Suicidal ideation and suicide attempts among immigrant adolescents from the former Soviet Union to Israel

Suicidal Behaviour, including Ideation and Self-Harm, in Young Migrants: A Systematic Review

Young people experience high rates of suicidal ideation, self-harm, suicide attempt and death due to suicide. As a result of increasing globalisation, young people are increasingly mobile and can migrate from one country to another seeking educational and employment opportunities. With a growing number of young migrants, it is important to understand the prevalence of suicidal behaviour among this population group. We systematically searched Medline, Embase, and PsycINFO from inception until 31 March 2022. Eligible studies were those providing data on suicidal ideation, self-harm, suicide attempt, and death due to suicide. Seventeen studies were included in the review, some of which provided data on multiple outcomes of interest. Twelve studies provided data on suicidal ideation, five provided data on self-harm, eight provided data on suicide attempt, and one study had data on suicide death among young migrants. The quality of the included studies was varied and limited. The studies included in this review commonly reported that young migrants experience higher rates of self-harm and suicide attempt, but no major differences in suicidal ideation and suicide death compared to non-migrant young people. However, the limited number of studies focused on suicidal behaviour among young migrants highlights the need for further high-quality studies to capture accurate information. This will enable the development of policies and interventions that reduce the risk of suicidal behaviour among young migrants.

Homesickness in developing world expatriates and coping strategies

This article examines the developing world expatriates’ experience of homesickness when they are deployed to western countries. The research considers the consequences of being homesick on the expatriates and their organisations; the paper then clarifies the strategies used by the expatriates to cope with the condition. The research employed qualitative research built on unstructured interviews with expatriates from the developing world who have been deployed in western countries by their employing multinational. The findings revealed that homesickness has consequences for both expatriates and organisations. These consequences include psycho-social disorder, deterioration of physical health which damagingly affect individual wellbeing, work outcomes and organisational commitment. The practical implications centre on the opportunity for policy and strategy formulation by international HRM within organisations to improve the mental health of developing world expatriates, thus seeding the ingredients for better performance and job satisfaction. Our study makes significant additions to the expatriate literature in exposing the homesickness experiences of expatriates from the developing world in advanced economies. We identify two main coping strategies used by expatriates. The research explicates how developing world expatriates use these strategies in practices.

Prevalence of mental disorders in migrants compared with original residents and local residents in Ningxia, China

BACKGROUND

Ecological migrants has a special background compared with other types of migrant. However, the mental health status of ecological migrants who were expected to benefit from a massive "ecological migration project" initiated by the Chinese government is unknown. This study aims to explore the influence of environmental change on individuals' mental health and to improve current understanding of the mechanisms that mental disorders occurred.

METHODS

The data were extracted from a cross-sectional study. Anxiety disorders, mood disorders and substance use disorders were assessed using the Chinese version WHO-CIDI. The prevalence of mental disorders was stratified by migration status into ecological migrant, local resident and original resident groups. Unconditional logistic regression models were used to calculate the risk of prevalence among these three groups.

RESULTS

After controlling for gender, ethnicity, age, marriage, and education, the migrants had lower risk of mental disorders than original residents [OR = 0.70 (95 % CI: 0.57-0.86)], p < 0.001), but had a higher risk of mental disorders than local residents [OR = 1.29 (95 % CI: 1.06-1.55)], p = 0.007).

CONCLUSION

The ecological migration project may be beneficial to people's mental health by improving their living environment and social economy.

Suicidal ideation and migration aspirations among youth in central Mexico

Over the past 100 years the state of Guanajuato has consistently been one of the highest migrant sending states in Mexico. Youth living in high migratory states such as Guanajuato are heavily influenced by the expectation that they will travel to the US, and research has shown that those who do not migrate may be looked down upon by members of their community. This secondary analysis looks at the connection between suicidal ideation and migration aspirations among a group of adolescents living in Guanajuato, Mexico. Data were originally collected in 2007 as part of a comprehensive health survey of youth attending an alternative high schooling program. Regression analyses show that suicidal ideation predicts intentions to migrate among both males and females, while other factors differentially influence the adolescents by gender. The results indicate that suicidal ideation may be associated with migration aspirations among Mexican youth living in high migratory communities. Study limitations and implications are discussed.

