Are suicide attempts by young Latinas a cultural idiom of distress?

Temporal trends in suicide attempts among adolescents aged 12-15 years from 12 low- and middle-income countries

PURPOSE

Suicide is a major public health problem, especially in low- and middle-income countries (LMICs). However, current data on temporal trends in suicide attempts are limited. Therefore, we explored the temporal trends in suicide attempts among adolescents aged 12-15 years from 12 LMICs.

METHODS

The data for this study were obtained from the Global School-based Student Health Survey (GSHS) 2009-2017, wherein the interval between two surveys in most of the participating countries was approximately 6 years. The prevalences of suicide attempts were reported as weighted prevalences and 95% confidence intervals (CIs). Pooled overall estimates were calculated using meta-analysis with a random-effects model. Linear regression was used to assess the associations of a country's GNI/capita with the prevalence and temporal variations of suicide attempts.

RESULTS

The pooled prevalence of suicide attempts in the LMICs decreased significantly from 17.56% in the first survey to 13.77% in the second survey (difference = 3.65%, 95% CI = 0.35-6.95%, P = 0.03). However, significant decreasing trends were only observed in two countries (Benin and Samoa), the prevalence in the remaining countries remained relatively stable. The pooled prevalence of suicide attempts decreased significantly in boys and in the 12- to 13 year age group (difference = 3.77% and 4.44%, Both P < 0.05). In addition, the correlations of gross national income per capita with the prevalences of suicide attempts was negative but not significant (P > 0.05).

CONCLUSIONS

Our findings reveal a decreasing trend in the prevalence of suicide attempts among 12-15 year-old adolescents in 12 LMICs. However, the trend varied in each country. This suggests the need for tailored suicide prevention strategies in each country to reduce suicide attempts.

A longitudinal examination of cultural risk factors of suicide and emotion regulation

The present study is a secondary analysis that tested whether difficulties with emotion regulation (DER) would statistically mediate cultural risk factors of suicide and depression symptoms or suicidal behaviors among (a) Black, Indigenous, and People of Color (BIPOC) and (b) lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. BIPOC (n = 246), and LGBTQ (n = 203) participants completed measures on cultural risk factors of suicide, DER, depression symptoms, and suicidal behaviors at three time points from a larger remote randomized controlled trial (RCT). Simple and parallel mediation explored whether there were indirect effects of cultural risk of suicide on depression or suicidal behaviors via DER. Hypotheses were partially supported: simple mediation revealed that cultural risk factors of suicide at Time 1 predicted only depression symptoms at Time 3 via DER at Time 2 among BIPOC (indirect effect = .09, SE = .04, 95% CI [.01, .17]) and LGBTQ individuals (indirect effect = .05, SE = .02, 95% CI [.02, 08]). Parallel mediation revealed an indirect effect of cultural stressors of suicide and depression via lack of emotional awareness, difficulty with goal-directed behavior, and difficulty accessing emotion regulation strategies for BIPOC, whereas it was via difficulties with goal-directed behavior for LGBTQ persons. With replication, these findings support the importance of cultural risk factors when screening for suicide and inform tailoring of psychosocial interventions targeting emotion regulation with BIPOC and LGBTQ individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Suicidal behaviors among Latina adolescents: An ecodevelopmental approach and narrative review

INTRODUCTION

For the past several decades, Latina adolescents have consistently shown high rates of suicidal behaviors (i.e., suicidal ideation, planning, and attempts), higher than Latino adolescents and adolescents of most other ethnic groups. Yet, progress toward establishing evidence-based intervention efforts to address this urgent public health issue has been slow. The purpose of this narrative review is to summarize empirical findings on etiological factors associated with Latina adolescent suicidal behaviors using an ecodevelopmental, gender-specific framework that contextualizes Latina adolescent development.

METHODS

To be included, peer reviewed empirical manuscripts had to focus on suicidal behaviors (i.e., suicide attempts, suicide plan, and/or suicidal ideation) of adolescents (ages 11-19 or in grades 7-12) who self-identified as either Latina or Hispanic and a girl in the United States.

