Connecting with social and emotional well-being in rural Australia: An evaluation of 'We-Yarn', an Aboriginal gatekeeper suicide prevention workshop.

OBJECTIVE: This evaluation considered the potential of We-Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales. DESIGN: A mixed methods approach included surveys, in-depth interviews and workshop observations. SETTING: Aboriginal suicide prevention training in rural New South Wales, Australia. PARTICIPANTS: Attendees at We-Yarn training. INTERVENTION: We-Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non-Aboriginal facilitator. We-Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness. MAIN OUTCOME MEASURES: Pre and post-workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content. RESULTS: We-Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training. CONCLUSION: We-Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre-existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important.

"Our lifestyle is a mix-match": Traditional healers talk about suicide and suicide prevention in South Africa.

Practitioners of traditional African medicine (traditional healers) are an important part of the health care system in South Africa, yet their voices are often absent from discussions about public health. In this context, we set out to investigate how a group of traditional healers in South Africa understand suicide and suicide prevention. In-depth, semistructured interviews were conducted with 6 traditional healers and analysed using thematic content analysis. The traditional healers report they are frequently consulted by suicidal individuals and they are confident about their ability to help people in a suicidal crisis. Findings suggest that traditional healers understand suicidal behaviour as a symptom of social disconnection and cultural discontinuity. Traditional healers report that suicidal individuals can be helped by reestablishing interpersonal connections, reconnecting to family and ancestors, and renewing their cultural identities through rituals. These findings suggest that there is some congruence between the way traditional healers understand suicide and the Western scientific and biomedical literature. Our findings raise important questions about cultural approaches to suicide research which are commonly premised on dualistic thinking that constructs culture as something distinct from Western biomedicine.

Reclaiming Indigenous identities: Culture as strength against suicide among Indigenous youth in Canada.

In Canada, Indigenous youth suicide represents one of several health disparities burdening Indigenous populations, and like many other of these disparities, can be understood as an expression of societal, historical, cultural and familial trauma. As the number of Indigenous youth who take their own lives every year in Canada continues to far exceed national averages, it appears that conventional suicide prevention efforts remain ineffective among this population. A growing body of research argues that conventional interventions, largely rooted in Western individual-level behavioural change frameworks, are culturally discordant with Indigenous paradigms. In response, some Indigenous communities are turning to cultural revitalization as a holistic community-driven response to suicide prevention and treatment. The following commentary explores the emerging evidence base for "culture as treatment" - a novel approach to suicide that emphasizes the significance of interconnectedness in healing, alongside the revitalization of traditional values to reclaim community wellness. In doing so, we seek to contribute to a changing discourse surrounding Indigenous youth suicide by acknowledging culture as strength against this national crisis.

Pitfalls in the Interpretation of Traumatic Socioethnic Practices.

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non-voluntary-inflicted trauma.

Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children.

BACKGROUND: Although identified as a significant public health concern, few studies have examined correlates of suicide risk in school-aged children. Recent studies show a relation between sluggish cognitive tempo (SCT) symptoms and a range of adverse outcomes linked to suicidal ideation, including depression, emotion dysregulation, lowered self-esteem, and peer problems/social withdrawal, yet no study to date has examined SCT in relation to suicide risk. METHODS: We tested the hypothesis that SCT would be associated with suicide risk in a sample of 95 psychiatrically hospitalized children (74% male; 62% black) between the ages of 8 and 12 (M = 10.01, SD = 1.50). Parents completed measures of their child's psychiatric symptoms, including SCT and depression, as well as a measure of their own psychopathology. Children completed measures assessing loneliness and depression. Both parents and children completed measures of suicide risk. RESULTS: White children reported greater suicide risk than nonwhite children. After controlling for demographic characteristics, loneliness, parental psychopathology, and correlated psychiatric symptoms, including both parent- and child self-reported depressive symptoms, SCT remained uniquely associated with children's suicide risk. Results were consistent across both parent and child measures of suicide risk. CONCLUSIONS: This multi-informant study provides strong preliminary support for an association between SCT symptoms and suicide risk in psychiatrically hospitalized children, above and beyond loneliness, depression, and demographic characteristics. Findings are discussed in the context of the interpersonal theory of suicide. Additional studies are needed to replicate and extend these findings, with a particular need for studies that examine the cognitive processes and daydreaming content of individuals displaying elevated SCT symptomatology.

Global trends in teenage suicide: 2003-2014.

