The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women

Interpersonal Relationship and Suicide Attempt: The Role of Family and Social Relationship

ABSTRACT

This study investigates the role of family and social relationships in cases of attempted suicide in China. Studies, mostly analyzing data from developed countries, have indicated that interpersonal relationships are important predictors of suicidal behaviors. This study's data were derived from a case-control study in China. Family relationships included relationships with spouses, parents, and parents-in-law. Poor family and social relationships were significantly associated with increased risk of attempted suicide in women and men. Depression and social support significantly mediated the association between interpersonal relationship and attempted suicide. Poor relationship with spouse was significantly associated with an elevated risk of attempted suicide. Relationship with parents-in-law was also significantly associated with attempted suicide in women, whereas family relationships played a more important role than social relationships in suicidal behaviors, especially in men. The findings imply that suicide prevention in China could be conducted from the perspective of improving family relationships, especially husband/wife and parents/daughters-in-law relationships.

Empowerment Moderates the Relationship Between Partner Abuse and Suicidal Ideation for Immigrant Women

PURPOSE

Research shows strong associations between intimate partner violence (IPV) among women and suicidal ideation but this topic is understudied among immigrant women in abusive relationships in the United States. Empowerment may play a significant role in protecting abused immigrant women from suicidal ideation but has not been studied with quantitative data.

METHOD

The current study used convenience sampling. Immigrant women who experienced IPV were asked about IPV severity, empowerment, and where they were born. Bivariate associations among variables were assessed; empowerment was tested as a moderator of the relationship between IPV and suicidal ideation.

RESULTS

The sample comprised 293 immigrant women, with 62.8% reporting suicidal ideation with a significantly greater proportion of women from South America than elsewhere reporting suicidal ideation. Empowerment buffered the effect of IPV on suicidal ideation.

CONCLUSION

Prevalence of suicidal ideation among immigrant women experiencing IPV is concerning. Severity of IPV, region of the world where women were born, and empowerment were all related to suicidal ideation, showing directions for future research. Empowerment nursing interventions are needed to address IPV and resulting mental health problems among immigrant women. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 19-28.].

Relational aggression in romantic relationship: empirical evidence among young female adults in Malaysia

BACKGROUND

Aggressive behaviour in romantic relationship is a social problem of great concern. Studies related to the influence of psychosocial factors on relational aggression are still limited. Furthermore, these factors have not been widely studied in the local context, resulting in the issue of relational aggression among young female adults still not being addressed. This study aims to explore whether psychosocial factors such as big five personality traits, adult attachment style and loneliness could predict relational aggression in romantic relationships among young female adults in Malaysia. In addition, this study aims to identify the moderating effect of social support in the relationship between psychosocial factors and relational aggression in romantic relationship.

METHODS

A quantitative research approach was used with 424 young female adults in Malaysia aged between 18 and 30 years old (mean age = 24.18) were recruited through multistage sampling design by completing a questionnaire consisting of the Big Five Inventory (BFI), Experiences in Close Relationships Scale II (ECRS-II), Revised UCLA Loneliness Scale, Measure of Relational Aggression and Victimization (MRAV) and Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Multiple regression analysis predicted significant relationship between agreeableness personality, loneliness, avoidant attachment style and anxious attachment style with relational aggression in romantic relationships. Hierarchical regression analysis found a significant effect of social support as a moderator between loneliness with relational aggression in romantic relationships.

CONCLUSIONS

Thus, the results show that young female adults with low level of agreeableness, high level of loneliness, avoidant attachment style and anxious attachment style are at a higher risk of engaging in relational aggression in romantic relationships. The implication of this study can help in understanding the psychosocial factors that form the basis of relational aggression in romantic relationships. Hence, the gap in knowledge warrants further research.

