A Review of Cultural Disparities Regarding Suicidal Behavior in At Risk Populations

Adolescent suicide remains a debilitating and tragic phenomenon in the United States. Suicide is the third leading cause of death among adolescents, accounting for a greater number of fatalities than the next seven leading causes combined for 15- to 24-year-olds (Centers for Disease Control and Prevention [CDC], 2006). Distinct ethnic groups show unique patterns of suicidal behavior. “At risk” populations are those with elevated rates of suicide death, attempt, or ideation, among them being Latinos, African Americans, and American Indian/Alaska Natives. Latino adolescents have shown a tendency to be at greater risk for depressive symptoms, suicide ideation, and suicide attempts than other racial/ethnic minority adolescents (Canino & Roberts, 2001; Hovey & King, 1996; Zayas, Lester, Cabassa, & Fortuna, 2005). Across the lifespan, the median age of suicide death is approximately a decade earlier for African American suicide victims than for other ethnic groups (CDC, 2006), and among American Indians between the ages of 15 and 19, suicide accounts for nearly 20% of deaths (CDC, 2006).

Culture-specific beliefs and behaviors can act as either hazardous or preventive agents on self-injurious behaviors. Analysis of the literature has produced five salient motifs accounting for cultural disparities in suicidality: family, cultural environment, history, identity, and religiosity.


Familial expectations (familismo), unity and cooperation are obligatory among Latinos; collectivism is enforced while the importance of individual achievements and identity is deemphasized (Goldston et al., 2008; Zayas et al., 2005). One fourth of Latino-American adolescents in a study by Hovey & King (1996) reported critical levels of depression and suicide ideation, which through multiple regression analyses revealed family dysfunction as strongly predictive of depressive symptoms. Yet higher scores on a responsibility to family subscale implicated strong familial connectedness as a disincentive for suicidal behavior (Oquendo et al., 2005).

Among African Americans, increased family support and peer support are associated with decreased suicidality (Matlin, Molock, & Tebes, 2001), while deficits in family functioning and support are strongly associated with suicide attempts among low-income African American men and women (Compton, Thompson, & Kaslow, 2004).


Emotional disturbances associated with immigration, and the various adaptations brought on from contact with a foreign culture, place the Latino population at an elevated risk for suicidal behavior (Goldston et al., 2008). The process of acculturation to American society and the stressors related to transitioning are positively associated with depression and suicidal ideation among Latino adolescents in particular (Hovey & King, 1996).

Deindustrialization in urban areas related to various socioeconomic difficulties such as lack of education, community resources, and employment have been attributed specifically to the urban African American population as risk factors for suicidal behavior (Kubrin, Wadsworth, & DiPietro, 2006).

Life on an isolated reservation produces higher rates of suicide among American Indian/Alaska Native youth, most often attributed to the phenomenon of suicide contagion (Bechtold, 1988). At the same time, tribal life can incite a desire to maintain cultural identity and create tight-knit community relations (Johnson & Tomren, 1999), which may protect American Indians/Alaska Natives against suicide.


Two widely established stressors that have been linked to psychological distress in the African American population are racism and discrimination (Goldston, et al., 2008). Perceived discrimination has been associated with depression, increased substance use, and hopelessness among African American adolescents (Gibbons, Gerard, Cleveland, Wills, & Brody, 2004).

Due to historical trauma of forced relocation of American Indian/Alaska Native families and children in the late 1800s, intergenerational trauma created by this ethnic cleansing produced a pervasive feeling of demoralization and increased ongoing suicide risk within these populations (Goldston et al., 2008; Whitbeck, Adams, Hoyt, & Chen, 2004). Furthermore, there is evidence that alcohol being introduced by white settlers into the American Indian/Alaska Native populations, and genetic inexperience of metabolizing alcohol for these populations, largely contributes to the high rates of suicide by intoxication (Silk-Walker, Walker, & Kivlahan, 1988).


Oquendo et al. (2005) found that being Latino and self-identifying as such served as a proxy for cultural constructs protecting against suicide. That is, individuals accepting belongingness to the Latino group were found to possess the culturally driven protective factors associated with the Latino identity (i.e. family and religiosity; Oquendo et al., 2005).

For African Americans, positive racial identity or racial centrality is associated with lower depressive symptoms and higher esteem (Sellers, Copeland-Linder, Martin, & Lewis, 2006). More so, African Americans who have attempted suicide feel more disconnected from their own ethnic group as compared with their nonsuicidal counterparts (Kaslow et al., 2004).

The degree to which an individual is embedded in traditional cultural values plays a large role in inspiring prosocial behaviors and preventing suicidality among American Indians and Alaska Natives (Whitbeck et al., 2004). Low ethnic identity (possibly as a result of past forced relocation and loss of language and culture) is a risk factor for suicidality among American Indian/Alaska Native adolescents (Goldston et al., 2008).


Eighty-seven percent of Latino participants in a study by Cabassa, Lester, and Zayas (2007) reported that faith in God heals depression and 77% agreed that praying to God for forgiveness would relieve depressive symptoms. Low rates of suicide ideation by Latinos in a study by Oquendo et al. (2005) were found to be associated with one’s self-identification as Catholic and thus, high moral objection to suicide.

African American youth have been consistently found to report more religious activities than other groups (Molock, Puri, Matlin, & Barksdale, 2006). For African American students, self-directed religious coping (the belief that God plays an indirect and passive role in one’s life) is positively associated with more hopelessness, depression and suicide attempts (Molock et al., 2006).

A study by Beals et al. (2005) found that the use of traditional healing ceremonies is positively linked to the strength of American Indian/Alaska Native identity, which in turn is associated with lower risk of suicidal behavior. Regular church attendance was the strongest negative correlate of attempted suicide identified for Inuit youth in a study by Kirmayer, Boothroyd, and Hodgins (1998).

Implications and Suggestions for Treatment

Familial connectedness among Latino youth is an important factor when considering mental wellbeing.  Since Latinos rely heavily on family as a support structure, positive-influence members should be incorporated into suicide prevention efforts. Practicing religious activities in place of negative coping mechanisms was shown to be favorable among young Latinos facing emotional disturbances, and may be an important component to consider for treating suicide risk (Cabassa et al., 2007).

Factors to address in suicide prevention for African Americans include incorporation of informal sources of support and culturally sensitive programs that foster openness and trust of mental health professionals while expunging perceived judgment (Nisbet, 1996). Integration into familial and community networks without creating a stigma weakness or instability is important to black individuals given the reduced rates of suicide among socially engaged individuals (Goldston et al., 2008; Joe et al., 2006).

Among American Indian/Alaska Native individuals, traditional healing approaches appear to be the most frequently sought means of treatment (Beals et al., 2005).  Therefore, if integrated into professional treatment, may perhaps increase success rates. Because of the high rate of associated fatalities, alcoholism and substance abuse treatment should be of highest priority in an intervention (Wallace et al., 2003).

Emma Hamilton has her Bachelor of Science in Psychology and Spanish Studies from the University of Minnesota. She currently works as a family recruiter at the renowned Minnesota Center for Twin and Family Research and volunteers in her free time as an advocate for Minnesota Latinos through La Oportunidad, Inc. and HACER (Hispanic Advocacy and Community Empowerment through Research). Emma hopes to enter graduate school in the near future and intends to continue researching mental health within marginalized populations. 


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