A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa, Ethiopia, and Toronto, Canada

According to a literature of theory and advocacy, immigration and resettlement jeopardize the mental health of children and youth, largely because of factors such as intergenerational tensions arising from conflicts about the retention of traditional values, and experiences of prejudice and discrimination. The current study examines the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada, were compared with a matched sample of Ethiopian youngsters in Addis Ababa, Ethiopia. Data came from structured interviews with the person most knowledgeable about the family (usually a parent), as well as from the children themselves. Youth reported higher levels of emotional problems (EP) than their parents. Predictors differed for parent and child ratings. In both the Toronto and Addis Ababa samples, parental mental health predicted parent-rated, but not self-rated EP. Contrary to immigration stress theory, parental perceptions of prejudice predicted EP in Addis Ababa, but not Toronto, and parent-child discordance regarding ethnic adherence were predictors of self-rated emotional problems in Ethiopia, but not in Canada. Perceived discrimination was a significant predictor of self-rated emotional problems in both settings. Implications for theory and further research are discussed.

Self-harm and suicidal behaviors in Hong Kong adolescents: prevalence and psychosocial correlates

The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH) and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed.

Suicide rates among Turkish and American youth: a cross-cultural comparison

This study compares youth (<24 years) suicide rates in Turkey and the United States; a demographic and cross-cultural comparison and exploration of possible causative factors. Publicly available data were compared for children, adolescents, and young adults for years 1992-2004. The mean general population suicide rate in Turkey (per 100,000) was, male = 3.53 and female = 2.31 (for the US, males = 18.37, females = 4.31); for ages below 15 years the rate was, males = 0.28 and females = 0.39 (for the US, males = 1.09 and females = 0.38); while for aged 15-24 years the rate was, males = 4.58 and females = 5.22 (for the US, males = 18.84 and females = 3.36). The patterns for Turkey are: (a) Female youth had a higher suicide rate than male youth; this was the reverse of the U.S. pattern, (b) Youth suicide increased during the time period in Turkey, whereas it was relatively stable in the US, (c) However, suicide rates in Turkey were generally lower than the US, (d) Fifty percent of all female suicide victims in Turkey were under the age of 24 years (versus 11% in the US). Possible psychosocial causative factors may include (a) negative social status of females (forced marriage, young marriage age, low literacy, honor killings); (b) substantial rural to urban migration which disrupts ties and exposes migrants to a less traditional cultural system; (c) shortage of mental health services; (d) and possibly, reduced religious education enrollment may be an additional factor.

Suicidal behavior among immigrants

INTRODUCTION

This paper explores the association between suicidal behavior and immigrant status among Israeli residents from the former USSR (FSU).

METHOD

The Israeli component of the World Mental Health Survey (INHS) provided information on suicide ideations, plans and attempts. The INHS samples included Israel-born Jews (n = 2,114) and post-1990 immigrants from the FSU (n = 814). Data on completed suicide were extracted from the countrywide report of the Ministry of Health.

RESULTS

The controlled lifetime rates of suicidal behavior among FSU immigrants were significantly higher than among their Israel-born counterparts. A higher risk was found in the first years following immigration among young adults with higher education and without a spouse. Completed suicide rates were higher among the FSU immigrants than in the general Israeli population with the largest risk among young-adult immigrant men.

DISCUSSION

The findings are consistent with previous studies and are discussed in the context of both suicide rates in the country of origin and migratory stressors. Preventive measures are suggested.

Adolescent suicide and health risk behaviors: Rhode Island's 2007 Youth Risk Behavior Survey

BACKGROUND

Suicide is the third-leading cause of death among high school students in the U.S.

PURPOSE

This study examined the relationships among indicators of depressed mood, suicidal thoughts, suicide attempts, and demographics and risk behaviors in Rhode Island high school students.

METHODS

Data from Rhode Island's 2007 Youth Risk Behavior Survey were utilized for this study. The statewide sample contained 2210 randomly selected public high school students. Data were analyzed in 2008 to model for each of five depressed mood/suicide indicators using multivariable logistic regression.

RESULTS

By examining depressed mood and suicide indicators through a multivariable approach, the strongest predictors were identified, for multiple as well as specific suicide indicators. These predictors included being female, having low grades, speaking a language other than English at home, being lesbian/gay/bisexual/unsure of sexual orientation, not going to school as a result of feeling unsafe, having been a victim of forced sexual intercourse, being a current cigarette smoker, and having a self-perception of being overweight.

CONCLUSIONS

The strength of associations between three factors (immigrant status, feeling unsafe, and having forced sex) and suicide indicators adds new information about potential predictors of suicidal behavior in adolescents.

Prevalence and correlates of mental disorders in Israeli adolescents: results from a national mental health survey

BACKGROUND

The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence-based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004-2005 in a representative sample of 957 adolescents aged 14-17 and their mothers.