Domestic Coercive Control and Common Mental Disorders Among Women in Informal Settlements in Mumbai, India: A Cross-Sectional Survey

Coercive control behaviors central to the abuse of power appear more frequent than other types of domestic violence, but little is known about its frequency, features, and consequences for women in India. We aimed to examine the prevalence of domestic coercive control and its association with physical, sexual, and emotional domestic violence in the preceding year and symptoms of depression, anxiety, and suicidal thinking. In a cross-sectional survey, we interviewed 4,906 ever-married women aged 18-49 years living in urban informal settlements in Mumbai, India. We developed a 24-item scale of coercive control, assessed physical, sexual, and emotional violence using existing questions, and screened for symptoms of depression with the Patient Health Questionnaire (PHQ9), anxiety with the Generalized Anxiety Disorder (GAD7) questionnaire, and suicidal thinking with questions developed by the World Health Organization. Estimates involved univariable and multivariable logistic regression models and the prediction of marginal effects. The prevalence of domestic coercive control was 71%. In total, 23% of women reported domestic violence in the past 12 months (emotional 19%, physical 13%, sexual 4%). Adjusted models suggested that women exposed to controlling behavior had greater odds of surviving emotional (aOR 2.1; 95% CI 1.7, 2.7), physical (1.4; 1.0, 1.9), and sexual (1.8; 1.1, 3.0) domestic violence in the past 12 months; and higher odds of a positive screen for moderate or severe depression (1.7; 1.3, 2.2), anxiety (2.1; 1.3, 3.1), and suicidal thinking (1.7; 1.2, 2.3), and increased with each additional indicator of coercive control behavior. When women reported 24 indicators of coercive control, the adjusted predicted proportion with moderate or severe depressive symptoms was 60%, anxiety 42%, and suicidal thinking 17%. Inclusion of coercive control in programs to support domestic violence, would broaden our understanding of domestic abuse to resemble most victims experience and improve interventions.

The role of general self-efficacy in intimate partner violence and symptoms of posttraumatic stress disorder among women veterans

Whereas some prior studies have assessed associations between general self-efficacy, intimate partner violence (IPV) experiences, and posttraumatic stress disorder (PTSD) symptoms cross-sectionally, there is limited research investigating the potential directions of these effects or the longitudinal effects over multiple assessment points. We investigated the role of general self-efficacy in experiences of IPV and PTSD symptoms across time among 411 women veterans of the U.S. Armed Forces. Online survey data were collected at baseline (Time 1; T1), 18 months after baseline (Time 2; T2), and 2 years after baseline (Time 3; T3). Structural equation models were used to test hypotheses that T2 general self-efficacy would mediate reciprocal associations between IPV experiences and PTSD symptoms while controlling for T2 IPV experiences, T1 PTSD symptoms, and demographic and military covariates (i.e., age, military sexual trauma, and combat exposure). Specifically, we hypothesized that T2 general self-efficacy would mediate the association between (a) T1 IPV experiences and T3 IPV experiences, (b) T1 IPV experiences and T3 PTSD symptoms, (c) T1 PTSD symptoms and T3 IPV experiences, and (d) T1 PTSD symptoms and T3 PTSD symptoms. Findings revealed that T1 PTSD symptoms predicted lower T2 general self-efficacy, and, in turn, lower T2 general self-efficacy was associated with higher T3 IPV experiences, 95% CI [0.06, 0.41]; no other hypotheses were supported. The findings speak to the importance of clinical interventions which promote general self-efficacy as well as assess and treat PTSD symptoms among women who experience IPV.

Neighborhood Disorder, Social Support, and Outcomes Among Violence-Exposed African American Women

Intimate partner violence (IPV) against women, particularly those living in poverty who have multiple marginalized identities, is a significant public health issue. IPV is associated with numerous mental health concerns including depression, hopelessness, and suicidal behavior. The present study examined the ecological determinants of these mental health outcomes in a high-risk sample of 67 low-income, African American women survivors of IPV. Based on an ecological framework that conceptualizes individuals as nested in multiple, interactive systems, we examined, longitudinally, the main and interactive effects of self-reported neighborhood disorder and social support from family members and friends on participants' mental health (i.e., self-reported depressive symptoms, hopelessness, and suicide intent). In multiple regression analyses, neighborhood disorder interacted with social support from family members to predict depressive symptoms and hopelessness over time. Neighborhood disorder also interacted with social support from friends to predict hopelessness and suicide intent over time. High levels of social support buffered against the dangerous effects of neighborhood disorder on depressive symptoms, hopelessness, and suicide intent; at low levels of social support, there was no significant association between neighborhood disorder and those mental health outcomes. Neighborhood disorder and social support did not yield significant main effects. These findings underscore the importance of interventions that target individuals, families, and communities (e.g., community empowerment programs). Group interventions may also be important for low-income, African American women survivors of IPV, as they can help survivors establish and strengthen relationships and social support.

