Acculturation and suicide-related risk in ethnoracially minoritized youth in the US: a scoping review and content analysis of the empirical evidence.

PURPOSE: Among Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth, the US born have higher risk of suicidal thoughts and behaviors (attempts and death-by-suicide) than first-generation migrants. Research has focused on the role of acculturation, defined as the sociocultural and psychological adaptations from navigating multiple cultural environments. METHODS: Using content analysis, we conducted a scoping review on acculturation-related experiences and suicide-related risk in Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth (henceforth described as "ethnoracially minoritized adolescents"), identifying 27 empirical articles in 2005-2022. RESULTS: Findings were mixed: 19 articles found a positive association between acculturation and higher risk for suicide ideation and attempts, namely when assessed as acculturative stress; 3 articles a negative association; and 5 articles no association. Most of the research, however, was cross-sectional, largely focused on Hispanic/Latinx youth, relied on demographic variables or acculturation-related constructs as proxies for acculturation, used single-item assessments for suicide risk, and employed non-random sampling strategies. Although few articles discussed the role of gender, none discussed the intersections of race, sexual orientation, or other social identities on acculturation. CONCLUSION: Without a more developmental approach and systematic application of an intersectional research framework that accounts for racialized experiences, the mechanisms by which acculturation may influence the risk of suicidal thoughts and behavior remain unclear, resulting in a dearth of culturally responsive suicide-prevention strategies among migrant and ethnoracially minoritized youth.

System Dynamics of Cognitive Vulnerabilities and Family Support Among Latina Children and Adolescents.

The paper describes an approach to developing a data-driven development of a feedback theory of cognitive vulnerabilities and family support focused on understanding the dynamics experienced among Latina children, adolescents, and families. Family support is understood to be a response to avoidant and maladaptive behaviors that may be characteristic of cognitive vulnerabilities commonly associated depression and suicidal ideation. A formal feedback theory is developed, appraised, and analyzed using a combination of secondary analysis of qualitative interviews (N = 30) and quantitative analysis using system dynamics modeling and simulation. Implications for prevention practice, treatment, and future research are discussed.

Infusing the trauma-informed approach in youth suicide research: Lessons from the field.

Adolescent suicide is a serious public health problem in Chile. Given the high prevalence of suicidal behaviors and suicide, youth suicide researchers must approach participants, families, and communities with care. Special attention must be given to suicide-related trauma among survivors of suicidal behaviors and of suicide. In this article, we discuss how investigators can infuse the trauma-informed model in their work. Our discussion is organized around research stages and tasks: study design, recruitment, data collection and analysis, and care for the research team. We illustrate the integration of the trauma-informed (TI) model key elements and principles with examples from our work in youth suicide research. We posit that infusing the TI model in research aligns with the ethical mandate of beneficence. Our goal is to help other researchers reflect on how to design and implement TI informed research that is attuned to participants, staff, and communities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trajectories of Well-Being Among Latina Adolescents Who Attempt Suicide: A Longitudinal Qualitative Analysis.

Significant research questions persist regarding the short- and long-term outcomes of Latina adolescents who attempt suicide. To address these limitations, we utilize an ecodevelopmental framework to identify potential factors that shape differential outcomes following a suicide attempt. Through an exploratory, longitudinal, qualitative research design, we investigate two research questions: How do trajectories of well-being vary among Latina teens after a suicide attempt? What risk and protective factors might contribute to different trajectories? We conducted qualitative interviews with 17 Latina participants living in predominantly low-income households in New York City. Interviews took place within the 6 months following their suicide attempts, and again, 12 months later. Analysis revealed three distinct trajectories after a suicide attempt: resilience, tenuous growth, and chronic stress. Our findings elucidate potential factors that contribute to resilience following a suicide attempt and underscore the importance of prevention and intervention programs that foster adolescents' connectivity across ecodevelopmental contexts.

Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men.

While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.

Treatment Narratives of Suicidal Latina Teens.

In this article, we examine the treatment narratives of Latina adolescent suicide attempters to understand their experiences undergoing care. For this study, we conducted content and thematic analysis of 68 interviews with Latina adolescent suicide attempters. Most teens who described positive experiences undergoing treatment (n = 39, 44.1%) did so when discussing outpatient mental health services (n = 30, 72.9%). Latinas felt that the providers who fostered their autonomy and connectedness helped them become active agents in their recovery. Clinicians serving suicidal Latinas must allow them to exercise agency while feeling emotionally connected to providers. To help Latinas manage their suicidality, treatments need to address the teens' developmental needs.

Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men.

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals' likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.

Acculturation and Its Discontents: A Case for Bringing Anthropology Back into the Conversation.

