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#4 - Suicide DANS NOS SOCIÉTÉS MULTICULTURELLES - 5 septembre 2011

Samedi le 10 septembre aura lieu la 9e Journée mondiale de prévention du suicide. Un peu partout à travers le monde, des activités d’envergure locale et nationale se tiendront pour sensibiliser la population, les gouvernements et tout autre organisme à l'effet que le suicide peut être prévenu. Nous vous invitons à visiter le site web de vos centres locaux de prévention du suicide ou associations pour connaître les activités qu’ils ont préparé pour l’occasion. Le thème de l’édition 2011 est la prévention du suicide dans nos sociétés multiculturelles. Le 26e congrès de l’Association international de prévention du suicide, qui aura lieu à Beijing du 13 au 17 septembre 2011, abordera principalement la question culturelle. En lien avec ces événements, notre liste de nouveautés porte sur ce sujet.

Pour vous abonner à notre liste d'envoi, complétez le formulaire en-ligne.

Hjelmeland, H. (2011). Cultural context is crucial in suicide research and prevention. Crisis, 32(2), 61-64.
Résumé: With the focus on biological explanations of human behavior on the increase, the focus on cultural explanations is in turn decreasing (Brinkmann, 2009). This biological turn of events may thus become – or perhaps it already has – one of the most important challenges in ensuring a focus on cultural issues in suicide research and prevention. The increased focus on biology may contribute to shifting the attention away from the importance of cultural issues. Alarcón (2009) recently stated that this is an uphill battle in psychiatry, which would also make it an uphill battle in suicidology. It is, however, important to remember that the “suicidal brain” is still situated inside the skull of a whole person, and this person is embedded within his/her specific cultural context: a cultural context that consists of several different cultural contexts simultaneously. Many factors in these contexts are crucial in the suicidal process, more or less regardless of an individual’s genetic/biological makeup. There can be no doubt that suicidologists from all disciplines have the same goal, namely, to prevent suicide. We just work from different angles. However, no matter which angle we are working from, we need to take the (socio)cultural context into consideration. Always. The sociocultural context is crucial in suicide research and prevention.

Donnelly, T. T., Hwang, J. J., Este, D., Ewashen, C., Adair, C., & Clinton, M. (2011). If I was going to kill myself, I wouldn't be calling you. I am asking for help: Challenges influencing immigrant and refugee women's mental health. Issues in Mental Health Nursing, 32(5), 279-290.
Résumé: It is estimated that 37% of Canadians experience some types of mental health problem. As a result of the migration process, many immigrant and refugee women suffer serious mental illness such as depression, schizophrenia, posttraumatic stress disorder, suicide, and psychosis. The purpose of this exploratory qualitative study, informed by the ecological conceptual framework and postcolonial feminist perspectives, was to increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping. Ten women (five born in China and five born in Sudan) who were living with mental illness were interviewed. Analysis revealed that (a) women's personal experience with biomedicine, fear, and lack of awareness about mental health issues influences how they seek help to manage mental illness; (b) lack of appropriate services that suit their needs are barriers for these women to access mental health care; and (c) the women often draw upon informal support systems and practices and self-care strategies to cope with their mental illnesses and its related problems. The authors discuss implications for practice and make recommendations for intervention strategies that will facilitate women's mental health care and future research.

Chu, J. P., Hsieh, K.-Y., & Tokars, D. A. (2011). Help-seeking tendencies in Asian Americans with suicidal ideation and attempts. Asian American Journal of Psychology, 2(1), 25-38.
Résumé: Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed.

El-Sayed, A. M., Tracy, M., Scarborough, P., & Galea, S. (2011). Suicide among Arab-Americans. PLoS ONE, 6(2), e14704.
Résumé: BACKGROUND: Arab-American (AA) populations in the US are exposed to discrimination and acculturative stress-two factors that have been associated with higher suicide risk. However, prior work suggests that socially oriented norms and behaviors, which characterize recent immigrant ethnic groups, may be protective against suicide risk. Here we explored suicide rates and their determinants among AAs in Michigan, the state with the largest proportion of AAs in the US. METHODOLOGY/PRINCIPAL FINDINGS: ICD-9/10 underlying cause of death codes were used to identify suicide deaths from among all deaths in Michigan between 1990 and 2007. Data from the 2000 U.S. Census were collected for population denominators. Age-adjusted suicide rates among AAs and non-ethnic whites were calculated by gender using the direct method of standardization. We also stratified by residence inside or outside of Wayne County (WC), the county with the largest AA population in the state. Suicide rates were 25.10 per 100,000 per year among men and 6.40 per 100,000 per year among women in Michigan from 1990 to 2007. AA men had a 51% lower suicide rate and AA women had a 33% lower rate than non-ethnic white men and women, respectively. The suicide rate among AA men in WC was 29% lower than in all other counties, while the rate among AA women in WC was 20% lower than in all other counties. Among non-ethnic whites, the suicide rate in WC was higher compared to all other counties among both men (12%) and women (16%). CONCLUSIONS/SIGNIFICANCE: Suicide rates were higher among non-ethnic white men and women compared to AA men and women in both contexts. Arab ethnicity may protect against suicide in both sexes, but more so among men. Additionally, ethnic density may protect against suicide among Arab-Americans.