The Relationship between Women's Resources and Health-Related Quality of Life in a Sample of Female Victims of Intimate Partner Violence

While it is known that resource inadequacy increases the risk of exposure to intimate partner violence (IPV) and that women's health is significantly impacted by IPV, scant research has documented diminished resources as a primary determinant of women's health. Fifty female victims of moderate to severe IPV completed assessments of their physical, sexual and psychological experiences of IPV, resource profile, symptoms of posttraumatic stress disorder (PTSD) and depression and mental and physical health-related quality of life (HRQoL). Women's resources, controlling for age, income, psychological abuse and sexual coercion, were unique predictors of symptoms of PTSD, symptoms of depression; and mental HRQoL. The public health implications of the adequacy of women's resources are discussed in the context of IPV prevention and intervention. Future studies should evaluate the efficacy of economic empowerment programs regarding the impact on IPV survivors' mental and physical health and safety.

Childhood Abuse and Suicidal Behaviors Among Chinese Migrant Workers: The Mediating Role of Alexithymia and Social Support

This study aims to investigate the lifetime prevalence of suicidal behaviors in a sample of Chinese migrant workers. It also examined the mediating role of alexithymia and social support in the link between childhood abuse and suicidal behaviors. A total of 1,563 migrant workers were surveyed by using cluster sampling. Results showed that the estimated lifetime prevalence of suicide ideation, plan, and attempt among Chinese migrant workers was 12.8%, 8.1%, and 4.6%, respectively. Structural equation modeling analyses revealed a significant positive association between childhood abuse and suicidal behaviors; this association was partially mediated by social support. A significant path from childhood abuse through alexithymia and social support to suicidal behaviors was also established. Findings of this study emphasize the importance of social support and alexithymia in understanding the possible mechanisms underlying the relationship between childhood abuse and suicidal behaviors and suggest possible avenues for suicide interventions.

Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally Sensitive Markers of Suicide Risk

Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. This pilot laboratory investigation utilized a within-subjects design to identify patterns in text messaging (SMS) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt (N=33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) two weeks before a suicide attempt, relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as one approached a suicide attempt. Results suggest private electronic communication has the potential to provide real-time digital markers of suicide risk.

The effect of intimate partner violence on women's mental distress: a prospective cohort study of 3010 rural Indian women

PURPOSE

Intimate partner violence (IPV) encompasses physical, sexual, and psychological abuse, as well as controlling behavior. Most research focuses on physical and sexual abuse, and other aspects of IPV are rarely investigated. We estimated the effect of these neglected aspects of IPV on women's mental distress.

METHODS

We used data from 3010 women living in rural tribal communities in Rajasthan, India. Women completed baseline interviews and were re-interviewed approximately 1.5 years later. We measured IPV with questions adopted from the Demographic and Health Survey's Domestic Violence Module, which asked seven questions about physical abuse, three questions about psychological abuse, and five questions about partner controlling behavior. Mental distress was measured with the 12-item General Health Questionnaire (score range 0-12). We used Poisson regression models to estimate the relation between changes in IPV and mental distress, accounting for time-fixed characteristics of individuals using individual fixed effects.

RESULTS

Women reported an average of 2.1 distress symptoms during baseline interviews. In models that controlled for time-varying confounding (e.g., wealth, other types of abuse), experiencing psychological abuse was associated with an increase of 0.65 distress symptoms (95% CI 0.32, 0.98), and experiencing controlling behavior was associated with an increase of 0.31 distress symptoms (95% CI 0.18, 0.44). However, experiencing physical abuse was not associated with an increase in distress symptoms (mean difference = - 0.15, 95% CI - 0.45, 0.15).

