social relationships, that could mitigate the effects of discrimination is limited in this population. Given the historical and contemporaneous importance of the Black church in African American communities, church members are important support network members and a major source of social support for older African Americans.

PURPOSE

To address these knowledge gaps, this study will (1) examine the association between racial discrimination and psychiatric disorders; and (2) determine whether church relationships moderate the impact of racial discrimination on psychiatric disorders.

METHODS

Data from African American respondents aged 55 and older were drawn from the National Survey of American Life (N = 837). Church relationship variables included receipt of emotional support from, frequency of contact with, and subjective closeness to church members. Regression analyses were used to test the study aims.

RESULTS

Analyses indicated that more frequent experiences of racial discrimination were associated with meeting criteria for any DSM-IV disorder and a greater number of DSM-IV disorders. Significant interactions revealed that frequency of contact with and subjective closeness to church members mitigated the association between discrimination and meeting criteria for any 12-month disorder and number of 12-month disorders.

CONCLUSIONS AND IMPLICATIONS

Altogether, these findings support the literature on the detrimental effects of discrimination on the mental health of older African Americans and provide a more nuanced understanding of the role of church members in the lives of older African Americans. The study findings suggest that church relationships are effective stress coping resources for older African Americans dealing with discrimination. Given the importance and relevance of church members, initial clinical assessments should assess clients' level of religious involvement and relationships with church members.

How spousal physical abuse impacts suicidal ideation among community-dwelling older adults: the effects of protective factors

PURPOSE

The purpose of this study is to examine the impact on suicidal ideation (SI) of having experienced spousal physical abuse and the possible effects of protective factors on the relationship between depressive symptoms and SI among community-dwelling older adults.

METHODS

Using Wisconsin Longitudinal Study data (N = 6,125), a path analysis was conducted to examine the impact of spousal physical abuse on SI and test the possible effects of protective factors.

RESULTS

First, the experience of spousal physical abuse had a significant impact on both depressive symptoms and SI. Second, problem-focused coping, social support, and having a family confidant reduced depressive symptoms directly and mitigated SI indirectly. Third, emotional-focused coping had both direct and indirect effects on depressive symptoms and SI, leading to increases in both. Fourth, although the practical significance may be small, emotional-focused coping worked as a moderator between depressive symptoms and SI.

CONCLUSIONS

Interventions are necessary to increase protective factors and decrease risk factors of depressive symptoms and SI among older adults. In addition, regular screening tests of Intimate Partner Violence, depressive symptoms and SI are recommended.

Profiles of sleep and depression risk among Caribbean Blacks

Objectives: Sleep problems are associated with a host of psychiatric disorders and have been attributed to race disparities in health and wellness. Studies of sleep and mental health do not typically consider within-group differences among Blacks. Thus, our understanding of how the sleep-mental health relationship among Caribbean Blacks is limited. This study identified sleep profiles among Caribbean-born Blacks who reside in the United States.Design: Latent class analysis and data from the National Survey of American Life Re-interview study were used to identify and compare the associations between 'sleep quality classes,' sociodemographic factors, stress, and depression risk among Caribbean Blacks.Results: Two sleep quality classes were identified - 'good sleep quality' and 'poor sleep quality' - with each class demonstrating a complex pattern of sleep experiences, and illuminating the association between sleep and depression risk.Conclusions: Findings provide insight into the influence of sociodemographic factors and social stressors on the sleep experience of Caribbean Blacks and the importance of considering within-group differences to better understand risk and resilience among Caribbean Blacks living in the United States. Findings also highlight the importance of screening for sleep problems in an effort to reduce the burden of depression experienced by this population.

Suicidal ideations and Attempts Within the Family Context: The Role of Parent Support, Bonding, and Peer Experiences with Suicidal Behaviors

The rate of suicidality is increasing faster in Black American youth than in any other group in the USA. Researchers have found that family-level factors are important environmental factors for predicting depression and anxiety among Black youth, but less is known about how family- and friendship-level factors are associated with suicidal ideation and attempts among Black youth. This secondary analysis used the data from the National Longitudinal Study of Adolescents to Adult Health with a sample of Black adolescents (N = 4232) with a mean age of 16 years. The predictors included parental and other contextual factors on the outcome, which was suicidal behaviors. A multinomial analysis was employed to assess which factors contributed to or prevented suicidal behaviors. Our results indicated that parental support was significantly and positively associated with reporting suicidal ideation and attempts. The results indicated that Black youth with a decrease in parental support were 41% more likely to report ideation and 68% more likely to report attempting suicide compared to those reporting no parental support. Findings from our study support the assertion that the influence from the familial microsystem is pronounced in modifying suicidal behavior of Black youth.

