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Culturally Competent Suicide Prevention Strategies


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Title: Culturally Competent Suicide Prevention Strategies

Culturally Competent Suicide Prevention

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
  • 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

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

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

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

  • Students uncertainty about how to help depressed
  • 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.

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

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)

  • 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)

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

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.

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).

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.

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).

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.)

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).

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).

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.

  • 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).

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).

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).

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).

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
  • Acculturative stress is another risk factor.

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

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.

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

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  • 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
  • Do we have any special obligation to create a
    welcoming environment for minority students?
  • Is there an obligation to engage in outreach?

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

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

Strategic Development of Satellite Offices
  • Culture Center
  • Trio Programs
  • Upward Bound
  • Student Opportunity Services (SOS)
  • Athletic Department
  • International Student Residence Hall

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

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

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

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

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.

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

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

  • 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

  • Jed Foundation Bubble Chart

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.

  • Edwin S. Schneidman, Ph.D. died 5/15/09 at age
    91 he was a pioneer in the field of suicide
  • 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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