Anthropologists' contribution to the study of cultural change is urgent in light of the increasing number of people of different backgrounds who are migrating around the globe and settling in new communities, and the opportunities and challenges that come along with that process. By examining the anthropological literature on acculturation going back to the 1936 Memorandum by Redfield, Linton and Herskovits, this paper reviews and assesses the discipline's perspective on acculturation, and lays out the case for why it is critical for anthropologists to re-engage the concept. Although other disciplines, particularly psychology and sociology, have dominated the field of acculturation research more recently, they mostly have done so with a narrow focus. While it is important to acknowledge the pitfalls of anthropology's past study of acculturation, there are important features of the acculturation construct that continue to be relevant. Among these are the study of acculturation as a process that is multidimensional; the investigation of how different kinds of power affect the acculturation process; the impacts of attitudes, actions and policies of the receiving group on how acculturation proceeds; the role of "real history" in understanding processes of acculturation; and the global perspective on these processes. We suggest ways in which anthropologists can reignite the field of acculturation research by engaging with Redfield, Linton and Herskovits' framework and subsequent anthropological literature.

Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City.

OBJECTIVE: Syndemic theory has been proposed as a framework for understanding the role of multiple risk factors driving the HIV epidemic among sexual and gender minority individuals. As yet, the framework has been relatively absent in research on Latinos/as. METHODS: We used logistic regression to assess relationships among cumulative syndemic conditions - including clinically significant depression, high-risk alcohol consumption, discrimination, and childhood sexual abuse - engagement with multiple partners and condomless anal intercourse (CAI) in a sample of 176 Latino men who have sex with men (MSM) in New York City. RESULTS: In bivariate analyses, an increase in the number of syndemic factors experienced was associated with an increased likelihood of reporting multiple partners and CAI. In multivariable analyses, participants with 2, 3, and 4 factors were significantly more likely to report multiple partners than those with 0 (aOR=4.66, 95% CI [1.29, 16.85); aOR=7.28, 95% CI [1.94, 27.28] and aOR=8.25, 95% CI [1.74, 39.24] respectively; p<0.05. Regarding CAI, only participants with 3 and 4 factors differed from those with 0 aOR=7.35, 95% CI [1.64, 32.83] and OR=8.06, 95% CI [1.39, 46.73] respectively. CONCLUSIONS: Comprehensive approaches that address syndemic factors, and capitalize on resiliency, are needed to address the sexual health needs of Latino MSM.

An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas.

To date, there is little research to validate empirically differences between nonsuicidal self-injurious behavior (NSSI) and attempted suicide among Latina adolescents. Understanding the characteristics and contextual features of self-harmful behaviors among Latina teens is a critical public health and social justice matter given the disproportionate rates of attempted suicide and anticipated population growth of this vulnerable group. In this article, we draw on an ecodevelopmental model to focus attention on factors in the sociocultural environment that shape suicidal behaviors and NSSIs. Through analysis of qualitative interviews conducted with girls who used NSSI (n = 18), attempted suicide (n = 29), used NSSI and attempted suicide (n = 8,) and had no reported lifetime history of self-harm (n = 28), we describe the sociocultural factors that shaped psychosocial vulnerabilities and gave rise to decisions to use NSSI or attempt suicide. Our analysis revealed that adolescents who engaged in NSSI perceived their negative feelings as something that could be controlled through self-injurious acts, whereas powerlessness was a theme underlying the emotional states of girls who attempted suicide. When NSSI ceased to function as a mechanism for control, girls came to sudden decisions to attempt suicide. Most teens identified specific, and often multiple, situations that induced intense affective states and shaped decisions to inflict self-harm. Two situational experiences emerged as particularly salient and promising for subsequent studies on self-harmful behaviors among Latina adolescents: transnational stress and bullying. We describe each of these and offer suggestions for future research and practice.

Clinical Encounters with Immigrants: What Matters for U.S. Psychiatrists.

About 3.2 percent of the population across the globe are migrants. Today, unprecedented numbers of people are relocating in the U.S. and more than ever, psychiatrists find themselves caring for immigrant patients. International migration is a multilayered issue that often has implications for the mental health of migrants. Thus, there is an increasing interest in understanding how the different factors associated with migration processes affect the mental health outcomes of immigrants. We group these factors into three categories: immigrant process, clinical encounter, and mental health services. When possible, we incorporate a gendered and life span perspective and suggest avenues for including what we know into the care of children, adults, and elderly psychiatric patients with immigrant backgrounds. We pay special attention to the immigrant paradox literature, which explains why some immigrants are healthier when they start their journey, and why their mental health deteriorates as they live longer in the host societies. We aim at providing psychiatrists an understanding of what to ask, assess, and consider when caring for patients who are international migrants.

Aspirations of Latina adolescent suicide attempters.

Parents' aspirations and expectations are communicated to their offspring. Children internalize their parents' aspirations and accept some of the expectations while rejecting others, all part of the developmental process and identity-consolidation. When the aspirations and expectations of youth and parents are incongruent, the outcomes in youths' behavior can be deleterious, such as when adolescents manifest suicidal behaviors. We examined aspirations expressed by 12 Latina adolescent suicide attempters and their parents and compared them to 12 non-suicidal Latinas and parents. Qualitative analyses revealed that incongruence of aspirations between girls and their parents were greater among suicidal teens. Suicidal and non-suicidal Latinas presented contrasting aspirations: the former on gaining independence and the latter on completing their education and pursuing careers. Findings may inform developmental research and ways in which clinicians and policymakers can help Latinas achieve their own and their parents' aspirations.