Suicide, Race, and Social Work: A Systematic Review of Protective Factors among African Americans

Purpose: Suicide among African Americans has increased significantly in the past 15 years, yet it remains a neglected topic in social work research. This systematic review examines social work's contribution to suicide research while focusing on the social context in which African Americans live.Method: Using a critical race theory, we examine protective factors specific to African Americans that may mitigate suicide risks. Results reveal that the social work profession has produced 20 suicide-related studies between 1980 and 2018.Results: Identify three types of protective factors against suicide among African Americans. These are: micro-level factors (private regard / strong African American identity and impulsive response to discrimination), mezzo-level factors (family support and the role of women), and macro-level factors (social support, poverty and lack of awareness, religion, access to care, and internal response to community violence).Conclusion: Finding demonstrate evidence of the relationship between protective factors and suicide among African Americans. Implications for the use of Critical Race Theory in Social Work research and practice are provided along with implications to advance suicide training in social work education programs.

Race, Family Conflict and Suicidal Thoughts and Behaviors among 9-10-Year-Old American Children

Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US.

Everyday Discrimination, Depressive Symptoms, and Suicide Ideation Among African American Men

Suicide has remained a leading cause of death among African American males, yet empirical investigations that focus on the experiences of this group are limited. Therefore, we aim to interrogate the impact of everyday discrimination as a risk factor for depressive symptoms and suicide ideation among African American men. Data were drawn from the African American male subsample of the National Survey of American Life (n = 1,271). Path analysis and tests for indirect effects were used to examine relationships between everyday discrimination, depressive symptoms, and suicide ideation. Three sources of everyday discrimination were examined (any everyday discrimination, race-based everyday discrimination, and other everyday discrimination). Study findings revealed that race-based everyday discrimination was the only type of discrimination that was significantly associated with both increased rates of depressive symptoms and suicide ideation. Further, the indirect effect from race-based everyday discrimination to suicide ideation via depressive symptoms was also statistically significant. Thus, the impact of daily encounters with discrimination extends beyond depressive symptoms and is related to higher rates of suicide ideation. Moreover, experiences with discrimination do not have to be overt to be harmful toward African American men's mental health. Culturally relevant suicide prevention interventions are needed to account for the role of discrimination in the lives of African American men.

"What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults

A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.

Protective factors against suicidal ideation among community-dwelling older adults with experience of spousal physical abuse: focusing on direct and indirect protections

Purpose of the Study: The current research investigated the impact of protective factors - problem-focused coping, emotion-focused coping, having as a confidant either family or friends, and social support from friends - on suicidal ideation among older adults using Wisconsin Longitudinal Study (WLS) data. This study also investigated the indirect effects of protective factors on suicidal ideation (hereafter SI) as mediated by depressive symptoms among older adults who have experienced physical abuse from a spouse or romantic partner.Method: Data from The Wisconsin Longitudinal Study (WLS) were used. The sampled respondents were 475 men and women ages 64 to 65 who reported a history of being physically abused by a spouse or romantic partner. A path analysis using Mplus was employed to identify protective factors against SI.Results: Problem-focused coping and social support had negative indirect effects on SI as mediated by depressive symptoms. Emotion-focused coping had positive direct and indirect effects on SI.Conclusion: Tailored services to boost protective factors and regular screening tests are imperative to reduce depressive symptoms and SI among older adults who have experienced spousal or romantic partner physical abuse.