Larkin, G. L., Rivera, H., Xu, H., Rincon, E., & Beautrais, A. L. (2011). Community responses to a suicidal crisis: implications for suicide prevention. Suicide and Life-Threatening Behavior, 41(1), 79-86.
Résumé: We conducted a cross-sectional, random-digit-dial survey to evaluate public responses to a hypothetical question: "If someone you knew was suicidal, what would you do first?" Younger people were more likely to call a suicide hotline, and less likely to go to an emergency room (ER) or call 911; immigrants (in the U.S. <15 years) were more likely to call 911, and less likely to call a suicide hotline; African Americans were more likely to go to the ER and call 911; Hispanics were more likely to call 911 but less likely to call a suicide hotline. These results suggest that public messages about hotlines and emergency options for suicidal patients need to be tailored to relevant population characteristics including age, education, ethnicity, and language preferences.

Olson, L. M., Wahab, S., Thompson, C. W., & Durrant, L. (2011). Suicide notes among Native Americans, Hispanics, and Anglos. Qual Health Res. [Epub].
Résumé: Suicide is a significant health problem, yet many questions regarding suicide remain unanswered. One of the most frequently asked questions is related to motive: "Why did that person complete suicide?" We explored motivations for completing suicide, especially with regard to cultural differences, by analyzing suicide notes written by Native Americans, Hispanics, and Anglos in New Mexico. Five categories emerged describing motivation: feelings of (a) alienation, (b) failure or inadequacy, (c) being psychologically overwhelmed; (d) the desire to leave problems behind, and (e) reunification in an afterlife. The largest difference to emerge between ethnic groups was in the alienation category, which included more Hispanics and Native Americans than Anglos. The overall lack of differences in motivation among the ethnic groups suggests that commonalities in suicidal behavior outweigh the differences. Practical implications for research and practice are discussed, along with strengths and limitations of the study.

Matlin, S. L., Molock, S. D., & Tebes, J. K. (2011). Suicidality and depression among African American adolescents: the role of family and peer support and community connectedness. American Journal of Orthopsychiatry, 81(1), 108-117.
Résumé: Rates of suicide are increasing among African American adolescents and pose a significant public health concern. One area that has received little attention is the relationship between various types of social support and suicide, and the extent to which support moderates the relationship between depressive symptoms and suicidality. A total of 212 African American adolescents completed in-school surveys on three types of social support: family support, peer support, and community connectedness. The survey also addressed depressive symptoms and suicidality, as measured by reasons for living, a cognitive measure of suicide risk. Hierarchical multiple regression analyses were used to examine direct and moderating relationships between types of social support and suicidality. The results indicated that increased family support and peer support are associated with decreased suicidality, and peer support and community connectedness moderated the relationship between depressive symptoms and suicidality. Over a third of the variability in reasons for living was predicted by family support, peer support, and community connectedness. Implications for research and preventative interventions for African American adolescents are discussed.

Winterrowd, E., Canetto, S. S., & Chavez, E. L. (2011). Friendship factors and suicidality: common and unique patterns in Mexican American and European American youth. Suicide and Life-Threatening Behavior, 41(1), 50-65.
Résumé: Research suggests a link between friendships and suicidality among U.S. youth, but this link has not been confirmed across ethnicities. The relationship between friendships and suicidality among Mexican American and European American adolescents was examined in this study. Specifically, the role of friendship problems (i.e., social isolation, poor quality friendships) and problematic friends (i.e., friends who were disconnected from school, delinquent friends) was explored. Participants were 648 community youth. Friends' school disconnection was related to Mexican American girls' suicidal ideation, while friends' delinquency was associated with European American youth suicidal behavior. Friendship factors were no longer associated with suicidality after controlling for suicidality correlates such as depression. These findings indicate that the relationship between friendships and suicidality varies by gender and ethnicity. They also suggest a dominant role of depression.