CONCLUSIONS

Psychological abuse and controlling behavior may be important drivers of the relation between IPV and women's mental health.

Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol

Background

Suicide among veterans is a problem nationally, and suicide prevention remains a high priority for the Department of Veterans Affairs (VA). Focusing suicide prevention initiatives in the emergency department setting provides reach to veterans who may not be seen in mental health and targets a critical risk period, transitions in care following discharge. Caring Contacts is a simple and efficacious suicide prevention approach that could be used to target this risk period. The purpose of this study is to (1) adapt Caring Contacts for use in a VA emergency department, (2) conduct a pilot program at a single VA emergency department, and (3) create an implementation toolkit to facilitate spread of Caring Contacts to other VA facilities.

Methods

This project includes planning activities and a pilot at a VA emergency department. Planning activities will include determining available data sources, determining logistics for identifying and sending Caring Contacts, and creating an implementation toolkit. We will conduct qualitative interviews with emergency department staff and other key stakeholders to gather data on what is needed to adapt and implement Caring Contacts in a VA emergency department setting and possible barriers to and facilitators of implementation. An advisory board of key stakeholders in the facility will be created. Qualitative findings from interviews will be presented to the advisory board for discussion, and the board will use these data to inform decision making regarding implementation of the pilot. Once the pilot is underway, the advisory board will convene again to discuss ongoing progress and determine if any changes are needed to the implementation of the Caring Contacts intervention.

Discussion

Findings from the current project will inform future scale-up and spread of this innovation to other VA medical center emergency departments across the network and other networks. The current pilot will adapt Caring Contacts, create an implementation toolkit and implementation guide, evaluate the feasibility of gathering outcome measures, and provide information about what is needed to implement this evidence-based suicide prevention intervention in a VA emergency department.

Psychosocial Mediators Between Intimate Partner Violence and Alcohol Abuse in Low-Income African American Women

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

Examining Associations Between Strangulation and Depressive Symptoms in Women With Intimate Partner Violence Histories

Intimate partner violence (IPV) is associated with poor mental health outcomes among women. Studies on IPV and mental health show that experiencing more than one type of IPV often enhances women's depression or depressive symptoms. However, most of these studies conceptualize IPV as physical, psychological, or sexual violence. Little is known about specific experiences of severe IPV, such as strangulation, that put victims at greater risk of lethality and serious injury and their association with women's depression. This study examined associations between IPV, strangulation, and depression among women using secondary data collected for a randomized clinical trial testing an integrated HIV-IPV prevention intervention for abused women. Women were recruited from healthcare service delivery organizations, Department of Health and Human Services, and family court. Women (n = 175) completed assessments on IPV, strangulation, mental health, social support, and self-esteem. The majority reported strangulation (n = 103) and depressive symptoms (n = 101). Women who experienced strangulation also reported more severe physical (p < .001), sexual (p < .001), and psychological (p < .001) abuse. However, in multivariate logistic regression with sociodemographics, violence variables, and strangulation, none of these variables were associated with a higher risk for depressive symptoms. Social support had a protective effect on depressive symptoms. Findings suggest strangulation is prevalent among abused women seeking services, warranting screening, assessment, and referral in these settings.

Empowerment and Social Support: Implications for Practice and Programming Among Minority Women with Substance Abuse and Criminal Justice Histories

Programs for women with substance abuse and criminal justice histories often incorporate empowerment and social support into service delivery systems. Women's empowerment research has focused on the relationship between women's personal identities and the larger sociopolitical context, with an emphasis on how community-based resources are critical for promoting well-being. Social support often protects against negative outcomes for individuals who live with chronic stress. However, few studies have evaluated community resource knowledge and empowerment among marginalized women or how social support might strengthen or weaken this relationship. This study investigated resource knowledge, social support, and empowerment among 200 minority women in substance abuse recovery who had recent criminal justice involvement. Results indicated that resource knowledge was related to empowerment and belonging social support marginally moderated this relationship. In addition, education level increased and current involvement in the criminal justice system decreased empowerment. Implications for research, practice, and policy are discussed.