The object of this article is to review the past decade of research on teenage suicide, with a particular emphasis on epidemiologic trends by age, gender and indigenous ethnicity. As such, a review of research literature from 2003 to 2014 was conducted via a comprehensive search of relevant psychological and medical databases. Wide gaps in our knowledge base exist concerning the true extent of teenage suicide due to lack of data, particularly in developing countries, resulting in a Western bias. The gender paradox of elevated suicidality in females with higher completed suicide rates in males is observed in teenage populations worldwide, with the notable exceptions of China and India. Native and indigenous ethnic minority teens are at significantly increased risk of suicide in comparison to general population peers. Often those with the highest need for mental health care (such as the suicidal adolescent) have least access to therapeutic support.Globally, suicide in teenagers remains a major public health concern. Further focused research concerning completed suicides of youth below the age of 18 is required across countries and cultures to understand more about risk as children progress through adolescence. Gender and ethnic variations in suicidality are embedded within cultural, historical, psychological, relational and socio-economic domains. Worldwide, the absence of child/adolescent-specific mental health policies may delay the development of care and suicide prevention. Overall, it is vital that clinicians adopt a holistic approach that incorporates an awareness of age and gender influences, and that cultural competency informs tailored and evaluated intervention programmes.

Suicides in Aboriginal and Torres Strait Islander children: analysis of Queensland Suicide Register.

OBJECTIVE: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children. METHODS: Using the Queensland Suicide Register, suicides in Indigenous children (10-14 years) and other Australian children in the same age band were compared. RESULTS: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children - 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children. CONCLUSIONS: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required.

Kava drinking associated with suicidal behaviour among young Kanaks using kava in New Caledonia.

OBJECTIVE: To examine associations between recreational use of kava and indicators of suicidal behaviour among youth in New Caledonia. METHODS: This cross-sectional community-based survey was administered to 1,400 young people aged 16-25 years. A multivariate analysis tested for associations between lifetime kava use and lifetime suicidal ideation and attempts. Because ethnicity affected the correlation between kava use and suicidal behaviour, data were analysed separately for Kanak youth and youth of other ethnic communities. RESULTS: Overall, 42% of respondents reported any lifetime kava use, 34% reported past suicidal ideation and 12% any suicide attempts. Among Kanak youth, kava use increased the likelihood of reporting both suicidal ideation (aOR = 2.40, 95% CI: 1.58-3.66) and suicide attempts (aOR = 1.98, 95% CI: 1.11-3.52). No such association was found in the non-Kanak group. CONCLUSIONS: The discrepancy between the effects of kava drinking on suicidal behaviour between Kanak youth and youth of other ethnic groups may be related to differences in patterns and quantity of kava use. In view of the paucity of data on the effects of kava on mental health in young people, further investigation is required. IMPLICATIONS: The results call for an increased awareness of the potential adverse health effects of kava consumption in New Caledonia where it has spread in recent times and among communities where previously it was never used.

The "Mental" Health of Canada's Indigenous Children and Youth: Finding New Ways Forward.

Focusing, as it is meant to do, on child mental health, this special issue of Healthcare Quarterly singles out for attention a distinctive category of concerns that, when viewed through lenses common to many Indigenous peoples, is arguably better left unmarked. That is, attempts to carve up the world in such a way that health concerns centre on matters of the "mind," on the one hand, and on "physical" ill health, on the other, are expressive of a form of self-understanding that is more consonant with the classic dualisms of traditional, "Western," Cartesian thought (e.g., the mental in counter-distinction to the physical; selves set off against societies), and quite out of place in those more holistic frameworks of understanding favoured by many of the world's Indigenous peoples (Chandler 2010). Why such putative cultural differences might make a difference - or at least a difference in what is written here - is that any account of health matters in which Indigenous people might actually recognize themselves requires, as a constitutive condition of its coherence, a kind of radical reframing - a shift in axes that replaces the arguably "false" dichotomy between mental and physical health with something better approximated by the much-overheard and more broadly inclusive notion of personal and community "well-being."

Explaining suicide in an urban slum of Mumbai, India: a sociocultural autopsy.

BACKGROUND: Health demographic mortality studies use verbal autopsies to identify suicide as a cause of death. Psychological autopsies focus almost exclusively on associated high-risk psychiatric disorders. New approaches considering contextual factors are needed for preventing suicide and promoting mental health. AIMS: This study examined explanations of suicide reported by surviving family members or close friends with reference to social, cultural, and environmental conditions as well as the challenges of life in the Malavani slum of Mumbai. METHODS: An EMIC (Explanatory Model Interview Catalog) interview based on a cultural epidemiological framework considered underlying problems, perceived causes, and sociocultural contexts. It was administered to survivors of 76 people who had died by suicide (56.6% women). RESULTS: Accounts of underlying problems typically referred to various aspects of tension (73.7%). Perceived causes often identified multiple factors. The sociocultural contexts of suicide included the victimization of women, the personal and social impact of problem drinking, marital problems, physical health problems, mental tension, possession and sorcery. Women were particularly vulnerable to the impact of problem drinking by a spouse or father. CONCLUSIONS: This study demonstrates the value of an approach to sociocultural autopsy examining local contexts and explanations of suicide. Findings highlight needs for both mental health services and culturally sensitive social interventions.