Winterrowd, E., Canetto, S. S., & Chavez, E. L. (2010). Friendship and suicidality among Mexican-American adolescent girls and boys. Death Studies, 34(7), 641-660.
Résumé: Friendship factors have been implicated in adolescent suicidality, but this relationship has not been verified across ethnicities. This study examined suicidality and friendship problems (i.e., social isolation, poor friendship quality, friends' school disconnection, and friends' delinquency) among Mexican-American adolescents, an understudied, vulnerable group in terms of suicidality. Three hundred thirty-eight community adolescents, two thirds of whom were educationally-at-risk, participated in the study. Suicidal ideation and behavior rates were high, particularly among girls. Friends' school disconnectedness increased girls' odds for suicidal ideation by 13%. This association was even greater for girls in good academic standing. Friendship problems were not associated with suicidality in boys. Ethnic identity was a minor factor in suicidal ideation, and only for girls. These findings confirm, among Mexican American adolescents, the role of gender in the relationship between friendship and suicidality.

Zayas, L. H. (2011). Latinas Attempting Suicide: When Cultures, Families, and Daughters Collide. New York: Oxford University Press.
Résumé: Since 1991, surveys conducted by the Centers for Disease Control and Prevention have shown that Latina teenagers attempt suicide at a far higher rate than other American youth in the same age group; one in seven Latinas attempt suicide while one in ten black and white girls do. While these numbers came as a shock to the general public, many urban clinicians have long suspected this disparity without having the data to confirm the problem or draw attention to it. Here, in a compelling account of a troubling trend that draws on interviews conducted both with girls who attempted suicide and those who did not, Luis Zayas begins to unravel the mystery of why such a large proportion of Latinas attempt suicide. Beginning with a description of the U.S. Hispanic population and the many values, beliefs, norms, and child-rearing practices that Hispanic families share in common, Zayas goes on to look at the development of young Latinas, girls caught between two cultures, struggling to reconcile them. By drawing on developmental, cultural, and family psychology and acculturation and immigration theory and research, Zayas' in-depth research forms a conceptual basis for understanding Latina suicide attempts. He illustrates with the girls' own words, and those of their parents, how social, psychological, family, and cultural factors come together into a flashpoint. The result is a startling look at the nexus of influences that make Latina adolescence a particularly risky time. This book presents the anatomy of experiences before, during, and after suicide attempts and suggests new ways of understanding them. More importantly, it offers researchers and clinicians a model for understanding and working with young Latinas and their families in a compassionate, culturally sensitive manner.

Wong, Y. J., Koo, K., Tran, K. K., Chiu, Y.-C., & Mok, Y. (2011). Asian American college students' suicide ideation: A mixed-methods study. Journal of Counseling Psychology, 58(2), 197-209.
Résumé: The purpose of this mixed-methods study was to explore the phenomenon of suicide ideation among 293 Asian American college students. Guided by T. Joiner's (2005) interpersonal-psychological theory of suicidal behavior, the authors examined the relationships among perceived burdensomeness, thwarted belongingness, self-construals, and suicide ideation. Compared with thwarted belongingness, perceived burdensomeness was a more robust predictor of suicide ideation. However, thwarted belongingness moderated the positive association between perceived burdensomeness and suicide ideation. Furthermore, interdependent self-construal and independent self-construal both weakened the link between perceived burdensomeness and suicide ideation and between thwarted belongingness and suicide ideation. The authors also conducted a qualitative analysis of participants' open-ended responses about their perceptions of why Asian American college students might consider suicide. The authors identified a core phenomenon of unfulfilled expectations as well as 2 broad themes related to this core phenomenon: unfulfilled intrapersonal expectations and unfulfilled interpersonal expectations, comprising the subthemes of (a) family, (b) relationship, (c) cultural differences, and (d) racism. These findings are discussed in terms of implications for suicide-related clinical interventions and primary prevention efforts among Asian American college students.

Bursztein Lipsicas, C., Makinen, I. H., Apter, A., De Leo, D., Kerkhof, A., Lonnqvist, J., et al.
(2011). Attempted suicide among immigrants in European countries: an international perspective. Social Psychiatry and Psychiatric Epidemiology, [Epub].
Résumé: PURPOSE: This study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin. METHODS: The material, 27,048 persons, including 4,160 immigrants, was obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour, the largest available European database, and was collected in a standardised manner from 11 European centres in 1989-2003. Person-based suicide-attempt rates (SARs) were calculated for each group. The larger immigrant groups were studied at each centre and compared across centres. Completed-suicide rates of their countries of origin were compared to the SARs of the immigrant groups using rank correlations. RESULTS: 27 of 56 immigrant groups studied showed significantly higher, and only four groups significantly lower SARs than their hosts. Immigrant groups tended to have similar rates across different centres. Moreover, positive correlation between the immigrant SAR and the country-of-origin suicide rate was found. However, Chileans, Iranians, Moroccans, and Turks displayed high SARs as immigrants despite low suicide rates in the home countries. CONCLUSIONS: The similarity of most immigrant groups' SARs across centres, and the correlation with suicidality in the countries of origin suggest a strong continuity that can be interpreted in either cultural or genetic terms. However, the generally higher rates among immigrants compared to host populations and the similarity of the rates of foreign-born and those immigrants who retained the citizenship of their country of origin point to difficulties in the acculturation and integration process. The positive correlation found between attempted and completed suicide rates suggests that the two are related, a fact with strong implications for suicide prevention.

