Reducing Suicide A National Imperative (2002) / Chapter Skim
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6 Society and Culture
6 Society and Culture
Pages 193-228
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From page 193... ...
Society and culture play an enormous role in dictating how people respond to and view mental health and suicide. Culture influences the way in which we define and experience mental health and mental illness, our ability to access care and the nature of the care we seek, the quality of the interaction between provider and patient in the health care system, and our response to intervention and treatment.
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From page 194... ...
These circumstances are presented at the front and left-hand side of the social safety net in Figure 6-1. For example, historically, in the Austro-Hungarian Empire in the nineteenth century, suicide rates have been reported to be correlated with low levels of social integration (Ausenda et al., 1991~.
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From page 195... ...
attributes the differences between Norway and Denmark's suicide rates to be due to difference in social integration; and in Norway, where the level of integration among young men was reported to be in decline, suicide rates among this groups are increasing. Over time, the doubling of the Irish suicide rate since 1945 appears to be directly related to lower levels of regulation and integration (Swanwick and Clare, 1997~.
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, whose suicide rates reflect a general worsening of health conditions in a time of societal turmoil and crisis with vast economic, political, and social changes. Further, Confucian societies, Japan and China in particular, have comparatively higher suicide rates than other Asian societies.
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From page 197... ...
Family and other social support are protective factors, as will be discussed. Marital Status Marital status provides an opportunity to see the convergence of sociodemographic effects on suicide; its influence on suicide rates varies by gender, culture and across the life course.
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From page 198... ...
Models that account for gender often have found that divorce increases suicide risk in men only; in women divorce does not seem to exert a strong influence on suicide (e.g., Kposowa, 2000; Pescosolido and Wright, 1990~. In Israel, increased divorce rates between 1960 and 1989 were associated with higher suicide rates for men and lower suicide rates for women (Lester, 1997~.
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From page 199... ...
Increases in the suicide rates in Ireland between 1970 and 1985 were correlated with a general decline in social cohesion as marked by a fall in the marriage rate and rise in the number of separated couples (Kelleher and Daly, 1990~. A study in Scotland (Cavanagh et al., 1999)
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From page 200... ...
, with one study suggesting that perceived social support may account for about half the variance in suicide potential for youth (D'Attilio et al., 1992~. Research has demonstrated that social support moderates suicidal ideation and risk of suicide attempts among various racial/ethnic groups, abused youths and adults, those with psychiatric diagnoses, and those facing acculturation stress (Borowsky et al., 1999; Hovey, 1999; Kaslow et al., 1998; Kotler et al., 2001; Nisbet, 1996; Rubenstein et al., 1989; Thompson et al., 2000; Yang and Clum, 1994~.
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From page 201... ...
who are involved with organized religion are less likely to complete suicide (Nisbet et al., 2000~. Similarly, areas in the former Soviet Union with a strong tradition of religion had lower suicide rates from 1965 to 1984 (e.g., the Caucasus and Central Asia; Varnik and Wasserman, 1992~.
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From page 202... ...
These findings do, however, lend support to the notion that religiosity plays a protective role against suicide. Although most studies of religion and suicide have focused on adult samples, some have found that church attendance among youths of various ethnic/racial backgrounds reduces suicide risk, including suicide attempts (Conrad, 1991; Kirmayer et al., 1998; 1996~.
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From page 203... ...
Religious activity has also been found to be protective against suicide risk factors such as alcohol abuse, drug abuse, and anxiety disorder (Bream et al., 1997a; Braam et al., 1997b; Gorsuch, 1995; Koenig et al., 1992; Koenig et al., 1993; Koenig et al., 1994; Pressman et al., 1990~. Further, a number of studies provide some evidence that spiritual protective factors (e.g., religious beliefs)
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From page 204... ...
Clearly, a society's perception of suicide and its cultural traditions can influence the suicide rate. Greater societal stigma against suicide is thought to be protective from suicide, while lesser stigma may increase suicide.
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, and Zimmerman (1987) found, for example, that state welfare spending appears to influence suicide rates via increasing income and lowering divorce (see above section on marital status and suicide)
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Nisbet (1996) contends, however, that observations of income's effects on Black suicide rates most strongly reflect changes in African Americans' social support networks as their socioeconomic status changes.
