Rheeda L. Walker

Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice

Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains—history of past attempt and the nature of current suicidal symptoms—that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity.

An empirical investigation of acculturative stress and ethnic identity as moderators for depression and suicidal ideation in college students.

The purpose of this study was to explore the relationships of acculturative stress and ethnic identity to depressive symptomatology and suicidal ideation in college students. The SAFE Acculturative Stress Scale, Multi-Group Ethnic Identity Measure, Beck Depression Inventory, and Beck Suicide Scale were administered to 452 college students. The authors found that acculturative stress and ethnic identity moderated the depression-suicide ideation relationship for African American but not European American college students. Given that vulnerability toward suicidal thoughts is increased for African American college students who report symptoms of depression accompanied by either high-acculturative stress or poor group identity, these culturally relevant factors should be included in protocol for suicide risk assessment.

Evidence-based assessment of depression in adults

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and suicidality; (d) an approach to suicidality that distinguishes between resolved plans and preparations and desire and ideation; (e) assessment of the atypical, seasonal, and melancholic subtypes; (f) parameters of course and chronicity; and (g) comorbidity and bipolarity. These complexities need to be accounted for when certain assessment approaches are preferred, and when ambiguity exists regarding the categorical versus dimensional nature of depression, and whether and when clinician ratings outperform self-report. The authors conclude that no one extant procedure is ideal and suggest that the combination of certain interviews and self-report scales represents the state of the art for evidence-based assessment of depression.

Construct Validity of a Measure of Acculturative Stress in African Americans

The properties of the main measure of acculturative stress have not been systematically examined. The authors conducted a study of the construct validity of the Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (A. M. Padilla, Y. Wagatsuma, & K. J. Lindholm, 1985) in a sample of 248 African American university students (156 of whom attended a historically Black college). After controlling for general life stress, the authors found that the relations of acculturative stress to depressive and anxious (but not suicidal) symptoms remained. Also, African American students at a historically Black college reported less acculturative stress than African American students at a large state university. These findings clarify the nature of a key construct and measure of acculturative stress.

A Meta-Study of Black Male Mental Health and Well-Being

Aggregating and interpreting available qualitative data is a necessary next step to understanding the mental health needs and experiences of Black men. This study describes the findings from a meta-synthesis of qualitative research on Black men’s mental health and well-being using Paterson, Thorne, Canam, and Jillings’s qualitative meta-study approach. Though previous studies have reported various forms of racism as salient concerns for Black men’s mental health and well-being, findings from this meta-study revealed seven themes that present an initial step toward advancing the knowledge pertaining to how Black men perceive and express their mental health and well-being. For instance, male gender socialization and economic status were found to play as large a role in Black men’s mental health and well-being as racism. Additional theoretical perspectives are proposed, and implications for clinical practice and research are discussed.

Suicide and unintentional poisoning mortality trends in the United States, 1987-2006: two unrelated phenomena?

BackgroundTwo counter trends in injury mortality have been separately reported in the US in recent times - a declining suicide rate and a rapidly rising unintentional poisoning mortality rate. Poisoning suicides are especially difficult to detect, and injury of undetermined intent is the underlying cause-of-death category most likely to reflect this difficulty. We compare suicide and poisoning mortality trends over two decades in a preliminary assessment of their independence and implications for suicide misclassification.MethodsDescription of overall and gender- and age-specific trends using national mortality data from WISQARS, the Web-based Injury Statistics Query and Reporting System, maintained by the Centers for Disease Control and Prevention (CDC). Subjects were the 936,633 residents dying in the 50 states and the District of Columbia between 1987 and 2006 whose underlying cause of death was classified as suicide, unintentional poisoning, or injury mortality of undetermined intent.ResultsThe official US suicide rate declined 18% between 1987 and 2000, from 12.71 to 10.43 deaths per 100,000 population. It then increased to 11.15 deaths per 100,000 by 2006, a 7% rise. By contrast to these much smaller rate changes for suicide, the unintentional poisoning mortality rate rose more than fourfold between 1987 and 2006, from 2.19 to 9.22 deaths per 100,000. Only the population aged 65 years and older showed a sustained decline in the suicide rate over the entire observation period. Consistently highest in gender-age comparisons, the elderly male rate declined by 35%. The elderly female rate declined by 43%. Unlike rate trends for the non-elderly, both declines appeared independent of corresponding mortality trends for unintentional poisoning and poisoning of undetermined intent. The elderly also deviated from younger counterparts by having a smaller proportion of their injury deaths of undetermined intent classified as poisoning. Poisoning manifested as a less common method of suicide for this group than other decedents, except for those aged 15-24 years. Although remaining low, the undetermined poisoning mortality rate increased over the observation period.ConclusionsThe official decline in the suicide rate between 1987 and 2000 may have been a partial artifact of misclassification of non-elderly suicides within unintentional poisoning mortality. We recommend in-depth national, regional, and local population-based research investigations of the poisoning-suicide nexus, and endorse calls for widening the scope of the definition of suicide and evaluation of its risk factors.

Acculturation and Acculturative Stress as Indicators for Suicide Risk Among African Americans

The literature on African American suicide and the acculturation literature were examined to derive a possible explanation for increases in suicide deaths for African American men and apparent resilience for African American women. Historically, African Americans were believed to be unaffected by suicide because of protective factors (e.g., strong religious values and cohesive familial support systems) embedded in the culture. However, minority mental health investigators have found that acculturation sometimes leads to negative consequences for individuals from ethnic minority backgrounds. Accordingly, acculturation and acculturative phenomena are proposed as a model to shed light on African American male suicide as African Americans increasingly engage mainstream values, beliefs, and practices in the absence of traditional protective factors.

Affective and attributional features of acculturative stress among ethnic minority college students

Little is known about the affective features of acculturative stress or its relation to attributional styles for negative events. The authors examined associations among acculturative stress, attributional style, and positive and negative affect among 96 ethnic minority college students. They hypothesized that acculturative stress would be characterized by elevated negative affect and global and stable attributions for negative events. Consistent with prediction, acculturative stress was significantly associated with negative affect and global attributions, even when controlling for other relevant predictors. Attributional style did not account for the association between negative affect and acculturative stress. Positive affect and stable and internal attributional styles were not related to acculturative stress. The authors discuss implications for reducing stress associated with acculturation.

Do sociocultural factors predict suicidality among persons of African descent living in the U.S.

Given that researchers have found increased risk for suicidality and other psychiatric problems among acculturated individuals, we predicted similar results for African-descended people living in the U.S. We surveyed a community sample of 423 adult men and women of African descent to determine acculturations relationship to Black suicide. Participants completed the African American Acculturation Scale, the Multi-Dimensional Support Scale, and a subscale of the Spiritual Well-Being Scale. Suicidal ideation and history of suicide attempt were defined as a “yes” response to the questions, “have you ever considered taking your own life?” and “have you ever attempted to take your own life?” We found that religious well-being (not acculturation) was predictive of both suicidal ideation and history of suicide attempt.

Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults.

Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.