Husain, N., Chaudhry, N., Durairaj, S. V., Chaudhry, I., Khan, S., Husain, M., et al.
(2011). Prevention of self harm in British South Asian women : study protocol of an Exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP). Trials, 12(1), 159.
Résumé: Suicide is a global public health problem. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide. Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. The low uptake of statutory services within this community calls into question the appropriateness of the existing services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group. The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm. METHODS: We plan to test a culturally adapted Problem Solving Therapy (C MAPS) in British south Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU). Outcome assessments will be carried out at 3 and 6 months. At the end a sub group of the participants will be invited for qualitative interviews. DISCUSSION: This study will test the feasibility and acceptability of the C MAPS in British south Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a definitive RCT using repetition of self harm and cost effectiveness as primary outcome measures.

Goosen, S., Kunst, A. E., Stronks, K., van Oostrum, I. E., Uitenbroek, D. G., & Kerkhof, A. J. (2011). Suicide death and hospital-treated suicidal behaviour in asylum seekers in the Netherlands: a national registry-based study. BMC Public Health, 11(1), 484.
Résumé: Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide death and hospital-treated non-fatal suicidal behaviour in asylum seekers in the Netherlands and to identify factors that could guide prevention. METHODS: We obtained data on cases of suicide death and suicidal behaviour from all asylum seeker reception centres in the Netherlands (period 2002-2007, age 15+). The suicide death rate in this population and in subgroups by sex, age and region of origin were compared with the rate in the Dutch population; the rates of hospital-treated suicidal behaviour were compared with that in the population of The Hague using indirect age group standardization. RESULTS: The study included 35 suicide deaths and 290 cases of hospital-treated suicidal behaviour. The suicide death rate and the incidence of hospital-treated suicidal behaviour differed between subgroups by sex and region of origin. For male asylum seekers, the suicide death rate was higher than that of the Dutch population . For females, the suicide death rate did not differ from the Dutch population . The incidence of hospital-treated suicidal behaviour was high in comparison with the population of The Hague for males and females from Europe and the Middle East/South West Asia, and low for males and females from Africa. Health professionals knew about mental health problems prior to the suicidal behaviour for 80% of the hospital-treated suicidal behaviour cases in asylum seekers. CONCLUSIONS: In this study the suicide death rate was higher in male asylum seekers than in males in the reference population. The incidence of hospital-treated suicidal behaviour was higher in several subgroups of asylum seekers than in the reference population. We conclude that measures to prevent suicide and suicidal behaviour among asylum seekers in the Netherlands are indicated.

Al-Maskari, F., Shah, S. M., Al-Sharhan, R., Al-Haj, E., Al-Kaabi, K., Khonji, D., et al. (2011). Prevalence of depression and suicidal behaviors among male migrant workers in United Arab Emirates. Journal of Immigrant and Minority Health, [Epub].
Résumé: Migrant workers comprise 80% of the population of the United Arab Emirates, but there is little research on their mental health. To determine the prevalence and correlates of depression among workers living in labor camps, we conducted a cross-sectional survey in labor camps in Al Ain city. The Depression Anxiety and Stress Scale (DASS-42) was used to assess depression and suicidal ideation among the study participants. Off the 319 contacted workers agreed to participate, however 239 fully completed the DASS-42. The prevalence of a score >=10 ("depression") was 25.1% (60/239). Depression was correlated with physical illness (97/301),, working in construction industry (prevalence 124/304), earning less than 1,000 UAE Dirham per month (prevalence 203/314), and working more than 8 h a day (prevalence 213/315), 20/261 (6.3%) of the study participants reported thoughts of suicide and 8/265 (2.5%) had attempted suicide. People with suicidal ideation were more likely to have a physical illness , earn less than 1,000 UAE Dirham per month , and work for more than 8 h a day. The study identified self reported indicators of a substantial burden of depression, and thoughts of self-harm among laborers surveyed. Policy level intervention and implementation, is needed to improve working conditions, including minimum wages and regulation of working hours is recommended.

Lester, D., Saito, Y., & Ben Park, B. C. (2011). Suicide among foreign residents of Japan. Psychology Reports, 108(1), 139-140.
Résumé: The suicide rate of Koreans living in Japan is twice as high as that of Koreans in South Korea. Reasons for this high suicide rate are discussed, including effects of economic crises and discrimination.

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