Suicide from diverse perspectives

Citation

McKenzie, A.T.a.K. (2013), "Suicide from diverse perspectives", Ethnicity and Inequalities in Health and Social Care, Vol. 6 No. 2/3. https://doi.org/10.1108/EIHSC-02-2014-0005

Suicide from diverse perspectives

Article Type: Guest Editorial From: Ethnicity and Inequalities in Health and Social Care, Volume 6, Issue 2/3.

Nearly one million people die by suicide each year (World Health Organization, 2011). Suicide rates have increased in the last 45 years by 60 per cent, making suicide one of the three leading causes of death among those aged 15-44 years. In some countries suicide is a leading cause of death in young people.

There are common approaches to suicide prevention, but they may be more effective in some population groups than others. In part, this is because different groups within a country may have different levels of risk or access to services. The factors that promote suicide and prevent suicide vary significantly for different population groups. Understanding these differences could be the basis of equitable suicide prevention strategies.

There are over 20 major urban centres worldwide with more than 1,000,000 immigrants. Economic, religious and cultural diversity is increasing. There are high-recorded suicide rates in Aboriginal, Maori, First Nations and Inuit people. Unfortunately, despite these facts and that countries are becoming more diverse than ever, more often than not at country level there is too little information on differential risk and too little information on effective prevention strategies for policy makers to act on.

This special issue of Ethnicity and Inequalities in Health and Social Care highlights some of the risk and protective factors for racialised minority groups and ethno-cultural minority groups. Once we know what the factors are that are involved in the decision-making process the question that we seek to answer is: what can be done about it? A number of the papers in this issue also address specific prevention strategies and techniques to help reduce suicide risk for ethno-cultural and racialised minorities.

There is no one leading reason why someone chooses suicide. There is an ongoing interplay between individual risk factors, historical and current contextual/social factors as well as time (McKenzie et al., 2003; Shah et al., 2011). All of these aspects are important in the process of either protecting someone from suicide or leading to a suicide.

Individual level factors such as age, gender, social relations, employment, religion, discrimination and mental health issues are some of the potential factors in the decision process towards a suicide. These can differ significantly for each individual (Bhui and McKenzie, 2008), often they can compound on each other to increase the risk but the individual factors alone do not always determine whether someone is at risk for suicide.

The social context that we live in, are brought up in, and that changes around us also plays a part in the decision process. Historical forces such as residential schools, wars and/or cultural apartheid can still have an effect on multiple groups. The current relationship with the larger society, how a group is viewed and treated and positioned within the mainstream society may also affect the larger ethno-cultural or racialised groups’ opportunities, opinions and mental health well-being. These larger social and contextual issues on their own may relate to increased or decreased suicides within communities (see Chandler and Lalonde, 2008a, b for a discussion on how cultural continuity can affect suicide rates). However, they often interact with the individual level factors (e.g. Bhui et al., 2007; Stack and Kposowa, 2011; Stack and Wasserman, 2007).

This interaction between the individual and the ecological is the third dimension (Shah et al., 2011). The risk of suicide may change within individuals when social level factors change, for example, through migration. The act of moving/relocating to another country does not in itself result in suicide but interacts with individual level factors (e.g. mental health problems) to potentially lead to suicide.

The fourth component of this relationship is time. Time can be considered in two ways. First, length of exposure to an individual or a contextual level factor such as bullying, or thwarted aspirations can increase the likelihood of suicide risk. Second, time may be needed for an interaction between individual and societal level factors to intensify (Shah et al., 2011). For example, in the summer of 2011, a couple of high profile suicides/overdoses in North America among hockey players got journalists and scientists postulating that the physical nature of the sport, the stigma of suicide within sport and the potential mental health and addictions of the players may have interacted over time so that the players chose suicide (Branch, 2011; Moisse, 2011). It is not known whether this is the reality, and there is no guarantee that these were the only factors involved in these tragic deaths but this highlights how an interaction between individual level factors and the social context may work over time.