Objective and Subjective Social Isolation and Psychiatric Disorders among African Americans

Social isolation is a major problem in the United States that has adverse impacts on health and well-being. However, few studies investigate social isolation among African Americans or the impact of social isolation on psychiatric disorders. This study addresses this gap by investigating the impact of objective (absence of contact with others) and subjective (lacking feelings of closeness to others) social isolation on psychiatric disorders among African Americans. The sample includes 3,570 African Americans from the National Survey of American Life. Regression models were used to test the impact of objective and subjective isolation on 12-month MDD, any 12-month DSM disorder and number of 12-month DSM disorders. Analyses indicated that subjective isolation from family only, friends only, and both groups were associated with greater odds of meeting criteria for 12-month MDD, any 12-month disorder and number of 12-month DSM disorders. However, objective isolation was unrelated to either measure of psychiatric disorder. Study findings indicate that affective characteristics of social isolation (feelings of closeness with family and friends) are more significant for psychiatric disorders than are objective features (social contact). Our discussion notes that the connections between subjective and objective social isolation and psychiatric disorders are complex and potentially reciprocally associated with one another. Clinical practice should focus on both possible associations.

Major discriminatory events and suicidal thoughts and behaviors amongst Black Americans: Findings from the National Survey of American Life

BACKGROUND

Risk for suicide is growing among certain groups of Black Americans, yet the topic remains understudied. Discrimination appears to increase risk for suicidal thoughts and behaviors, but the evidence has been mixed for Black Americans. This study aimed to examine the association between major discriminatory events and suicidal thoughts and behaviors among Black American adults.

METHODS

We drew data from the National Survey of American Life, a representative sample of Black Americans, and used multivariable logistic regression to examine the associations between nine major discriminatory events and suicidal thoughts and behaviors (ideation, plan, attempt), adjusting for sociodemographic characteristics and psychiatric disorders.

RESULTS

We found that some major discriminatory events increased odds of reporting suicidal thoughts and behaviors, while others did not. Further, findings suggest the mediating role of psychiatric disorders.

LIMITATIONS

The study drew from cross-sectional data and did not allow for causal inferences.

CONCLUSIONS

Major discriminatory events have important implications for clinical practice, as well as diagnostic criteria when considering race-related stressors as a precipitator of suicidal thoughts and behaviors.

Self-compassion and family cohesion moderate the association between suicide ideation and suicide attempts in Chinese adolescents

BACKGROUND

In recent years, many studies have examined risks factors that facilitated the transition from suicide ideation to suicide attempts. Few studies, however, have examined protective factors against this transition. The current study thus assessed two protective factors, self-compassion and family cohesion, in buffering the transition from suicide ideation to suicide attempts.

METHOD

A number of 520 Chinese adolescents (43.46% females, mean age = 12.96 years) completed questionnaires assessing self-compassion, family cohesion, suicide ideation, and suicide attempts two times with a 12-month interval.

RESULTS

Self-compassion significantly moderated the association between Wave 1 SI and later SA. The positive dimension of self-compassion thwarted the transition from SI and SA, and the negative dimension of self-compassion strengthened the associations. In addition, family cohesion also significantly moderated the transition from SI to SA.

CONCLUSION

Increasing the levels of self-compassion and family cohesion may be the targets for treating adolescents with suicide ideation to prevent them from attempting suicide.

Associations Between the NIH Toolbox Adult Social Relationship Scales and Suicidal Ideation

Various measures of social support have been associated with suicidal ideation (SI). However, a brief, consistent, multidimensional approach to social support assessment has not been established. We assessed the NIH Toolbox Adult Social Relationship (ASR) scales and their associations with the Beck Scale for Suicidal Ideation (BSI). Five ASR scales (emotional support, instrumental support, friendship, loneliness, perceived rejection) were used to predict BSI scores among psychiatric inpatients at baseline (N = 79) and at 3-months follow-up (N = 63). Mean BSI scores were 22.2 (SD 8.6) at baseline and 5.7 (SD 6.7) at follow-up. The ASR scales had high internal consistency (Cronbach's α = 0.93-0.96). Emotional support was associated with SI at baseline and 3-month follow-up. Instrumental support, loneliness and perceived rejection were associated with SI at baseline. Friendship was not associated with SI at either time-point. The ASR scales appear promising in differentiating aspects of social support most relevant to SI.

Association of Suicide and Other Mortality With Emergency Department Presentation

IMPORTANCE

Emergency departments (EDs) have the potential to play a pivotal role in suicide risk detection and prevention, yet little is known about the profile of risk of suicide after ED visits in the United States.