RESULTS

A total of 19 studies met review criteria and focused on microsystemic and intrapersonal predictors. Microsystemic predictors included family (i.e., family-adolescent discrepancies in acculturation, family functioning, family-daughter interactions), peer (i.e., victimization, friendships), and school (i.e., functioning, achievement) factors, while intrapersonal predictors were emotional vulnerability, psychosocial functioning, and substance use.

CONCLUSIONS

Family-related phenomena were the most widely studied. Research on school and peer microsystems was comparatively sparse, and several promising intrapersonal development factors have been underexplored. A notable limitation of existing studies is that samples consisted primarily of U.S.-born adolescents living in urban areas. Additional research is needed to characterize factors on other ecodevelopmental levels, identify resilience processes, and examine within-group diversity among Latina adolescents. Implications for intervention and future directions are discussed.

Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations

Mental illness is one of the largest contributors to the global disease burden. The importance of valid and reliable mental health measures is crucial in order to accurately measure said burden, to capture symptom improvement, and to ensure that symptoms are appropriately identified and quantified. This is of particular importance in low and middle-income countries (LMICs), where the burden of mental illness is relatively high, and there is heterogeneity in linguistic, racial, and ethnic groups. Using the PHQ-9 as an illustrative example, this systematic review aims to provide an overview of existing work and highlight common validation and reporting practices. A systematic review of published literature validating the use of the PHQ-9 in LMICs as indexed in the PubMed and PsychInfo databases was conducted. The review included n = 49 articles (reduced from n = 2,349). This manuscript summarizes these results in terms of the frequency of reporting on important procedures and in regards to the types of reliability and validity measured. Then, building off of the existing literature, we provide key recommendations for measure validation in LMICs, which can be generalized for any type of measure used in a setting in which it was not initially developed.

Depression in Latino and Immigrant Refugee Youth: Clinical Opportunities and Considerations

This article reviews the risk and protective factors and symptom presentation of depression in Latino and immigrant refugee children and adolescents. The significance of culture, linguistics, and community in the emergence of depression in Latino and immigrant refugee children and adolescents and their families is explored. The article provides practical implications for diagnosis and treatment of depression in this special population of youth.

Cross-cultural validation of the German and Turkish versions of the PHQ-9: an IRT approach

BACKGROUND

The Patient Health Questionnaire's depression module (PHQ-9) is a widely used screening tool to assess depressive disorders. However, cross-linguistic and cross-cultural validation of the PHQ-9 is mostly lacking. This study investigates whether scores on the German and Turkish versions of the PHQ-9 are comparable.

METHODS

Data from Germans without a migration background (German version, n = 1670) and Turkish immigrants in Germany (either German or Turkish version, n = 307) were used. Differential Item Functioning (DIF) was assessed using Item Response Theory (IRT) models.

RESULTS

Several items of the PHQ-9 were found to exhibit DIF related to language or ethnicity, e.g. 'sleep problems', 'appetite changes' and 'anhedonia'. However, PHQ-9 sum scores were found to be unbiased, i.e., DIF had no notable impact on scale levels.

CONCLUSIONS

PHQ-9 sum scores can be compared between Turkish immigrants and Germans without a migration background without any adjustments, regardless of whether they complete the German or the Turkish version.

Treatment Narratives of Suicidal Latina Teens

In this article, we examine the treatment narratives of Latina adolescent suicide attempters to understand their experiences undergoing care. For this study, we conducted content and thematic analysis of 68 interviews with Latina adolescent suicide attempters. Most teens who described positive experiences undergoing treatment (n = 39, 44.1%) did so when discussing outpatient mental health services (n = 30, 72.9%). Latinas felt that the providers who fostered their autonomy and connectedness helped them become active agents in their recovery. Clinicians serving suicidal Latinas must allow them to exercise agency while feeling emotionally connected to providers. To help Latinas manage their suicidality, treatments need to address the teens' developmental needs.

Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts

OBJECTIVE

This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process.

DESIGN

Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants.

METHODS

In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data.

RESULTS

Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying.

CONCLUSION

The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly.

PRACTITIONER POINTS

Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.