METHODS

The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio-demographic and health correlates. Disorders were ascertained with the Development and Well-Being Assessment inventory and verified by child psychiatrists.

RESULTS

The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders.

CONCLUSIONS

The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society.

Immigration and suicidality in the young

OBJECTIVES

Little research has focused on the relation of immigration and suicidal behaviour in youth. Nevertheless, the impact of migration on the mental health of youth is an issue of increasing societal importance. This review aimed to present studies on the prevalence of suicidal behaviour in immigrant youth in various countries and to provide possible explanations for suicidal behaviour in immigrant youth, especially regarding acculturation.

METHODS

The review included a literature search to locate articles on the subject of suicidal behaviour in immigrant youth in the context of acculturation.

RESULTS

Studies on suicidal behaviour in culturally diverse youth are few and most of the existing research does not differentiate ethnic minorities from immigrants. Studies on epidemiology and on specific risk factors were found regarding various immigrant youth including Hispanics in the United States, Asians in North America and Europe, as well as comparative studies between different immigrant groups in specific countries.

CONCLUSIONS

The relation between immigration status and suicidal behaviours in youth appears to vary by ethnicity and country of settlement. Time spent in the new country as well as intergenerational communication and conflicts with parents have, in many of the studies, been related to suicidality in immigrant youth. Summing up, there is a clear and urgent need to further pursue the work in this field, to develop targeted public health interventions as well as psychosocial treatment for preventing suicide in these youth.

The impact of duration of residence on cause-specific mortality: a cohort study of migrants from the Former Soviet Union residing in Israel and Germany

A cohort study of migrants from the Former Soviet Union in Israel (N=528,848) and in Germany (N=34,393) was conducted. The impact of length of residence on cause-specific mortality was investigated using Poisson regression and differences between the migrant groups were assessed. In both migrant cohorts, all cause mortality in males but not in females significantly decreased with increasing duration of residence (RR=0.76, 95% CI: 0.73-0.79 for 9+years of residence compared to 0-3 years), specifically in Israel for infectious diseases, cancer and CVD. For male and female migrants in Israel there was a large reduction in external cause mortality. The cancer risk in male migrants declined from 1 to 0.76 (95% CI: 0.69-0.83) and in female migrants to 0.85 (95% CI: 0.78-0.93) after nine and more years of stay. Adjusting for several covariables, there were differences between migrants in the cause of death patterns in the two host countries, which may be associated with differences in their initial conditions or with effects of the destination country. The study highlights the need for migrant-specific prevention approaches.

Suicidal ideation and distress among immigrant adolescents: the role of acculturation, life stress, and social support

Acculturative stress and social support play important roles in suicide-related phenomena among adolescent immigrants. To examine their contributions, measures of acculturative and general life stress and a measure of multiple sources of social support were used to predict psychological distress and suicidal ideation among Korean-born high school students residing in the US. Korean students who were sojourning without both parents were compared to Korean students who immigrated with both parents, Korean students who remained in Korea, and American high school students in the US (total N = 227; 56.8% female). The sojourning group reported higher levels of life stress, distress, psychological symptoms, and suicidal ideation than the other groups. Within the two acculturating groups, levels of distress, symptoms, and suicidal ideation were associated with life stress, lack of parental support, and not living with both parents. The findings have important implications for suicide prevention among immigrant adolescents, and imply that parental support is particularly protective.

Mental health implications of migration: a review of mental health community studies on Russian-speaking immigrants in Israel

INTRODUCTION

Since late 1980s, 1,001,726 immigrants arrived in Israel from the former Soviet Union (FSU). A review of community studies on the mental health of these immigrants is presented.

METHOD

Israeli studies from the past two decades were reviewed. Presented are findings on the prevalence of psychological distress and psychiatric disorders as well as on a number of risk factors among FSU immigrants.

RESULTS

Higher psychological distress and psychiatric morbidity were consistently found among FSU immigrants compared to the Israel-born. Social support was identified as a major stress-mitigating factor in migration. Most studies reveal the persistence of psychological distress among FSU immigrants during the first 5 years following migration, with a risk period around the second and third years following migration.

DISCUSSION

Findings from Israel corroborate some findings on immigrants in other countries but as they are limited to a single immigrant population, replication of these studies is necessary.

Ethnicity, socio-economic status and self-harm in Swedish youth: a national cohort study

BACKGROUND

Previous studies have shown an elevated risk for self-harm in adolescents from ethnic minorities. However, potential contributions to this risk from socio-economic factors have rarely been addressed. The main aim of this article was to investigate any such effects.