OBJECTIVES

To examine 1-year incidence of suicide and other mortality among ED patients who presented with nonfatal deliberate self-harm, suicidal ideation, or any other chief concern, and to examine sociodemographic and clinical factors associated with suicide mortality risk.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study included statewide, all-payer, longitudinally linked ED patient records and mortality data from all California residents who presented to a California-licensed ED at least 1 time from January 1, 2009, to December 31, 2011, with deliberate self-harm, suicidal ideation but not self-harm, or neither (a 5% random sample). Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) for suicide and other manners or causes of death were determined for each patient group using statewide mortality data. Data were analyzed from January 10 to July 18, 2019.

MAIN OUTCOMES AND MEASURES

Suicide and other manners or causes of death were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Suicide rate and all mortality rates were measured per 100 000 person-years.

RESULTS

Among 648 646 individuals (mean [SD] age, 43.8 [20.6] years; 350 687 [54.1%] women) who visited an ED in California from 2009 to 2011, the rates of suicide deaths per 100 000 person-years in the year after index ED presentation were 693.4 deaths among 83 507 individuals presenting with deliberate self-harm (SMR, 56.8; 95% CI, 52.1-61.4), 384.5 deaths among 67 379 individuals presenting with suicidal ideation but not self-harm (SMR, 31.4; 95% CI, 27.5-35.2), and 23.4 deaths among 497 760 reference patients (SMR, 1.9; 95% CI, 1.6-2.3). Compared with the demographically matched general population, the rates of nonsuicide external-cause mortality were also increased among patients with self-harm (SMR, 14.2; 95% CI, 12.9-15.5), patients with suicidal ideation (SMR, 11.8; 95% CI, 10.6-13.0), and reference patients (SMR, 2.2; 95% CI, 2.0-2.3). In all 3 groups, the rates of suicide mortality per 100 000 person-years were higher among men (deliberate self-harm: 1011.1 deaths; suicidal ideation: 539.8 deaths; reference: 36.6 deaths), people 65 years or older (deliberate self-harm: 1919.5 deaths; suicidal ideation: 691.2 deaths; reference: 28.6 deaths), and non-Hispanic white patients (deliberate self-harm: 914.1 deaths; suicidal ideation: 511.6 deaths; reference: 33.8 deaths) than among their respective referent groups. Other sociodemographic factors and clinical diagnoses were associated with striking differences in suicide rates, but these patterns were heterogeneous across patient groups.

CONCLUSIONS AND RELEVANCE

These findings suggest that ED patients with deliberate self-harm or suicidal ideation are associated with substantially increased risk of suicide and other mortality during the year after ED presentation. The process of planning for ED discharge may present opportunities to help ensure safe transitions to continuing outpatient mental health care and to consider broader risk for unintentional injury and other causes of premature mortality.

Factors Protecting against Suicidal Ideation in South Korean Community-Dwelling Older Adults: A Systematic Literature Review

This systematic literature review investigates protective factors against suicidal ideation among community-dwelling older adults in South Korea. Existing research focuses on risk factors for suicidal thoughts among older adults living in the community, but research on protective factors for this population is rare. Furthermore, studies have been more likely to examine individual and social factors rather than macro factors, yet suicidal thoughts among older adults may come from various long-term challenges. This study applied Bronfenbrenner's ecological frame to synthesize 60 studies. The results reveal that protective factors against suicidal thoughts among community-dwelling older adults in South Korea are found at four levels: individual, family, community, and macro-level factors.

Discrimination, Serious Psychological Distress, and Church-Based Emotional Support Among African American Men Across the Life Span

Objective

This study tested whether church-based social support buffers the negative effects of discrimination on serious psychological distress (SPD) among three age groups-early, middle, and late adulthood-of African American men.

Methods

Negative binominal regression analyses for discrimination and SPD were performed using data from 1,271 African American men from the National Survey of American Life.

Results

Discrimination was positively associated with SPD for all age groups. An interaction between church-based support and discrimination indicated that under conditions of high levels of support from congregants, discrimination, and SPD were positively correlated. However, discrimination and SPD were unrelated for low levels of church-based support. Further, the interaction was significant for men aged 18-34 and 55 or older but not significant for men aged 35-54.

Discussion

This is the first study to document relationships among discrimination, SPD, and church-based support in a nationally representative sample of African American men. Overall, rather than revealing a stress-buffering function, findings were consistent with the resource mobilization perspective of social support, indicating that higher levels of assistance from church networks are provided when individuals experience high levels of both discrimination and SPD.