The Relationship between Childhood Trauma and Suicidal Ideation: Role of Maltreatment and Potential Mediators

OBJECTIVE

Childhood trauma is recognized as an important risk factor in suicidal ideation, however it is not fully understood how the different types of childhood maltreatment influence suicidal ideation nor what variables mediate the relationship between childhood trauma and suicidal ideation. This study examined the path from childhood trauma to suicidal ideation, including potential mediators.

METHODS

A sample of 211 healthy adults completed the Childhood Trauma Questionnaire (CTQ), Beck scale for Suicidal Ideation (BSI), Functional Social Support Questionnaire (FSSQ) and Hospital Anxiety and Depression Scale (HADS). Path analysis was used to investigate the relationship among study variables.

RESULTS

Of the several types of childhood maltreatment we considered, only childhood sexual abuse directly predicted suicidal ideation (β=0.215, p=0.001). Childhood physical abuse (β=0.049, 95% confidence interval: 0.011-0.109) and childhood emotional abuse (β=0.042, 95% confidence interval: 0.001-0.107) indirectly predicted suicidal ideation through their association with anxiety. Childhood neglect indirectly predicted suicidal ideation through association with perceived social support (β=0.085, 95% confidence interval: 0.041-0.154).

CONCLUSION

Our results confirmed that childhood sexual abuse is a strong predictor of suicidal ideation. Perceived social support mediated the relationship between suicidal ideation and neglect. Anxiety fully mediated the relationship between suicidal ideation and both physical abuse and emotional abuse. Interventions to reduce suicidal ideation among survivors of childhood trauma should focus on anxiety symptoms and attempt to increase their social support.

Suicidal Behavior Among Low-Income African American Women: A Comparison of First-Time and Repeat Suicide Attempters

This investigation ascertained dimensions of a suicide attempt and psychological and historical risk factors that differentiate low-income, female, African American suicide attempters as a function of having made a single, first-time attempt versus multiple attempts. Two groups were compared: first time attempters ( n= 135) and repeat attempters ( n= 139). Participants were recruited from a large, urban hospital following a suicide attempt (i.e., index suicide attempt). Sociodemographic characteristics, details of the index attempt (i.e., the attempt that prompted entry into the study), psychological functioning, hopelessness, substance abuse, and trauma history were assessed. The two groups were largely similar across sociodemographic characteristics. Multivariate analyses of variance were used to test hypotheses. Relative to first-time attempters, the attempts of repeat attempters involved higher levels of intent, planning, and perceived lethality and were associated with more psychological distress, hopelessness, substance abuse, and childhood trauma. Research and clinical implications of the findings are discussed.

Abusive Partners and Ex-Partners

This study examined how being abused by a current partner versus an ex-partner might affect psychological well-being and social support in a community sample of 398 women, half of whom had experienced abuse in the past 6 months. The impact of emotional and physical abuse was influenced by partner status, with emotional abuse being more detrimental to women abused by current partners and physical abuse being more detrimental to women abused by ex-partners. Emotional support was negatively related to depression in women abused by current partners, whereas practical support was negatively related to depression in women abused by ex-partners. The implications for interventions with abused women are discussed.

Two-year outcomes of the Early Risers prevention trial with formerly homeless families residing in supportive housing

This article reports 2-year outcomes from a cluster randomized, controlled trial of the Early Risers (ER) program implemented as a selective preventive intervention in supportive housing settings for homeless families. Based on the goals of this comprehensive prevention program, we predicted that intervention participants receiving ER services would show improvement in parenting and child outcomes relative to families in treatment-as-usual sites. The sample included 270 children in 161 families, residing in 15 supportive housing sites; multimethod, multi-informant assessments conducted at baseline and yearly thereafter included parent and teacher report of child adjustment, parent report of parenting self-efficacy, and parent-child observations that yielded scores of effective parenting practices. Data were modeled in HLM7 (4-level model accounting for nesting of children within families and families within housing sites). Two years' postbaseline, intent-to-treat (ITT) analyses indicated that parents in the ER group showed significantly improved parenting self-efficacy, and parent report indicated significant reductions in ER group children's depression. No main effects of ITT were shown for observed parenting effectiveness. However, over time, average levels of parenting self-efficacy predicted observed effective parenting practices, and observed effective parenting practices predicted improvements in both teacher- and parent-report of child adjustment. This is the first study to our knowledge to demonstrate prevention effects of a program for homeless families residing in family supportive housing.