METHOD

A national cohort of 1009 157 children born during 1973-1982 was followed prospectively from 1991 to 2002 in Swedish national registers. Multivariate Cox analyses of proportional hazards were used to estimate the relative risk of hospital admission for self-harm. Parental country/region of birth was used as proxy for ethnicity.

RESULTS

Youth with two parents born outside Sweden (except those from Southern Europe) had higher age- and gender-adjusted hazard ratios (HRs) of self-harm than the majority population (HR 1.6-2.3). The HRs decreased for all immigrant groups when socio-economic factors were accounted for but remained significantly higher for immigrants from Finland and Western countries and for youth with one Swedish-born and one foreign-born parent.

CONCLUSIONS

Socio-economic factors explain much of the variation by parental country of birth of hospital admissions for self-harm in youth in Sweden.

Socio-demographic correlates of suicidal ideation among Chinese adolescents in Hong Kong

Several socio-demographic correlates, including age of adolescents, family economic status, parental marital status, parental occupational status and parental educational level of adolescent suicidal ideation among Chinese adolescents (N = 5,557) were examined in this study. The results showed that older adolescents had a significantly higher level of suicidal ideation than did younger ones. Adolescents living in non-intact families had a significantly higher level of suicidal ideation than those in intact families. Adolescents with lower socioeconomic status (indexed by economic disadvantage, parental occupational status, and parental educational attainment) displayed higher levels of suicidal ideation than did adolescents with higher suicidal ideation. Although these socio-demographic correlates were significantly related to suicidal ideation, the practical significance was not high.

Suicide and suicidal behavior

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

Immigrant girls perceive less stress

AIM

To develop a new stress scale and use it for investigating impact of ethnicity on perception of stress.

SUBJECTS AND METHODS

One thousand one hundred and twenty-four students (grades 6-9) from 14 schools filled in a questionnaire at school with questions about age, sex, use of language at home (proxy for cultural background), stress and stressors. Factor analysis and analysis of variance were used to analyze the data.

RESULTS

Two-stress dimensions were identified, 'pressure'(7 items, Cronbach's alpha 0.862) and 'activation'(4 items, Cronbach's alpha 0.767). Scores on the two scales and a separate 'stress' item were higher in girls and increased with grade. Use of another language than Swedish at home showed a significant effect only for activation, with lower scores in girls. The interaction effect between sex and language was significant for all variables and was due mainly to lower stress in girls using another language than Swedish at home.

CONCLUSION

This new stress scale has some promising qualities like a condensed format, basis in a specific stress concept and formulated to be as age and culture independent as possible. Immigrant girls seem to perceive less stress than Swedish born girls, which opens up for questions about protective mechanisms.

Mental health among recent immigrants to Sweden from Eastern Europe and the former Soviet Union

Several European states such as Sweden have become transit countries for migrants, as well as reception countries for an increasing number of young migrants, not only asylum seekers and refugees from beyond Europe but also from the European Union's new members, after the dissolution of the Soviet bloc in 1989 and then the Soviet Union itself in 1991. Over 110000 immigrants from Eastern Europe and the former Soviet Union resided in Sweden in 2002, although the exact figure is difficult to estimate because of the varied legal status of the migrants. International migration is not a new phenomenon in this part of the world, of course: people have always moved in the search of greater personal safety, among other reasons. However, new groups with new psychosocial needs and demands on the healthcare systems of the host countries will be a challenge. The aim of this article is to give an overview of three sets of empirical data: •

Mental health in migrant children

Many factors have been identified to explain differences in mental health problems between migrant and native children: the process of migration, the ethnic minority position of migrants, their specific cultural background and the selection of migrants. In this paper, the international literature regarding mental health of migrant children is reviewed using strict selection criteria. An extensive search was carried out to locate journal articles on the subject of mental health in migrant youth published since the 1990s. Only 20 studies met all inclusion criteria. Besides the conclusion that the studies did not unequivocally find an increased risk of mental health problems in migrant children, it proved to be very difficult to draw any sound conclusions with respect to these children's risk of mental health problems, since the impact of migration on children's mental health varied with the informants used and the characteristics of the migrant group and of the host country. The lack of univocal definitions of key terms further complicated generalised conclusions in this research field. As such, this research field is in urgent need of more research using standardised research designs, methodology and definitions. A proposition for this research design is made.

A longitudinal study of acculturative stress and homesickness: high-school adolescents immigrating from Russia and Ukraine to Israel without parents

BACKGROUND

Acculturative stress and homesickness are psychological reactions to cross-cultural transition. They may cause a decline in social functioning, increased psychological distress, and, in severe cases, psychiatric disorders among immigrants.

