Peter Goldblum

A tool for the culturally competent assessment of suicide: The Cultural Assessment of Risk for Suicide (CARS) Measure.

Despite important differences in suicide presentation and risk among ethnic and sexual minority groups, cultural variations have typically been left out of systematic risk assessment paradigms. A new self-report instrument for the culturally competent assessment of suicide, the Cultural Assessment of Risk for Suicide (CARS) measure, was administered to a diverse sample of 950 adults from the general population. Exploratory factor analysis yielded a 39-item, 8-factor structure subsumed under and consistent with the Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010), which characterizes the vast majority of cultural variation in suicide risk among ethnic and sexual minority groups. Psychometric properties showed that the CARS total and subscale scores demonstrated good internal consistency, convergent validity with scores on other suicide-related measures (the Suicide Ideation Scale, the Beck Depression Inventory suicide item, and the Beck Hopelessness Scale), and an ability to discriminate between participants with versus without history of suicide attempts. Regression analyses indicated that the CARS measure can be used with a general population, providing information predictive of suicidal behavior beyond that of minority status alone. Minorities, however, reported experiencing the CARS cultural risk factors to a greater extent than nonminorities, though effect sizes were small. Overall, results show that the CARS items are reliable, and the instrument identifies cultural suicide risk factors not previously attended to in suicide assessment. The CARS is the first to operationalize a systematic model that accounts for cultural competency across multiple cultural identities in suicide risk assessment efforts.

Cultural versus classic risk and protective factors for suicide

ABSTRACT The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.

Innovations in the practice of culturally competent suicide risk management.

Although guidelines for culturally competent suicide risk management are sparse, recent advances in theory and assessment provide direction for culturally competent practice. The Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010) was one of the first comprehensive efforts to provide a framework that guides an understanding of how culture influences suicide risk across multiple cultural identities. The Cultural Assessment of Risk for Suicide (CARS), a 39-item self-report measure assessing culturally specific suicide risk factors, was developed based on the Cultural Theory and Model of Suicide. These theoretical and measurement works, although foundational in their importance for synthesizing a broad literature, have not been tested and translated into applied clinical practice. The current case study is a translational effort that applies these approaches to culturally competent suicide practice with “Zoe,” an Asian American veteran trans woman in her early thirties with moderate-high suicide risk. Application of the Cultural Theory and Model of Suicide and the CARS illuminated cultural risk factors that were not considered in Zoe’s original safety plan (e.g., family conflict, minority stress; hidden suicidal ideation and behaviors; and cultural expressions of suicidal distress as anger, fatigue, and shame). These results yielded differences in Zoe’s risk management plan and created a culturally informed approach that corresponded with a concomitant decrease in suicidal symptoms. This study demonstrated that the CARS may detect alternative cultural expressions of suicidal distress and behaviors and yield important implications for suicide risk assessment and management planning for culturally diverse clients.

An Empirical Model and Ethnic Differences in Cultural Meanings Via Motives for Suicide

OBJECTIVE The importance of cultural meanings via motives for suicide - what is considered acceptable to motivate suicide - has been advocated as a key step in understanding and preventing development of suicidal behaviors. There have been limited systematic empirical attempts to establish different cultural motives ascribed to suicide across ethnic groups. METHOD We used a mixed methods approach and grounded theory methodology to guide the analysis of qualitative data querying for meanings via motives for suicide among 232 Caucasians, Asian Americans, and Latino/a Americans with a history of suicide attempts, ideation, intent, or plan. We used subsequent logistic regression analyses to examine ethnic differences in suicide motive themes. RESULTS This inductive approach of generating theory from data yielded an empirical model of 6 cultural meanings via motives for suicide themes: intrapersonal perceptions, intrapersonal emotions, intrapersonal behavior, interpersonal, mental health/medical, and external environment. Logistic regressions showed ethnic differences in intrapersonal perceptions (low endorsement by Latino/a Americans) and external environment (high endorsement by Latino/a Americans) categories. CONCLUSION Results advance suicide research and practice by establishing 6 empirically based cultural motives for suicide themes that may represent a key intermediary step in the pathway toward suicidal behaviors. Clinicians can use these suicide meanings via motives to guide their assessment and determination of suicide risk. Emphasis on environmental stressors rather than negative perceptions like hopelessness should be considered with Latino/a clients.

