In spite of the acknowledged role of race and ethnicity in the United States, and the increasing diversity of our population, there have been remarkably few epidemiological studies of adolescent suicidal behaviors in the diverse groups that make up American society.
Suicide is a major public health problem in the United States. For example, suicide is the third leading cause of death for persons 15-24 years old (the rate was 13.1 per 100,000 in 1991; National Center for Health Statistics, 1994; Moscicki, 1997). Suicidal behavior has been reported as a leading cause of psychiatric emergencies among children and adolescents (Robinson, 1986) and one of the strongest predictors of psychiatric hospital admissions for adolescents (Hillard, Slomowitz, &r Deddens, 1988).
In the United States, as well as worldwide, suicide rates differ by age, gender, race or ethnicity, marital status, and SES (Moscicki, 1995). Most of these studies have had adults as their focus. For example, mortality statistics in the United States indicate that American Indians and Alaska Natives have the highest suicide rates of any ethnic group, about 50% higher than the overall rates (Moscicki, 1997). Although there have been studies of suicidal behaviors of adolescents (see reviews by Reynolds & Mazza, 1994; Shaffer & Hicks, 1994), there are virtually no data on suicidal behaviors among minority adolescents. This is surprising, since epidemiological studies suggest such behaviors are not uncommon.
Concerning suicide mortality, Smith, Mercy, and Warren (1985) compared suicide rates among Anglos and Latinos (of which 86% were Mexican American) in five southwestern states and found that, for all ages, the suicide rate for Latinos (9.0) in the areas was less than that for Anglos (19.2). This discrepancy between groups, however, was less for adolescents ages 15-19, as the suicide rate for Latino adolescents was 9.0 compared to 11.9 for Anglo adolescents. Suicides, moreover, occurred at a younger age for Latinos (32.9% under age 25) than for Anglos (17.3% under age 25). A recent report examined the epidemiology of trauma deaths in Los Angeles County (Demetriades et al., 1998). Excluding poisonings (17.7% of all trauma deaths) and drownings, the suicide rates for those under 15 years of age were 5.2 and 5.3 per 100,000 for African American males and females, 4.6 and 4.1 for Hispanic males and females, and 2.9 and 1.9 for European American males and females, compared with 3.8 and 3.9 for all males and females under 15. Overall, for all ages, there were no differences across the three largest ethnic groups for either males or females.
Recent community-based, epidemiological studies report prevalence of suicidal ideation for adolescents ranging from about 2% to as high as 60% (Garrison, Addy, Jackson, McKeown, & Waller, 1991b). The prevalence of suicide attempts tends to be much lower, with lifetime prevalence for adolescents ranging from 3.5% to 11% (Andrews & Lewinsohn, 1992). Results from the few studies that have examined ethnic differences have been equivocal, with several studies reporting no difference between European and African American adolescent suicidal behaviors (Dubow, Kaush, Blum, Reed, & Bush, 1989; Garrison et al., 1991b) and several reporting higher suicidal behavior among African American adolescents (Garrison et al., 1991a; Harkavy, Friedman, Asnis, Boeck,
& DiFore, 1987). Garrison, McKeown, et al. (1993), reporting data from a statewide survey in South Carolina, found that although suicide attempts were higher for Europeans than for African Americans, African American females reported the highest frequency of attempts requiring medical treatment. African Americans were less likely to report plans, but significant ethnic differences were not found for suicidal thoughts.
Lester and Anderson (1992), using data from a very small school-based sample in New Jersey, report that Hispanic students had higher scores on both depression and suicidal ideation than did African American students. Most of the Hispanic students were of Puerto Rican origin. Vega, Gil, Zimmerman, and Warheit (1993), using data from a large school-based survey of Cuban, Nicara-guan, other Hispanic, African American, and Anglo American males in grades six and seven, report that African Americans had the highest prevalence of suicidal ideation in the previous 6 months. Nicaraguans and other Hispanics had the highest levels of lifetime suicide attempts.
