Cultural Bias Complicates Suicide-Prevention Efforts

Psychiatrists and mental health professionals are steadily learning—and placing into practice—that preventing youth suicide among minority populations means understanding the social context in which members of those groups often live. Society discriminates doubly against African Americans and homosexuals, for example, both for whom they are and for any mental illness they may have, a combination that can increase the risk of suicide, two speakers said at the Suicide Prevention Action Network meeting in Washington, D.C., in July.

A century ago, it was a common belief in psychiatry that African Americans were too “unsophisticated” to get depressed or commit suicide, a characteristic attributed as well to other marginalized ethnic groups such as Chinese or Eastern European immigrants, said Sherry Davis Molock, Ph.D., M.Div., an associate professor of psychology at George Washington University. Some of that bias remains, predisposing clinicians to errors in diagnosis and treatment, she added.

While suicide rates among African-American youth were once lower than for whites, those rates have increased sharply over the last 30 years, especially between 1980 and 1995. Today, suicide ranks as the third leading cause of death among African Americans aged 15 to 24, after homicide and accidents.

Clinicians should take extra care in evaluating potential suicidality among these youths. Conventional suicidal symptoms may not be obvious at first in some minority groups, said Molock. For many cultural and social reasons, African Americans are more likely than whites to signal suicidality as behavioral or somatic complaints than as the classic sadness of depression, she said.

For example, because of cultural or religious stigma attached to suicide, some black youth may engineer their own deaths by “victim-precipitated homicide,” by confronting police or others who will use deadly force to respond to the provocation.

Also, more young African-American men die of drowning than any other ethnic group studied. That may be partly a measure of not knowing how to swim but it may also indicate unrecorded suicidality, since medical examiners may not be thinking suicide when listing the cause of death.

“Blacks will express little suicidal intent, even when asked,” she said. She recalled the case of one of her patients, a student who swallowed crushed glass but told doctors in the emergency room that it was an“ accident,” and was promptly discharged home.

“If it looks like a suicide, it probably is,” she emphasized.