Parent-Adolescent Acculturation Gap and Suicidal Ideation among Adolescents from an Emergency Department

The objective of this article is to examine the impact of parent-adolescent acculturation gap on vulnerability to suicidal ideation among adolescents presenting to an emergency department with suicidal behavior. A multiethnic sample of adolescents (n = 43) and their parents (n = 43) completed an acculturation measure, and adolescents reported on emotion reactivity, hopelessness, depressive symptoms, and suicidal ideation. The direction of the association between suicidal ideation and vulnerability variables varied depending on the size of the acculturation gap. Emotion reactivity was more negatively associated with suicidal ideation the larger the parent-adolescent acculturation gap, while hopelessness was more strongly associated with suicidal ideation the smaller the gap, adjusting for depressive symptoms. Assessments of racial/ethnic minority adolescents at risk for suicidal behavior should address parent-adolescent acculturation gaps.

An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas

To date, there is little research to validate empirically differences between nonsuicidal self-injurious behavior (NSSI) and attempted suicide among Latina adolescents. Understanding the characteristics and contextual features of self-harmful behaviors among Latina teens is a critical public health and social justice matter given the disproportionate rates of attempted suicide and anticipated population growth of this vulnerable group. In this article, we draw on an ecodevelopmental model to focus attention on factors in the sociocultural environment that shape suicidal behaviors and NSSIs. Through analysis of qualitative interviews conducted with girls who used NSSI (n = 18), attempted suicide (n = 29), used NSSI and attempted suicide (n = 8,) and had no reported lifetime history of self-harm (n = 28), we describe the sociocultural factors that shaped psychosocial vulnerabilities and gave rise to decisions to use NSSI or attempt suicide. Our analysis revealed that adolescents who engaged in NSSI perceived their negative feelings as something that could be controlled through self-injurious acts, whereas powerlessness was a theme underlying the emotional states of girls who attempted suicide. When NSSI ceased to function as a mechanism for control, girls came to sudden decisions to attempt suicide. Most teens identified specific, and often multiple, situations that induced intense affective states and shaped decisions to inflict self-harm. Two situational experiences emerged as particularly salient and promising for subsequent studies on self-harmful behaviors among Latina adolescents: transnational stress and bullying. We describe each of these and offer suggestions for future research and practice.

Examining the interplay among family, culture, and latina teen suicidal behavior

In this article, we explore the relationships among culture, family, and attempted suicide by U.S. Latinas. We analyzed qualitative interviews conducted with Latina teen suicide attempters (n = 10) and their parents. We also incorporated data collected from adolescents with no reported history of self-harm (n = 10) and their parents to examine why some individuals turned to suicide under similar experiences of cultural conflict. Our results reveal that Latina teens who attempted suicide lacked the resources to forge meaningful social ties. Without the tools to bridge experiences of cultural contradiction, the girls in our study described feeling isolated and alone. Under such conditions, adolescents turned to behaviors aimed at self-destruction. Unlike their peers who attempted suicide, adolescent Latinas with no lifetime history of attempted suicide were able to mobilize resources in ways that balanced experiences of acculturative tension by creating supportive relationships with other individuals.

Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin

INTRODUCTION

Research on factors associated with suicidal ideation and suicide attempts has been conducted largely in developed countries. Research on West African countries in particular is lacking.

METHODS

Data were obtained from the Global School-based Health Survey conducted in Benin in 2009. This was a cross-sectional study of three grades, spanning Junior and Senior High, which sampled a total of 2,690 adolescents. Data on the occurrence of demographic, psycho-social and socio-environmental risk factors were tested using multinomial logistic regression for their association with suicidal ideation and suicide attempts.

RESULTS

The survey indicated that 23.2% had thought about suicide and 28.3% had made a suicide attempt in the previous year. Anxiety, loneliness, being bullied, alcohol misuse, illicit drug use, and lack of parental support were independently related to the ideation outcomes, suicidal ideation without planning and suicidal ideation with planning. Multinomial regression analysis, using one suicide attempt and multiple suicide attempts as outcomes, revealed that female sex, anxiety, loneliness, being physically attacked, and illicit drug use were associated these outcomes.

DISCUSSION

The prevalence of suicide attempts reported in the survey is relatively high. It is possible that there are cultural factors that could explain this finding. Our research indicates that many factors are related to the occurrence of suicidal ideation and suicide attempts among youth in Benin. Illicit drug use and violence in particular are associated with a high rate of suicide attempts in Benin. Measures to address these issues may reduce the risk of self-inflicted violence.