Roberts and Chen (1995) examined suicidal ideation in a large sample of European and Mexican American middle school students. Mexican Americans had rates of ideation almost twice as high as those of their Anglo counterparts. Adjusting for the effects of covariates such as age, gender, language use, and household structure, Mexican American adolescents still had 1.7 times the risk of suicidal ideation. The percentage of Mexican American youths reporting they had thought about killing themselves on one or more days during the past week was 25.2%. This is similar to a rate of 23.4% reported by Swanson et al. (1992) for Mexican American students.
Reynolds and Mazza (1992) assessed suicidal behaviors in a sample of junior and senior high schools in eight states. The highest rate of a history of suicide attempts was found for Native American adolescents (25.5%) and the lowest rate was among African American youths. Hispanic youths also reported a high rate (16.3%) of lifetime suicide attempts. Walter et al. (1995) report that 14% of Hispanics reported suicidal behaviors compared to 12.8% of African Americans and 12.0% for "Other" ethnicities in a survey (N = 3,738) of four middle schools in New York City. The primary risk factor for suicidal behaviors was depression. The Hispanic students were largely Dominicans (they were 73.7% of the overall sample). Suicidal behavior was defined as intent to commit suicide or having attempted suicide ever in their lifetime.
Hovey and King (1996) report that 24.3% of a small sample (N = 70) of first- and second-generation Latino American adolescents reported critical levels of suicidal ideation on the Suicidal Ideation Questionnaire-Junior (SIQ-JR). As a comparison, 11% of the standardization sample exceeded a score of 31 (Reynolds, 1988). Hovey and King (1996) then explored the relationship between acculturative stress, depressive symptoms, and suicidal ideation. They found that perceived family dysfunction and nonpositive expectations for the future were significant predictors of acculturative stress; and that acculturative stress, perceived family dysfunction, and nonpositive "expectations for the future" were significant predictors of depression and suicidal ideation. Their overall results suggest that some acculturating Latino adolescents experience high levels of acculturative stress, and that these adolescents are also "at risk" for experiencing critical levels of depression and suicidal ideation.
Warheit et al. (1996) report no association between ethnicity (White non-Hispanic, Hispanic, African American) and suicidal ideation in South Florida. The study examined the relations between disaster-related stresses, depression scores, and suicidal ideation among adolescents (N = 4,978) all of whom have been exposed to Hurricane Andrew. Regression analysis showed that being female, hurricane-generated stresses, low levels of family support, pre-hurricane suicidal ideation, and post-hurricane depression scores were significant predictors of post-hurricane suicidal ideation. Ethnic status was not a significant predictor of suicidal ideation.
Howard-Pitney, LaFromboise, Basil, September, and Johnson (1992) studied Zuni adolescents and found significant correlations between a measure of suicide ideation and past suicide attempt behavior, drug use, depression, hopelessness, stress, psychological symptomatology, social support, liking for school, and interpersonal communication. Significant differences between the 30% of the students who reported having previously attempted suicide and the non-attempters were also found on these measures. The rate of suicide attempt (30%) was much higher than the 4-13% attempt rate found in general population youth studies but consistent with American Indian/Alaska Native boarding school population studies (Dinges & Duong-Tran, 1990; Manson, Beals, Dick, & Duclos, 1989). A striking gender difference pattern in suicide attempts was found at the Zuni pueblo that mirrored findings from the U.S. youth population (Kinkel, Bailey, & Josef, 1989), indicating that girls attempt suicide two to three times more than boys. Other research on Indian populations, such as Pueblo Indians (Biernoff, 1970) and the more recent boarding school studies, have suggested that gender differences in attempt rates are not as large.
