Sean Joe

12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life.

OBJECTIVE Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States. METHOD Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003. RESULTS Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts. CONCLUSIONS Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.

Church-Based Social Support and Suicidality Among African Americans and Black Caribbeans

This study explores the relationship between church-based informal social support and lifetime prevalence of suicide ideation and attempts within a representative national sample of African American and Black Caribbean adults. Characteristics of church-based social support networks, as well as emotional support and negative interaction with church members were examined in relation to lifetime suicide ideation and attempts. This study used data from the National Survey of American Life (2001–2003). Frequency of interaction with church members was positively associated with suicide attempts, while subjective closeness to church members was negatively associated with suicide ideation. Emotional support, service attendance, and negative interaction with church members were unrelated to both suicide ideation and attempts. Findings are discussed in relation to research on church-based support networks, different models linking church support and suicidality, and the mechanisms by which church-based networks deter suicide ideation and attempts.

Psychometric properties of the Beck Depression Inventory-II in low-income, African American suicide attempters.

Cross-cultural examinations of the validity and reliability of the Beck Depression Inventory–II (Beck, Steer, Ball, & Ranieri, 1996) is essential for its use in assessment and monitoring of the effectiveness of suicide interventions across racial groups. We tested the fit of a second-order, two-factor model and the internal reliability of the BDI–II in a sample of 133 African Americans with a recent history of suicide attempts. Additionally, we examined the convergent validity with the Hamilton Rating Scale for Depression (Reynolds & Koback, 1995). The results indicate that the BDI–II is a reliable and valid measure of depressive symptoms for African American suicide attempters.

Prevalence and correlates of non-fatal suicidal behaviour among South Africans

We examined nationally representative data from the 2002-2004 South Africa Stress and Health Study, a national household probability sample of 4351 persons aged 18 years and older: 9.1% of respondents reported lifetime suicide ideation, 3.8% a plan and 2.9% an attempt. Among four ethnic groups, the Coloureda group had the highest lifetime prevalence for attempts (7.1%). Those at higher risk of suicide attempts had one or more DSM-IV disorders.

Explaining Changes in the Patterns of Black Suicide in the United States From 1981 to 2002: An Age, Cohort, and Period Analysis.

To explore the different trends of suicide incidence among Blacks and possible contributing factors, the current study compared national epidemiologic data of suicide in the United States from 1981 to 2002. For the first time, period and birth-cohort effects on the incidence trends of Black suicide were evaluated using an age-period-cohort analysis. Cohort effects were found for males and females, suggesting that younger generations of Blacks are at higher risk. If younger cohorts carry their increased suicide risk into later life, then the recent decline in Black suicide rates will be reversed. The results of the current study are only interpretable in terms of group-level characteristics and population suicide rates and not individual-level characteristics. The possible explanation and the implications for prevention and future research are discussed.

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

OBJECTIVE We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES). METHOD Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions. RESULTS Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning). CONCLUSIONS The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

Religious Involvement and Suicidal Behavior among African Americans and Black Caribbeans

This study explores the relationship between religious denomination, four dimensions of religious involvement, and suicidality (lifetime prevalence of suicide ideation and attempts) within a nationally representative sample of African American and Black Caribbean adults. The relationship between religious involvement and suicide for African Americans and Black Caribbeans indicated both similarities and differences. For both groups, religious involvement was largely protective against suicidal ideation and attempts, although, in some instances, specific measures were associated with higher suicidality. Looking to God for strength, comfort, and guidance was protective against suicidal attempts and ideation, whereas stating that prayer is important in stressful situations was associated with higher levels of ideation for both groups and higher attempts among Black Caribbeans. For African Americans, reading religious materials was positively associated with suicidal ideation. Among Black Caribbeans, subjective religiosity was negatively associated with ideation, and being Catholic was inversely associated with attempts, whereas being Pentecostal was inversely associated with ideation. These findings are discussed in relation to previous research and current conceptual frameworks that specify multiple (e.g., prevention and resource mobilization) and often divergent pathways of religious effects on physical and mental health outcomes.

Suicide, negative interaction and emotional support among black Americans

ObjectivesThis study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults.MethodCross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older.ResultsMultivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans.DiscussionNegative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.

Non-organizational Religious Participation, Subjective Religiosity, and Spirituality among Older African Americans and Black Caribbeans

This study utilizes data from the National Survey of American Life to examine the sociodemographic and denominational correlates of religious involvement and spirituality among older African Americans and Black Caribbeans. Eleven measures of non-organizational religious participation, subjective religiosity, and spirituality are utilized. The findings indicate significant gender, income, region, marital status, denominational, and immigration status differences in religiosity and spirituality. Among older Black Caribbeans, income was a consistent correlate of religious participation and spirituality. The findings are discussed in relation to prior work in the area of religious involvement among older adults.