The healing of our people: substance abuse and historical trauma.

For the past two decades, one of the authors (Robert Morgan) has been involved in the development and implementation of culturally based outpatient, inpatient, and aftercare programs for Alaskan native and American-Indian populations in Alaska. After years of observation, it was concluded that the best efforts of our clinicians were inadequate to the task at hand, i.e., that of resolving the social and physical ills that have ravaged the Alaskan peoples since the occupation. Morgan and others sought to create a new model of diagnosis and treatment that combined the cultural strengths of the people with the technical and treatment skills of the conventional medical profession. The model was grounded in a clear understanding of the factors causing disease in the people, and that understanding came from the people themselves. Before the growth of the "healing plant" that Uncle Walter spoke of could be nurtured, it was necessary to first examine the question of cause and effect. Much of the cause is rooted in the "historical trauma" experienced by the Alaska Native People. The effects are numerous, but one of the most obvious symptoms is substance misuse.

Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences.

BACKGROUND: Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality. OBJECTIVES: To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation. METHOD: A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation. RESULTS: The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation. CONCLUSIONS: The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.

The good, the bad, and the unresolved death in Kaliai.

Lusi-Kaliai speakers in West New Britain, Papua New Guinea consider death to be either good or bad depending on whether it is the consequence of bad social relationships and causes social upheaval. A good death is under the control of the dying person and is the result of the natural process of aging. Good deaths are the ideal, but are rare in Kaliai. Bad death is more common and implies a rupture of social relations and results in the destruction of peace and social order. A death may be unresolved because people disagree as to its cause and its meaning for others. Strife resulting from an unresolved death may be irreparable, making closure impossible. The resulting social dysfunction can lead to further death and the breakdown of the community. However, when people understand the cause of death and can identify the causative agent, it is possible to resolve the problems leading to the death and restore order. Case studies illustrate how particular deaths fit these categories and how the people of Kaliai struggle to explain death, to cope with its inevitability, and to repair the social disruption in its wake.

Identity, activity, and the well-being of adolescents and youths: lessons from young people in a Micronesian society.

Comparative studies of the health, well-being, and social functioning of adolescents and youths have, in the past two decades, been focused on young people in developing countries where rapid social, cultural, and economic changes have been associated with dramatic increases in the rates of social problems indicative of poorer mental health. Young people in many Pacific Island societies suffer from some of the highest rates of social problems like suicide and substance abuse in the world. It is generally agreed that the increases in rates of social problems among youths in this region result from increases in psychosocial stress, anger, and frustration surrounding intergenerational conflict within the family. Much less is known about the aspects of everyday experiences of young people in the Pacific that can lead to psychosocial stress and the angry episodes of interpersonal conflict that often precede suicide attempts and binge drinking. This paper examines 40 cases of interpersonal conflict in young men's and women's experiences in the islands of Chuuk of the Federated States of Micronesia to better understand what can lead to elevated levels of psychosocial stress for youths in the Pacific. This study shows that the emotional crises of young people in Chuuk often emerge from the incongruence in their pursuit of valued personal and social identities within the family, the community, and the peer group. Thus youths who experience more incongruity in their engagements across the multiple activity settings of everyday life are at greater risk for stressful experiences.

'Atamai, fakakaukau and vale: 'mind', 'thinking' and 'mental illness' in Tonga.

This paper explores the concepts of "mind", "thinking" and "mental illness" from a Tongan perspective. Their old Tongan equivalents are 'atamai, fakakaukau and vale. Of specific interest is mental illness. A specific state of mind, mental illness is investigated, firstly, in the conflicting relationships of mind and thinking and, secondly, in the context of the dialectical relationships between traditional forms of disease and illness and medicinal and healing concepts and practices. Their inherently clear spatio-temporal basis gives them a sense of realism. This realistic sense is much more revealing when they are positioned in the context of ta and va, Tongan for "time" and "space". Ontologically, time and space are the common medium of existence of all things, in a single level of reality. On the epistemological level, time and space are social constructs, deriving from their relative arrangement across cultures. Conflicts inevitably arising from the time-space, form-content transformation of types of human activity, create symmetries and asymmetries in the natural, mental and social realms. By integrating time and space, a general ta-va theory could be developed, so that we can better understand the complexity surrounding nature, mind and society.