Culturally Competent Suicide Prevention Strategies

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Culturally Competent Suicide Prevention
Strategies

Presented by Richard Shadick, Ph.D. Pace
University Allyson Tanouye, Ph.D. University of
Hawaii-Manoa Robert Portnoy, Ph.D. - University
of Nebraska-Lincoln
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Suicide and Minority Students Different Yet the
Same

• Studies have shown that acculturative stress
  (stress associated with adaptation to a new
  environment) is directly associated with
  depression and SI for AA, Asian, Hispanic and
  International students (Walker et al., 2008,
  Hovey, 2000, Constantine et al, 2004) but this
  has also been shown to be true for White students
  who experience acculturative stress as a function
  of being immersed in the novel setting of college
  (Perez et al, 2002).
• The human want to belong transcends
  ethnic/cultural boundaries but may be compounded
  for minority students who have the doubled burden
  of fitting into college and fitting into the
  mainstream.

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The Planning Stage

• Focus groups
• Individual interviews
• Written feedback
• Students, faculty, staff, and administrators were
  included in the solicitation of new ideas

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Needs Assessment

• Think about experiences with students who were
  stressed and/or depressed
• What types of programs would meet the goals of
• prevention
• stigma reduction
• early detection

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Needs Assessment Outcomes

• Strong consensus about the stigma of mental
  health problems, especially depression and
  suicide
• Students beliefs that faculty mistook depression
  for laziness or ineptitude
• Faculty, staff, and administrators discomfort
  and confusion when dealing with depressed students

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• Students uncertainty about how to help depressed
  friends
• General confusion about differentiating normal
  stress levels from mental health impairment

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Suicide among Ethnic Minority College Students

• African Americans
• As of 2002, suicide was the third leading cause
  of death in African American youth, 15-24 years
  old (following homicide and accidents), at a rate
  of 6.5 per 100,000.

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African American Suicide

• In 2002, 84 of suicides in AA community were
  men. As with all races, women attempted more, but
  men completed more.

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African American Suicide (contd.)

• African American female youths rates 1.7 per
  100,000 (lowest for all racial groups)
• AA male youths rates 11 per 100,000
• AA male youth are more than 6 times more likely
  to commit suicide than AA female youth
• 63 used a firearm (67 of male AA youth and 40
  of female AA youth)

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Symptoms

• African Americans are less likely to use drugs
  during a suicide crisis
• In African Americans behavioral component of
  depression is more pronounced
• Some suicidal African American youth are not as
  likely to self-report depression or suicidal
  ideation as Caucasian youth (Gibbs, 1997)

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Protective Factors

• Religiosity possibly the most important
  protective factor for AA youth
• Social support from family and friends
• Elder advice
• (Gibbs, 1997 Utsey et al., 2007)
• Other helpful measures speak with your pastor,
  spiritual leader, or other trusted counselor
  surround yourself with supportive friends and
  family.

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Asian Americans

• The college student subgroup of Asian Americans
  has relatively high rates of suicide and suicide
  attempts compared with the rest of the nation
  (Morian, 2008). College-aged (15-24) Asian
  American women have the highest rates of all
  demographics in the US.

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Asian American Suicide (contd.)

• Asian Americans experiencing a high degree of
  interpersonal familial conflict have a three-fold
  greater risk of attempting suicide when compared
  with Asian Americans overall. The risk is tripled
  even among those who have never had a diagnosis
  of depression (Morian, 2008).

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Asian American Suicide (contd.)

• Over 70 of the Asian American population is
  foreign born (U.S. Census Bureau, 2004), and
  adjustment to U.S. cultures and subsequent social
  support has implications in a variety of social
  and psychological areas, including depression and
  suicide (Leong, Leach, Yeh, Chou, 2007, p.
  421).

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Asian American Suicide (contd.)

• Acculturation is of particular importance due to
  its strong association with depression among
  Asians and Asian Americans, and it is also a
  well-documented mediator and predictor of
  suicidal behavior and ideation (Leong, Leach,
  Yeh, Chou, 2007, p. 424).

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Asian American Suicide (contd.)

• Research consistently indicates a strong link
  between low acculturation and high suicidal
  thoughts and behaviors.
• That is, the less acculturated an Asian American
  youth is, the less age-group social support and
  greater strain in social interactions they have.
  (i.e., acculturative stress.)

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Asian American Suicide (contd.)

• Research links acculturative stress to suicidal
  thoughts and behaviors in this population,
  particularly when combined with familial conflict
  (Leong, Leach, Yeh, Chou, 2007).

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Asian American Suicide (contd.)

• Among Asian international students in the US,
  suicidal ideation was found to be related to
  higher levels of depressive symptoms and
  hopelessness, yet problem-solving skills and
  social support mediated life stress, depressive
  symptoms, hopelessness, and suicidal ideation
  (Leong, Leach, Yeh, Chou, 2007, p. 427).

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Asian American Suicide (contd.)

• Communal, cooperative culture really big focus
  on social support as a protective factor.
• Shame, a desire to save face, and protecting
  the familys honor may deter help seeking.

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Latino/as

• Latino/a youth are at a greater risk of suicide
  behavior than other ethnic groups (Duarté-Vélez
  Bernal, 2007, p. 435).
• Hispanic adolescents have shown a tendency to be
  at greater risk for depressive symptoms, suicide
  ideation, and suicide attempts than others groups
  of adolescents in the United States
  (Duarté-Vélez Bernal, 2007, p. 437).