The papers in this special issue cover a mixture of themes and minority groups. It is not possible to identify one risk factor for all suicides – the process is complex and multi-layered. Neither is it simple to identify one preventative strategy for all (each) racial or cultural minorities but the authors of the papers in this special issue have broadened our knowledge and provided insights to continue the conversation.

Han, Oliffe and Ogrodniczuk's paper is a qualitative exploration of culture- and context-specific suicidal behaviours among Korean-Canadian immigrants. Three themes emerged in the narratives with participants as triggers of suicidal thoughts: academic and work pressure, estrangement from family and altered identities. Recognition of traditional collectivist cultural values and affirming individual beliefs by healthcare providers could support “at risk” Korean Canadians.

Adedoyin and Salter conduct a literature review of associated risk factors, the influence of religion and spirituality among African-American adolescents. Risks of suicide among African Americans include preferred methods (e.g. firearms), disillusionment, discrimination and family disintegration. Churches are uniquely positioned to provide prevention to African Americans. The black Church has the infrastructure, and acceptance within the African-American community to take a lead in implementing suicide prevention programmes.

Humensky and colleagues describe the basis for a research evaluation strategy for Life is Precious (LIP) a programme based in community organisations addressing risk factors that are unique to Latinas, notably familism and generational conflict. LIP offers a number of activities – art therapy, school assistance and family activities – to at-risk Latinas. All participants are required to receive mental health counseling while in the programme.

Donskoy and Stevens’ paper explores people's memories of the pathways leading to the first episode of self-wounding. This paper is a survivor researcher-led pilot study. Even when suicidal feelings are present, self-wounding was described as a human response to an often intolerable situation, a means of recovering some control over emotions. There is a danger of oversimplifying the process and results – the complexity of emotions and feelings present a number of stories that do not follow a linear or casual pattern.

Cole and colleagues’ paper explores the moderating effects of interpersonal factors on depression and suicide in American Indians. This is a cross-sectional study of American-Indian college students. Their work seeks to understand the effects of being a burden to close others and an unmet need to belong leading to depression and suicide.

One final thought: technology is advancing at such a rapid pace and we are becoming far more “technologically social”. However we do not yet have a clear understanding of how these more traditional social forces (e.g. religion, culture and family) interact with or moderate social networking with regards to suicide. Is this an important risk factor for minority populations? In light of the recent proposed legal changes in Canada and the emphasis on how important technology is to young people this appears to be a growing avenue for suicide research. It is essential though to remember that the causes of and risk factors for suicide are never simple – even technology and the social stimulus and results of information posted online affect disparate groups differently.

Andrew Tuck is a Research coordinator based at Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Dr Kwame McKenzie is a Senior Scientist, Director of Health Equity and Director of Social Aetiology and Mental Health CIHR Training Program based at Centre for Addiction and Mental Health, Toronto, Ontario, Canada and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

References

Bhui, K. and McKenzie, K. (2008), “Rates and risk factors by ethnic group for suicides within a year of contact with mental health services in England and Wales”, Psychiatric Services, Vol. 59 No. 4, pp. 414-20
Bhui, K., McKenzie, K. and Rasul, F. (2007), “Rates, risk factors & methods of self-harm among minority ethnic groups in the UK: a systematic review”, BMC Public Health, Vol. 7, November, pp. 336-49
Branch, J. (2011), “Hockey players’ deaths pose a tragic riddle”, The New York Times, 2 September, p. B10, available at: www.nytimes.com/2011/09/02/sports/hockey/deaths-of-three-nhl-players-raises-a-deadly-riddle.html?_r=0 (accessed September 2013)
Chandler, M.J. and Lalonde, C.E. (2008a), “Cultural continuity as a protective factor against suicide in first nations youth”, Horizons, Vol. 10 No. 1, pp. 68-72
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McKenzie, K., Serfaty, M. and Crawford, M. (2003), “Suicide in ethnic minority groups”, British Journal of Psychiatry, Vol. 183 No. 2, pp. 100-1
Moisse, K. (2011), “NHL player deaths put spotlight on mental health”, ABC News, available at: http://abcnews.go.com/Health/MindMoodNews/nhl-player-deaths-put-spotlight-mental-health/story?id=14428405 (accessed 1 September 2011)
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