Two speakers at the recent Suicide Prevention Action Network (SPAN) meeting in Washington D.C. addressed the need for better understanding of the cultural biases of minority groups when therapists and care providers assess suicide risk. Sherry Molock, a clinical psychology professor at George Washington University, spoke specifically about ethnic minorities and the distinctive manner in which different cultural groups think about or even attempt suicide. In failing to understand how certain behaviors may indicate a suicide risk or suicide attempt, doctors and therapists may be unintentionally putting distressed individuals back into harms way. Similarly, Effie Malley, a SPAN prevention specialist, addressed the specific circumstances of sexual minorities such as lesbian, gay or transgendered individuals. Gay or lesbian youths are dramatically more likely to attempt suicide then their heterosexual counterparts. Malley asserts that by understanding the particular complexities that surround sexual minorities' suicidality, doctors and therapists will be better prepared to serve this group.
As quoted by Psychiatric News, both speakers offered insights into how therapists and responders might better serve these communities. Mollock stressed caution about differences in presentation:
Conventional suicidal symptoms may not be obvious at first in some minority groups, said Molock. For many cultural and social reasons, African Americans are more likely than whites to signal suicidality as behavioral or somatic complaints than as the classic sadness of depression, she said.
"Blacks will express little suicidal intent, even when asked," she said. She recalled the case of one of her patients, a student who swallowed crushed glass but told doctors in the emergency room that it was an "accident," and was promptly discharged home.
"If it looks like a suicide, it probably is," she emphasized.
In addressing the situation surrounding sexual minorities and suicidality, Malley focused more on sensitivity from therapists in what can be a difficult time for many individuals.
"Gender nonconformity" is itself a risk factor for suicidality, she said. "It is especially pronounced when a young person comes out too early or not at all, experiences internal conflicts about his or her sexual orientation, is involved in family conflicts over sexual orientation, or is bullied and victimized at school.
Clinicians need to be cautious about use of language, even when inadvertent, that might turn off young people who are in the midst of grappling with their sexual orientation, she noted. Asking a young man if he has a "girlfriend" can signal that a doctor or counselor is unwilling to face the boy's true feelings of sexuality.
Unlike treating many physical ailments, where to a large degree human bodies of all shapes, sizes and colors react similarly, mental health treatment can often be contingent on what is considered acceptable in specific cultures. The DSM even goes so far as to include cultural considerations in some of its diagnostic criteria. While many of the underlying emotional and physiological triggers for suicidality may be universal, the manner in which different groups express those desires are often quite different. As these two professionals explained to SPAN, understanding the differences and the cultural effects of various populations can help prevent suicide or more effectively confront it once it has been attempted.
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