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Latino/as Suicide (contd.)

• US-born Latinos (mostly Mexican) in a sample from
  CA, ages 15-34, were found to be at greater risk
  for suicide completion than their foreign-born
  counterparts (Duarté-Vélez Bernal, 2007).

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Latino/as Suicide (contd.)

• Tensions between acculturation pressures and
  familismo (values of collectivism,
  interdependence, and family loyalty) contribute
  to stress for Latino/a youth (Duarté-Vélez
  Bernal, 2007).

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Latino/as Suicide (contd.)

• Another study comparing over 1000 youth in Texas
  border towns and over 1000 Mexican-border towns
  found that Mexican Americans were more likely to
  report elevated scores for depression (48.08 vs.
  39.41), illicit drugs (21 vs. 4.9), and
  suicide ideation (23.4 vs. 11.57) than
  Mexicans (Swanson et al., 1992 as cited in
  Duarté-Vélez Bernal, 2007).

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Latino/as Suicide (contd.)

• Combined drug use and depressive symptoms in the
  Mexican Americans (Duarté-Vélez Bernal, 2007)
  was associated with increased risk for suicidal
  ideation.
• Acculturative stress is another risk factor.

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Native Americans

• Native Americans have the highest rate of suicide
  among minorities
• Range From - 11-14 per 100,000.
• Asian-Pacific Islanders, African-Americans and
  Hispanics have rates at approximately half --
  6.14-6.53 per 100,000

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Native American Suicide (contd.)

• Native American male suicide rates between the
  ages of 5-14 are three times higher than males
  within the same age range of any other group
• Between the ages of 15-34, they are two times
  higher than males of any group within the same
  age range.
• Currently, Native American male rates peak at 67
  per 100,000 in the 25-34 age group.

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Native American Suicide (contd.)

• Native American female rates, ranging from age
  5-34, have suicide rates that are 2.22 to 3.6
  times higher than females in the general
  population.

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NYPD BLUE

• Is it enough to just do our jobs?
• Is it only the science that we need to focus on,
  or is there an element of art in medicine and
  psychology?
• Do we have any special obligation to create a
  welcoming environment for minority students?
• Is there an obligation to engage in outreach?

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Implementation Stage

• Dissemination of information about topics such as
  symptoms of depression and suicidality,
  prevention and treatment, and helpful ways to
  talk with someone suffering from depression
• Enhancement of CAPS website
• Developed Brochure Recognizing and Assisting
  the Troubled Student

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• National Depression Screening Day
• Screening for Mental Health College Response
  (Online) Program
• Primary Care screenings for depression

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Strategic Development of Satellite Offices

• Culture Center
• Trio Programs
• Upward Bound
• Student Opportunity Services (SOS)
• Athletic Department
• International Student Residence Hall

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Liaison Relationships

• CAPS has developed strong liaison relationships
  with academic departments
• Consultation to and training for staff in
  positions that often involve sensitive
  interaction with students
• Scholarships and Financial Aid
• Dean of Students
• Services for Students with Disabilities

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Advising/Liaison to Minority Student Organizations

• Afrikan Peoples Union (APU)
• Mexican-American Student Association (MASA)
• University of Nebraska Inter-Tribal Exchange
  (UNITE)
• Asian World Alliance (AWA)
• Vietnamese Student Association (VSA)
• Chinese Student and Scholar Association (CSSA)
• Saudi Student Association (SSA)
• Afghan Student Association (ASA)

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NU Directions Program

• Alcohol harm reduction strategies
• Social norms approach
• Collaboration with local bars

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Other Collaborations

• University Police enforcement of firearms
  regulation (probably the greatest impact on
  lowering the suicide rate on college campuses)

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Threat Assessment Partnership

• Originally named Behavioral Response to
  Situations Team (BRST).
• While we like to see ourselves as nurturing,
  going by the acronym THE BREAST may have taken
  this concept a little too far.

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• Stress management programs
• Mindfulness
• Progressive Muscle Relaxation
• Biofeedback
• Hypnosis
• Visualization

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• Training of Health Aides to better recognize and
  refer for depression
• Training of faculty and staff at the departmental
  level
• Outreach to various student groups, regardless of
  topic, typically incorporates the messages
  contained in Recognizing and Assisting the
  Troubled Student

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• CAPS Grand Rounds series developed in 1993
• At least one presentation each semester focuses
  on minority mental health concerns.
• Presentations have been from student, faculty,
  and clinician perspectives

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• Jed Foundation Bubble Chart

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UCLA suicide prevention experts have summarized
the information to be conveyed to a person in
crisis as follows

• The suicidal crisis is temporary.
• Unbearable pain can be survived.
• Help is available.
• You are not alone.

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EDWIN S. SCHNEIDMAN1918-2009

• Edwin S. Schneidman, Ph.D. died 5/15/09 at age
  91 he was a pioneer in the field of suicide
  prevention.
• Dr. Schneidman, one of the founders of the Los
  Angeles Suicide Prevention Center, and the
  founder of the American Association of
  Suicidology, believed that two simple questions
  Where do you hurt? and How may I help you?
  could begin to unlock the suicidal impulse.
• He also often wrote about enriching life by
  contemplating death and dying and was a proponent
  of open dialogue on both topics, arguing that
  people should be unafraid of death.

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