Unit Acceptance and Psychological Distress among LGB Military Service Members: Preliminary Findings from a National Survey

Abstract Literature clearly elucidates the association between unit cohesion and service members’ well-being. Similarly, social support/acceptance of sexual identity is related to better mental health among lesbian, gay, and bisexual (LGB) populations. No research exists examining the relation between perceived unit acceptance of LGB service members and LGB service members’ psychological distress. Among LGB service members in this sample, the majority reported their units were accepting of LGB members. A significant minority reported serving in non-accepting units and these participants reported greater psychological distress. Findings inform researchers, policymakers, and mental health providers serving LGB service members seeking support related to unit non-acceptance.

Relations of religion with depression and loneliness in older sexual and gender minority adults

ABSTRACT Objectives: High levels of religious involvement have been associated with positive mental health outcomes in older adults. This study investigated whether the effects of religion on healthy aging could generalize to older LGBTQ adults. Methods: This study examined religious affiliation in childhood versus at present, as well as the relationships of outness to religious community and religious engagement with depression and loneliness in 102 lesbian, gay, and bisexual cisgender, transgender, and questioning adults (LGBTQ) over the age of 55. As part of a larger study, participants completed several questions and measures including: one outness to religious community item, 4 religious engagement questions, the Center for Epidemiological Studies Depression Scale, and the 8-item UCLA Loneliness Scale. Results: Many older LGBTQ adults reported changes in religious affiliation from childhood to adulthood. Greater levels of outness to religious communities and lower religious engagement were related to lower levels of depression and loneliness. Conclusions: Findings suggest that outness to religious communities may be beneficial to the mental health of older LGBTQ adults. Higher levels of distress may lead to higher levels of religious engagement. Clinical Implications: Religion, especially those that are supportive of sexual minorities, may help to improve the well-being of older LGBTQ adults.

Military Service Members’ Satisfaction With Outness

This study is among the first examining lesbian, gay, and bisexual (LGB) service members in the United States following the “don’t ask, don’t tell” policy repeal. Higher levels of outness predict better mental health among general LGB populations. The military environment, like other traditional/conservative settings, may alter this relation; however, no data are available on outness among LGB service members in the United States. We examined 236 service members’ level of outness and satisfaction with outness in relation to depression and anxiety symptoms. Results revealed greater level of outness was related to higher satisfaction with outness, with each variable related to better mental health. Importantly, satisfaction fully mediated the relation between level of outness and mental health, indicating satisfaction to be a more salient predictor than level alone. Findings relevant to military policy makers and health-care providers are discussed along with recommendations for advancement of research into outness among LGB people.

A Shortened Screener Version of the Cultural Assessment of Risk for Suicide

The current study aimed to establish a shortened version of the Cultural Assessment of Risk for Suicide (CARS) measure that can be more widely utilized under time constraints in clinical and applied settings. Based on a sample of 485 adults, confirmatory factor analysis, bivariate correlations, and Receiver-Operating Characteristic analyses were employed to determine the most psychometrically valid shortened version. The 14-item, 8-factor CARS screener (CARS-S) evidenced high reliability, high correlation with the original full version of the CARS questionnaire, and high convergent validity with measures of other suicide-related constructs of depression, hopelessness, suicidal ideation, and lifetime suicide attempts. The suggested clinical cut-off is 38.5. The shortened CARS-S offers a time-efficient assessment of cultural suicide risk factors.

An assessment of training in and practice of culturally competent suicide assessment.

Recent scholars have criticized the extant training and practice of suicide-risk assessment (SRA) as insufficient in terms of cultural competence (CC), arguing that advancements are needed in assessment tools and guidelines for training and practice in detecting suicide risk with diverse clients. These criticisms, however, have been based largely on conjecture. Data regarding barriers to or the extent of culturally competent suicide-risk-assessment (CCSRA) training and practice have been nonexistent. Aims of the current study were to assess the degree of training and practice in CCSRA among a random nationwide sample of 161 licensed doctoral-level psychologists. Results indicated that participants reported a bare minimum amount of training, lower diversity in, and fewer types of CCSRA training compared with general CC or SRA training. Even though psychologists in the current sample believed a patient’s cultural background moderately to very much impacts level of suicide risk, they reported that cultural factors are only slightly to moderately incorporated in SRA practices. In addition, participants reported low comfort in employing CCSRA into practice. A mixed-methods approach identified 4 predominant barriers to practice, listed in order of importance: insufficient training, lack of knowledge and awareness, lack of experience with cultural minority clients, and a lack of practice guidelines. Participants who graduated after 2002 reported receiving more training and being more comfortable with general CC, but not CCSRA practice. Results suggest that standardized guidelines and training are necessary to advance doctoral training and practice in CCSRA.

A qualitative analysis of suicide risk factors, preferred means, and means restriction feasibility within a homeless shelter environment

ABSTRACT Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.