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Increased unemployment in Ireland has been credited with increased suicide between 1978 and 1985 (Kelleher and Daly, 1990~. On the other hand, unemployment rates did not predict suicide rates in Hong Kong from 1976 to 1992, or in either the United States or Canada from 1950 to 1980 (Leenaars et al., 1993; Lester, 1999~.
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From page 208... ...
The increased stress of breaking social bonds increase suicide risk (Stack, 2000~. 1However, the Depression years saw a drop in the suicide rate from a high of 17 per lOOO,OOOinl933toalow9.6inl944.
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From page 209... ...
In ancient times in China, for example, those soldiers thought to be particularly brave stepped forward in front of battle lines to complete suicide as a demonstration of the fierceness of their loyalty and determination against invading armies from Central Asia (Lin, 1990; Liu and Li, 1990~. General political activity such as United States presidential elections correlates with decreased suicide rates; researchers suggest that this is a consequence of stronger social integration during these times (Boor, 1981~.
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From page 210... ...
In Japan, for example, the discrepancy between suicide rates in rural and urban districts increased from 1975 to 1985 but declined in subsequent years (Goto et al., 1994~. Social Changes and Suicide From the beginnings of the social science study of suicide rates, massive social change, especially that evidenced by the rise of the industrial age, has been implicated as a major cause of rising suicide rates (Masaryk, 1970; Porterfield, 1952~.
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From page 211... ...
Researchers attributed this "epidemic" to vast social changes associated with modernization and globalization, which resulted in the breakdown of traditional values and practices and the development of "normlessness" or anomie, especially among adolescents (Rubinstein, 1983~. In Western Samoa, for example, the rise in suicide rates since 1970 has been hypothesized to result from rising expectations among adolescents in the context of fading opportunities due to Western Samoa's peripheral position in the world economy (Macpherson and Macpherson, 1987~.
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From page 212... ...
(1998) report that countries with religious sanctions against suicide were less likely to report their suicide rates to the World Health Organization, and on average, their reported rates were lower than for countries without sanctions.2 In India, suicide rates may be misrepresented due to traditional and unique cultural practices such as "dowry death," which is a category of deaths of young married women including both homicide and suicide following from intense coercion for payment of unpaid or additional dowry.
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suggest that the high suicide rates in China might be due to lower deliberate miscalculations of rates there than in other countries where suicide is illegal or can elicit serious consequences for families. Integrating Approaches Individual and Aggregate Studies Studies that integrate the events at an individual level with events at an aggregate level can be extremely valuable to the understanding of suicide risk.
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Links between mental illness and culture, race, and ethnicity also have been described (US DHHS, 1999; US DHHS, 2001~. Risk factors are thought to involve everything from genetic variation in metabolism to the adverse effects of poverty and discrimination.
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Social support and various types of religious involvement and beliefs are protective against suicide. · Unemployment and low socioeconomic status generally increase suicide risk.
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Results from a national long-term prospective study and a retrospective study. Acta Psychiatrica Scandinavica, 75~2~: 139-143.
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1998. Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: A prospective study.
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Suicidal behavior as related to social support and assertiveness among Swedish and Turkish high school students: A cross-cultural investigation. Journal of Clinical Psychology, 51~2~: 158-172.
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1999. Moderating influence of social support on suicidal ideation in a sample of Mexican immigrants.
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Acta Psychiatrica Scandinavica, 99~6~: 419-422. Kaprio J
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2001. Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder.
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1998. A longitudinal investigation of depression, hopelessness, social support, and major and minor life events and their relation to suicidal ideation in adolescents.
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1987. Social support, social deficits, and the family: Toward the enhancement of well-being.
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Acta Psychiatrica Scandinavica, 103~4~: 275-281. Ratnayeke L
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Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatrica Scandinavica, 93~5~: 327-338.
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1988. The social supports of suicide attempters: The different roles of family and friends.
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1994. Life stress, social support, and problem-solving skills predictive of depressive symptoms, hopelessness, and suicide ideation in an Asian student population: A test of a model.
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I like living. I have sometimes been wildly, despairingly, acutely miserable, racked with sorrow, but through it all I still know quite certainly that just to be alive is a grand thing.
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