Suicide Attempts in Michigan HealthCare System; Racial Differences

BACKGROUND

Community-based studies have documented racial differences in social, psychiatric, and medical determinants of suicidal ideation; however, less is known about racial differences in the profile of suicide attempts in clinical settings.

AIM

The current study aimed to compare Blacks and Whites who attempted suicide for demographic factors, socioeconomic status, medical history, psychiatric disorders, and outcomes.

METHODS

This retrospective study was a retrospective chart review of DataDirect, which is an electronic data repository of the Michigan Health Care System, 2014 to 2017. This analysis included 6147 suicide attempts (5388 Whites and 759 Blacks). Race, sociodemographic factors, medical history, psychiatric disorders, and outcomes were measured.

RESULTS

Blacks and Whites with suicide attempt did not differ in age or gender, but varied by insurance type. Blacks were more commonly under Medicare and Medicaid, while Whites were more commonly under private insurance or self-pay (p < 0.05). Blacks with suicide attempt were more likely to be obese, while Whites with suicide attempt were more likely to be underweight. Frequency of psychiatric disorders, including depression, alcohol abuse, drug abuse, and psychosis, were not different between Whites and Blacks with suicide attempt; however, medical conditions showed a different profile across racial groups. When compared to Whites, Blacks had higher prevalence of uncomplicated hypertension, renal failure, chronic obstructive pulmonary disease, coagulopathy, and obesity (p < 0.05 for all comparisons). In contrast, Whites had higher prevalence of other neurological disorders than Blacks. There were no differences in in-patient survival rate between Whites and Blacks who attempted suicide.

CONCLUSION

There are considerable differences between Blacks and Whites with at least one suicide attempt. Although their psychiatric diagnoses seem to be similar, Blacks who have attempted suicide attempt have more medical comorbidities than their White counterparts. Lack of racial disparities in in-patient mortality rate of suicide attempts in the Michigan Health Care System is promising news given the higher physical health needs of Blacks when compared to Whites.

Church and Family Support Networks and Depressive Symptoms among African Americans: Findings from the National Survey of American Life

Aims:

We examined the associations between informal social support from church members and social support from extended family members and depressive symptoms within a national probability sample of African American adults ranging in age from 18 to 93.

Methods:

This analysis used data from the National Survey of American Life and accounted for religious service attendance and various demographic variables that have known associations with and are consequential for mental health.

Results:

Frequency of contact with church and family members and emotional support from family were inversely associated with depressive symptoms, and negative church and family interactions were positively associated with depressive symptoms. Emotional support from church members, however, was unrelated to depressive symptoms.

Conclusion:

This study underscores the important contributions of church relationships to depressive symptoms among African Americans across the adult life span, and confirms that these associations are independent of family relationship factors and religious service attendance.

Loneliness is closely associated with depression outcomes and suicidal ideation among military veterans in primary care

BACKGROUND

Although the substantial influence of social relationships on health is well-known, studies that concurrently examine the influence of varying dimensions of social connectedness on major depression are more limited. This study's aim was to determine to what degree several facets of social connectedness (number of confidants, social support, interpersonal conflict, social norms, and loneliness) are correlated with depression-related outcomes.

METHODS

Participants were primary care patients (n = 301) with probable major depression at a Veterans Health Administration hospital and its satellite clinics. Social connectedness was primarily measured using multi-item instruments from the NIH Toolbox of Adult Social Relationship Scales. Primary outcomes were clinical symptoms (depression and suicidal ideation) and secondary outcomes were self-reported health-related behaviors (medication adherence, patient activation, and help-seeking intentions).

RESULTS

In multivariate models adjusting for potential confounders and other facets of connectedness, loneliness was associated with higher levels of depression and suicidal ideation, as well as lower patient activation and help-seeking intentions. Social support and social norms about depression treatment were each associated with higher patient activation and help-seeking intentions. Social connectedness was not associated with medication adherence.

LIMITATIONS

The limitations of this study are primarily related to its cross-sectional survey design and study population.

CONCLUSIONS

Multiple aspects of social connectedness are associated with depression outcomes among military veterans with depression. Loneliness may represent the most important component of connectedness, as it is associated with depression severity, suicidality, and health-related behaviors.