Novins, Beals, Roberts, and Manson (1999) analyzed data from self-report surveys of 1,353 high school students representing three culturally distinct American Indian tribes for tribal differences in factors associated with suicidal ideation. Overall, 3.5% screened positive for suicidal ideation, but differences between groups were not statistically significant. Prevalences were 2.3% for Southwest, 5.0% for Northern Plains, and 3.8% for Pueblo youths. No single correlate of suicidal ideation was common to all three tribes. The correlates of suicidal ideation were consistent with each tribes' social structure, conceptualization of individual and gender roles, support systems, and conceptualizations of death. These results underscore the heterogeneity of suicidal ideation across three distinct American Indian tribes consistent with their cultural heterogeneity.
In one of the few studies of Asian-Pacific Islander adolescents in the United States, Yuen et al. (1996) found a 6-month prevalence of suicide attempts of 4.3% among Native Hawaiian high school students (N = 1,779). There were no significant differences between boys and girls, similar to some reports on Native American youths (Manson et al., 1989).
Roberts, Chen, and Roberts (1997) used data from an ethnically diverse sample of middle school students (N = 5,423) to examine differences in suicidal ideation, thoughts about suicide in the past 2 weeks, suicide plans, and suicide attempts. Ideation was examined using a four-item scale and a single item on suicidal thoughts. Ideation was higher among females, older youths, and lower status youths. The same general pattern held for recent suicidal plans and attempts, with the exception of gender, where the trend was for males to report more attempts. Lifetime plans and attempts were higher for females, older youths, and lower status youths. Data were sufficient to compare nine ethnic groups. Multivariate logistic regression analyses, adjusting for the effects of age, gender, and SES, yielded significant odds ratios using the Anglo group as the reference for suicidal ideation for the Mexican (OR = 1.76, p < 0.01), Pakistani (OR = 2.0, p < .01), and Vietnamese (OR = 1.48, p < .05) American groups. For thoughts about suicide in the past 2 weeks, only Pakistani and Mixed Ancestry youths had elevated risk. For suicidal plans in the past 2 weeks, Mixed Ancestry youths (OR = 2.02, p < .05) and Pakistani youths (OR = 3.20, p < .01) had elevated risk. For recent attempts, only the Pakistani American youths had elevated risk (OR = 3.19, p < .01).
Grunbaum, Basen-Enquist, and Pandey (1998), using data from 1,786 high school students (6.5% were Mexican American), report no significant differences between European and Mexican Americans in terms of suicide plans and suicide attempts in the past year. For males, the rates of attempted suicide were 6.3% for European and 6.9% for Mexican Americans; for females the rates were 11.2% for European and 14.9% for Mexican Americans. Substance use increased risk of suicidal behaviors, but not consistently across groups. Depression, a known significant risk factor for suicidal behaviors, was not examined.
Kann et al. (1998), using data from the Youth Risk Behavior Surveillance System of the Centers for Disease Control, report that 2.5% of students had seriously considered attempting suicide during the 12 months preceding the survey. Overall, Hispanic students (23.1%) were significantly more likely than African American students (16.4%) to have considered attempting suicide. More serious suicidal ideation was observed among the 15.7% of students nationwide who, during the 12 months preceding the survey, had made a specific plan to attempt suicide. Overall, Hispanic students (19.6%) were significantly more likely than European and African American students (14.3% and 12.5%, respectively) to have made a suicide plan. Hispanic female students (23.9%) were significantly more likely than African Female female students (16.0%) to have made a suicide plan. Hispanic male students (16.0%) were significantly more likely than European and African American male students (11.0% and 8.8%, respectively) to report this behavior. Nationwide, 7.7% of students had attempted suicide one or more times during the 12 months preceding the survey. Overall, Hispanic students (10.7%) were significantly more likely than white students (6.3%) to have attempted suicide. Hispanic male students (7.2%) were significantly more likely than European male students (3.2%) to report this behavior. Nationwide, 2.6% of students reported having made a suicide attempt during the 12 months preceding the survey that resulted in an injury, poisoning, or overdose that had been treated by a doctor or nurse. No ethnic differences were reported for such serious attempts.
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