Mental health clinicians' experiences of implementing evidence-based treatments.

Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments. In this qualitative study the authors explore the experiences of clinicians (N = 11) who were implementing evidence-based treatments, highlighting the factors that they perceived to be most critical to successful implementation. The clinicians' narratives reveal many leverage points that can inform administrators, clinical supervisors, and clinicians who wish to implement evidence-based treatments, as well as other stakeholders who wish to develop and test strategies for moving evidence-based treatments into routine care.

Means, Intent, Lethality, Behaviors, and Psychiatric Diagnosis in Latina Adolescent Suicide Attempters.

This article describes the means, intent, lethality, behavioral profile, and psychiatric diagnosis of adolescent Latina suicide attempters. From a large mixed-methods project studying the sociocultural processes of Latina suicide attempts, we selected 76 subjects for this report. In addition to quantitative research data, medical records were available for all 76 subjects and qualitative data from in-depth interviews for 34 of them. Using the qualitative and quantitative research data, we explored the intent and behavioral profile of the suicidal adolescents. Medical records provided additional information about the means the adolescents used in their attempts and about their psychiatric diagnosis. The lethality of suicide attempts was coded using the LSARS and the LSARS-II. Findings showed that Latina adolescent suicide attempts are of low lethality. Consistent with the literature, most adolescents reported that they attempted by using means available in their homes (cutting and overdosing with medications were the predominant methods). Interesting discrepancies emerged when comparing adolescents' self-reported behavioral profiles with clinicians' psychiatric diagnoses. This report has implications for diagnosis and treatment approaches for both inpatient and outpatient service providers.

Can Better Mother-Daughter Relations Reduce the Chance of a Suicide Attempt among Latinas?

National surveys and other research on adolescent Latinas show that adolescent females have higher rates of suicidal ideation, planning, and attempts than other ethnic and racial minority youth. Internalizing behaviors and family conflicts are commonly associated with suicidality in research on adolescents. In the case of Latinas, we explore the connection between adolescent Hispanic cultural involvement, mother-adolescent mutuality, internalizing behaviors, and suicidality. This paper presents data from a study of 232 Latinas, some with a recent history of suicide attempts (n = 122). The results show that higher adolescent Hispanic cultural involvement was associated with greater mother-daughter mutuality and thus led to reduction in the likelihood of suicide attempts. The relationship between mother-daughter mutuality and suicide attempts among Latinas is mediated by specific internalizing behaviors (withdrawn depressive). Our findings highlight the positive effect that Latino cultural values have in the relationship between Latina adolescent and their mothers and confirm the importance that internalizing behaviors and the mother-daughter relationship have for suicide attempters.

Familism, family environment, and suicide attempts among Latina youth.

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.

Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency.

OBJECTIVE: Latin American-trained IMGs in psychiatry face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this case study report, a group of IMGs reflect on their experiences and describe how they solved challenges. METHOD: Using cogenerative ethnography, four IMGs trained in Colombia, Dominican Republic and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, focus groups, and written reports were analyzed using data reduction, data display, and conclusion drawing techniques. RESULTS: We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorized these challenges into three domains: immigration and acculturation; social adjustment; and medical training. Quotes were selected to illustrate IMGs' challenges and coping strategies. CONCLUSION: Some of the combined cultural, social and academic challenges of Latin American-trained IMGs in psychiatry are described. Recognizing and planning for the personal challenges of IMGs in psychiatry can enhance the transition into psychiatric training. Ultimately, improvements in IMG training converts into improved healthcare for all patients.

Ganando Confianza: Research Focus Groups with Immigrant Mexican Mothers.

Immigrant families with children with developmental disabilities must be served using culturally sensitive approaches to service and research to maximize treatment benefits. In an effort to better understand cultural issues relevant to the provision of parenting programs for immigrant Mexican mothers of children with developmental disabilities, we conducted sustained focus groups through which we could learn more about our participants and thereby improve services. This paper reports on the challenges and lessons learned from these groups. We characterize the key lessons as (a) recruitment and retention is more than agreement to participate; (b) confidentiality is not just a word but an activity; (c) the complicated nature of language; (d) cultural norms shape the group process; (e) appreciating the value of taking time; and (f) gender issues and group interaction. Service providers and researchers who work with Mexican families may benefit from our experiences as they promote and develop programs and projects in the developmental disabilities field.

Family Relationships and Latina Teen Suicide Attempts: Reciprocity, Asymmetry, and Detachment.

Using qualitative data collected from adolescent Latinas and their parents, this article describes ways in which family relationships are organized within low-income Latino families (n = 24) with and without a daughter who attempted suicide. Based on a family-level analysis approach, we present a framework that categorizes relationships as reciprocal, asymmetrical, or detached. Clear differences are identified: Families of non-attempters primarily cluster in reciprocal families, whereas families with an adolescent suicide attempter exhibit characteristics of asymmetrical or detached families. Our results highlight the need for detailed clinical attention to family communication patterns, especially in Latino families. Clinicians may reduce the likelihood of an attempt or repeated attempts by raising mutual, reciprocal exchanges of words and support between parents and daughter.