Lessons Learned from 50 Years of Violence Prevention Activities in the African American Community

PURPOSE

This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years.

METHOD

Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community.

RESULTS

There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature.

CONCLUSIONS

Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence.

Family and Friendship Networks and Obsessive-Compulsive Disorder Among African Americans and Black Caribbeans

Although there is a large literature on the influence of social support on mental health there is limited research on social support and OCD. This is especially the case for African Americans and Black Caribbeans. This study examines the relationship between family and friendship networks and the prevalence of OCD. The analysis is based on the National Survey of American Life a nationally representative sample of African Americans and Black Caribbeans. Variables included frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions (conflict, criticisms) with family members. The results indicated that only negative interaction with family members was significantly associated with OCD prevalence. African Americans and Black Caribbeans with more frequent negative interactions with family members had a higher likelihood of having OCD. Subjective closeness and frequency of contact with family and friends was not protective of OCD. Overall the findings are consistent with previous work which finds that social support is an inconsistent protective factor of psychiatric disorders, but negative interactions with support network members is more consistently associated with mental health problems.

Extended family and friendship support and suicidality among African Americans

PURPOSE

This study examined the relationship between informal social support from extended family and friends and suicidality among African Americans.

METHODS

Logistic regression analysis was based on a nationally representative sample of African Americans from the National Survey of American Life (N = 3263). Subjective closeness and frequency of contact with extended family and friends and negative family interaction were examined in relation to lifetime suicide ideation and attempts.

RESULTS

Subjective closeness to family and frequency of contact with friends were negatively associated with suicide ideation and attempts. Subjective closeness to friends and negative family interaction were positively associated with suicide ideation and attempts. Significant interactions between social support and negative interaction showed that social support buffers against the harmful effects of negative interaction on suicidality.

CONCLUSIONS

Findings are discussed in relation to the functions of positive and negative social ties in suicidality.

Suicidality Protective Factors for African American Adolescents: A Systematic Review of the Research Literature

Overall rates of African American adolescent suicide have been increasing for the past 50 years; however, the research literature examining factors related to suicide for these vulnerable youth is sparse. The shortage of research literature on suicidality protective factors is particularly significant. Little is known about the impact of protective factors on African American youth, especially within subgroups (e.g., gender and socioeconomic status). Approximately 40% of African American youth live in poverty, exposing them to contextual stressors that place them at increased risk for suicidality. Females are significantly more likely to have suicidal ideation and make attempts, whereas males surpass females in their rates of completions. To better understand suicidality protective factors, we conducted a systematic review of the research literature on protective factors for African American adolescents, with a focus on gender differences and urban, low-income youth. This review yielded 26 articles that met inclusion criteria and identified protective factors in the following categories: familial, religiosity-based, relational/social, personal, and socioecological. Gender differences and protective factors for urban, low-income youth are discussed, regarding their role in the prevention of suicidality. This review highlights a need for further research to identify and clarify suicidality protective factors for African American adolescents.

Reciprocal Family, Friendship and Church Support Networks of African Americans: Findings from the National Survey of American Life

This study examined reciprocal support networks involving extended family, friends and church members among African Americans. Our analysis examined specific patterns of reciprocal support (i.e., received only, gave only, both gave and received, neither gave or received), as well as network characteristics (i.e., contact and subjective closeness) as correlates of reciprocal support. The analysis is based on the African American sub-sample of the National Survey of American Life (NSAL). Overall, our findings indicate that African Americans are very involved in reciprocal support networks with their extended family, friends and church members. Respondents were most extensively involved in reciprocal supports with extended family members, followed closely by friends and church networks. Network characteristics (i.e., contact and subjective closeness) were significantly and consistently associated with involvement with reciprocal support exchanges for all three networks. These and other findings are discussed in detail. This study complements previous work on the complementary roles of family, friend and congregational support networks, as well as studies of racial differences in informal support networks.

Family, friends, and 12-month PTSD among African Americans

PURPOSE

Despite a growing literature on the influence of social support on mental health, little is known about the relationship between social support and specific psychiatric disorders for African Americans, such as PTSD. This study investigated the relationship between social support, negative interaction with family and 12-month PTSD among African Americans.