AIM

This study examined changes in acculturative stress and homesickness over the first 3 years in the host country. It also investigated the role of pre-migration psychological resources, perceived discrimination, and perceived social support as predictors of acculturative stress and homesickness.

METHOD

211 high-school adolescents who immigrated from Russia and Ukraine to Israel without parents participated in the study. They filled out self-report questionnaires at four times: about half a year before emigration and during the three consecutive years after immigration.

RESULTS

Acculturative stress strengthened in the second year compared to the first year and decreased in the third year after immigration. Homesickness decreased from the first to the third year after immigration. Pre-migration psychological resources were negatively correlated with acculturative stress and homesickness. Perceived discrimination was positively correlated with acculturative stress and homesickness. Perceived social support from friends and teachers negatively correlated with acculturative stress and homesickness, while perceived social support from the adolescents' parents was not correlated with these variables.

CONCLUSION

Personal psychological resources and social support buffer acculturative stress and homesickness in immigrants, while discrimination aggravates their distress.

[Health and migration. Psychosocial determinants]

The article provides an overview of the contemporary literature on the social and psychological factors which are associated with migration. Derived from the operationalisation of "migration" and an examination of the methodological peculiarities of migration research, a (transactional) stress model of migration is proposed incorporating potentially stress-eliciting influences of migration including occupational pressures, social isolation and/or family-related problems and their impact on psychological and physical health. There are inconsistencies in the findings regarding psychological health, which can in part be explained through the phenomena of the "healthy migrant effect", duration of stay in the host culture or the culture-specificity. Moreover, a discussion is provided of the extent that disorders associated with differentially stressed migrants will be manifested in the health care system. Finally, concluding remarks are offered together with a short discussion of the implication of these findings for future research and social and health policy decision-making.

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM

Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that.

METHODS

This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts.

RESULTS

Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden.

CONCLUSIONS

Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.

Ethnicity versus migration: two hypotheses about the psychosocial adjustment of immigrant adolescents

STUDY BACKGROUND AND AIMS: This study investigates the psychosocial adjustment of immigrant adolescents and examines two hypotheses: the ethnicity hypothesis, which suggests that ethnic background determines the psychosocial reactions of immigrant adolescents; and the migration hypothesis, which suggests that the migration experience determines such reactions.

METHODS

The study compared four groups of respondents: first-generation immigrants (N = 63) and second-generation immigrants (N = 64) from the former Soviet Union (FSU) in Israel; and Jewish (N = 212) and non-Jewish (N = 184) adolescents in the FSU. A self-report questionnaire administered to the respondents collected demographic, educational and psychological data using standardised scales.

RESULTS

Immigrant adolescents reported higher psychological distress, lower self-esteem and higher alchohol consumption than non-immigrant adolescents. Second-generation immigrants generally showed a higher level of functioning than first-generation immigrants. These findings favor the migration hypothesis.

CONCLUSIONS

Our findings support the widely accepted view of migration as a potentially distress-provoking experience. They suggest that psychological reactions of immigrant adolescents, and in fact all immigrants, are best interpreted as reactive and are related to the universal stressful qualities of the migration experience. Further multiethnic comparative studies, however, are needed to confirm and refine these findings.

[Nonfatal suicidal acts in a group of psychiatric inpatients. Situation of Mediterranean immigrants]

We investigated the correlation of belonging to an ethnic cultural minority and nonfatal suicidal acts (suicide attempts), suicidal ideation, and self-injurious behavior in a group of 494 psychiatric inpatients at the time of admission. The frequency of nonfatal suicidal acts was 15.3% in the group of immigrants ( n=111) and 8.9% in the group of German patients. This difference is significant, but the impact of belonging to the immigration group covaries with the impact of female gender and young age (below 45 years). If all three factors come together the risk of suicide attempts increases threefold. In the immigrant group alone, nonfatal suicidal acts were correlated with "transcultural conflicts". In the group of suicide attempters, we tried to assess the risk of suicide with the help of the "suicide risk list" (Pöldinger) and the suicidal intention with the help of the "suicide intention scale" (Pierce). Additionally, we investigated the method of suicide attempts and categorized them into two groups: "hard" and "weak" methods. We did not find any significant difference between immigrants and German patients concerning suicide risk, suicide intention, and choice of the method. Although there are some methodological shortcomings, we interpret our findings as an indication that immigrant inpatients are more involved in managing the additional stress which results from their immigration. Perhaps nonfatal suicidal behavior represents a risky, but insufficient attempt at "solving" transcultural problems in the immigrant group.