METHODS

Analyses were based on a nationally representative sample of African Americans from the National Survey of American Life (n = 3315). Social support variables included emotional support from family, frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions with family.

RESULTS

Results indicated that emotional support from family is negatively associated with 12-month PTSD while negative interaction with family is predictive of 12-month PTSD. Additionally, a significant interaction indicated that high levels of subjective closeness to friends could offset the impact of negative family interactions on 12-month PTSD.

CONCLUSIONS

Overall, study results converged with previously established findings indicating that emotional support from family is associated with 12-month PTSD, while, negative interaction with family is associated with increased risk of 12-month PTSD. The findings are discussed in relation to prior research on the unique association between social support and mental health among African Americans.

Family and friendship informal support networks and social anxiety disorder among African Americans and Black Caribbeans

BACKGROUND

This study explores relationships between Social Anxiety Disorder (SAD) and quality and frequency of involvement with family and friends.

METHODS

Data are from a nationally representative sample of African American and Black Caribbean adults (n = 5191), the National Survey of American Life. SAD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview.

RESULTS

Findings indicated that among both populations, close supportive ties with family members and friends are protective against meeting criteria for SAD. Negative interactions with family (e.g., conflicts), however, are a risk factor for SAD among both African Americans and Black Caribbeans. For African Americans, an interaction indicates that the relationship between negative interaction and social anxiety is much stronger among African Americans who are not emotionally close to their families. For Caribbean Blacks, an interaction suggests that the odds of meeting criteria for SAD were higher among Black Caribbeans who had high negative interaction with family as well as low levels of friendship closeness.

LIMITATIONS

The cross-sectional nature of the study does not allow for causal attributions for findings.

CONCLUSIONS

This study demonstrates that SAD may impact black ethnic subgroups differently, which has important implications for understanding the nature, etiology, and treatment of this disorder.

Social support from church and family members and depressive symptoms among older African Americans

OBJECTIVE

This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans.

METHODS

The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis.

RESULTS

Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress.

CONCLUSION

This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

Extended family and friendship support networks are both protective and risk factors for major depressive disorder and depressive symptoms among African-Americans and black Caribbeans

This study explores relationships between lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) major depressive disorder (MDD), depressive symptoms, and involvement with family and friends within a national sample of African-American and Black Caribbean adults (n = 5191). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview and depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression subscale and the K6. Findings indicated that among both populations, close supportive ties with family members and friends are associated with lower rates of depression and MDD. For African-Americans, closeness to family members was important for both 12-month and lifetime MDD, and both family and friend closeness were important for depressive symptoms. For Caribbean Blacks, family closeness had more limited associations with outcomes and was directly associated with psychological distress only. Negative interactions with family (conflict, criticisms), however, were associated with higher MDD and depressive symptoms among both African-Americans and Black Caribbeans.

Hope as a Moderator of the Relationship Between Interpersonal Predictors of Suicide and Suicidal Thinking in African Americans

Suicide is currently the third leading cause of death of African Americans between the ages of 15 and 24 years. Possible risk factors of suicidal ideation for this population include the two interpersonal constructs of the Interpersonal Theory of Suicide, perceived burdensomeness and thwarted belongingness. Past research has demonstrated that hope is negatively associated with each of these two constructs of the Interpersonal Theory of Suicide and suicidal ideation. The aim of the current study was to investigate hope as a moderator between both thwarted belongingness and perceived burdensomeness and suicidal ideation in a sample of 107 African American college students. Results supported the hypotheses, as hope moderated the relationship between thwarted belongingness and suicidal ideation and perceived burdensomeness and suicidal ideation. This study suggests that African Americans who endorse high levels of hope are at a lower risk for suicidal thoughts when having perceptions of being a burden and not belonging. Clinical implications are discussed.

Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study

BACKGROUND

Suicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients.

METHOD

Older psychiatric outpatients (N = 24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Participants were recruited if they met these inclusion criteria: 1) ≥ 65 years old, 2) without severe cognitive deficit, 3) outpatients in the psychiatric clinics at the selected hospitals, and 4) self-reported first episode of suicidal ideation within the previous year. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis.

RESULTS

Suicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants' reasons for not executing suicide were family members' and friends' support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one's children, religious beliefs, and not knowing how to execute suicide.

CONCLUSION

Understanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.

Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

AIMS

Social support has consistently been reported to be effective in reducing suicidal ideation. This cross-sectional study was performed to determine whether home visits by commissioned welfare volunteers (i.e., organizations of community residents appointed by national or prefectural governments) are associated with a lower risk of suicidal ideation among the elderly.

METHODS

In August 2010, questionnaires were sent to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama prefecture, Japan, and 13,929 returned the questionnaire (response rate: 65.6%). We finally analyzed 11,218 subjects. Both home visits by commissioned welfare volunteers and suicidal ideation within the last 30 days were assessed in the questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) for suicidal ideation were calculated adjusting for age, sex, educational attainment, and marital status. We then additionally adjusted for instrumental and emotional support, separately.

RESULTS

The prevalence of suicidal ideation was 10.0% and higher in women than in men (11.4% vs. 8.0%). Home visits were significantly associated with a lower risk of suicidal ideation after adjusting for instrumental and emotional support, respectively (OR: 0.60, 95% CI: 0.53-0.69; OR: 0.67, 95% CI: 0.59-0.78). In sex-stratified analysis, the association was clearer for women than for men: the corresponding ORs among women were 0.55 (95% CI: 0.46-0.65) and 0.61 (95% CI: 0.52-0.73), whereas they were 0.71 (95% CI: 0.56-0.90) and 0.78 (95% CI: 0.61-0.99) among men.

CONCLUSION

Our findings suggest that home visits by commissioned welfare volunteers are significantly associated with lower suicidal ideation among the elderly, particularly in women.

Family factors contribute to general anxiety disorder and suicidal ideation among Latina Americans

PURPOSE

Despite a rapidly growing Latina/o American population, little is known about modifiable factors that could protect Latinas against major psychiatric disorders. The present study explored psychosocial risk (Negative Interaction) and protective factors (Family Cohesion, Social Support, Religious Involvement, Racial and Ethnic Identity) for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) among Latinas participating in the first national mental health epidemiological survey of Latina Americans.

METHOD

We conducted three sets of logistic regressions, predicting outcomes for 1,427 Latinas identified in the National Latino and Asian American Study (NLAAS), the first nationally representative, epidemiological study of Latino and Asian Americans living in the United States. These analyses followed preplanned steps: Model 1 used known predictors as controls and Model 2 added psychosocial risk and predictive factors beyond the known predictors.

RESULTS

For each outcome examined, psychosocial risk and protective factors produced a significantly better model fit in Model 2 than sociodemographic and acculturation variables known to predict mental health outcomes in Model 1. Negative Interactions were associated with increased likelihood of GAD and SI, whereas Family Cohesion seemed to be protective against GAD. No psychosocial factors predicted MDD.

CONCLUSIONS

Differential protective and risk factors for major psychiatric disorders suggest that assessment and intervention may need certain sex-specific components in order to improve health care and prevention for Latinas.

Suicidal behavior and attitudes in Slovak and Turkish high school students: a cross-cultural investigation

Suicidal behavior and its variation across social contexts are of importance for the science of suicidology. Due to its special character controlled experimental studies on suicide are ruled out for ethical reasons. Cross-cultural studies may throw light on the etiology of both suicidal behavior and its cross-cultural variation. The present study compared suicidal behavior and attitudes in 423 Slovak and 541 Turkish high school students by means of a self-report questionnaire. The two groups reported similar percentages (Slovak = 36.4%; Turkish = 33.8%) of lifetime, past 12-months or current suicidal ideation but significantly more Turkish (12.2%) than Slovak (4.8%) students reported lifetime or past 12-months suicide attempts. Slovak adolescents displayed more liberal and permissive attitudes toward suicide, while those of Turkish adolescents were more rejecting. Turkish students rated themselves to be more religious and hence they believed to a greater extent that suicidal persons would be punished in a life after death than their Slovak peers. However, attitudes of Turkish students toward an imagined suicidal close friend were more accepting than the attitudes of Slovak students. Comparison of suicidal and nonsuicidal students revealed that those reporting suicidal ideation or attempts were more accepting of suicide and viewed suicide as a solution to a greater extent than the nonsuicidal ones. The results from this study suggest that cultural factors play a role in suicidal behavior, attitudes and reactions in a predicted direction.