Self-efficacy difference among patients with cancer with different socioeconomic status: application of latent class analysis and standardization and decomposition analysis

INTRODUCTION

Although the relationship between partial socioeconomic status (SES) and self-efficacy has been studied in previous studies, few research have examined self-efficacy difference among patients with cancer with different SES.

METHODS

A cross-sectional survey involving 764 patients with cancer was completed. Latent class analysis (LCA) was applied to identify distinct groups of patients with cancer using four SES indicators (education, income, employment status and health insurance status). Standardization and decomposition analysis (SDA) was then used to examine differences in patients' self-efficacy among SES groups and the components of the differences attributed to confounding factors, such as gender, age, anxiety, depression and social support.

RESULTS

Participants were classified into four distinctive SES groups via using LCA method, and the observed self-efficacy level significantly varied by SES groups; as theorized, higher self-efficacy was associated with higher SES. The self-efficacy differences by SES groups were decomposed into "real" group differences and factor component effects that are attributed to group differences in confounding factor compositions.

CONCLUSION

Self-efficacy significantly varies by SES. Social support significantly confounded the observed differences in self-efficacy between different SES groups among Chinese patients with cancer.

The association between social relationships and self-harm: a case-control study in Taiwan

BACKGROUND

Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case-control study.

METHODS

The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models.

RESULTS

A total of 124 case-control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94).

CONCLUSIONS

More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere.

Protective factors and suicidality in members of Arab kindred

BACKGROUND

Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors.

AIMS

To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors.

METHODS

We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale.

RESULTS

Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2=11.17, p=.001), an anxiety disorder (87.5% vs. 22.9, χ2=21.02, p<.001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher's, p=.003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31±1.36 vs. 4.96±1.40, t=4.10, df=62, p<.001), and they have the view that suicide is somehow unacceptable (1.83±.10 vs. 1.89±.07, t=2.76, df=60, p=.008).

CONCLUSIONS

Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

"Let me count the ways:" fostering reasons for living among low-income, suicidal, African American women

Protective factors for fostering reasons for living were examined among low-income, suicidal, African American women. Bivariate logistic regressions revealed that higher levels of optimism, spiritual well-being, and family social support predicted reasons for living. Multivariate logistic regressions indicated that spiritual well-being showed unique predictive value for reasons for living. Further, the multivariate model accurately predicted reasons for living 72% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and increased reasons for living. Implications for community-based preventive and recovery-oriented intervention efforts and future research are discussed.

Suicidal behavior among low-income, African American female victims of intimate terrorism and situational couple violence

This study examined risk of suicidal behavior among low-income, African American women (N = 369) in three types of male intimate relationships- intimate terrorism (IT) (i.e., physical violence used within a general pattern of coercive control), situational couple violence (SCV; i.e., episodic physical violence that is not part of a general pattern of coercive control), and nonviolent (NV; i.e., no physical violence). IT victims had more than double the odds of suicidal behavior compared to SCV victims and this association remained significant after controlling for physical violence severity, depression symptoms, and alcohol and drug abuse. Risk of suicidal behavior was not significantly different for SCV victims compared to women in NV relationships. Findings emphasize the need for researchers and practitioners to distinguish between types of male partner violence when examining its context and consequences for female victims.

Recovery from depressive symptoms, state anxiety and post-traumatic stress disorder in women exposed to physical and psychological, but not to psychological intimate partner violence alone: a longitudinal study

BACKGROUND

It is well established that intimate male partner violence (IPV) has a high impact on women's mental health. It is necessary to further investigate this impact longitudinally to assess the factors that contribute to its recovery or deterioration. The objective of this study was to assess the course of depressive, anxiety and post-traumatic stress disorder (PTSD) symptoms and suicidal behavior over a three-year follow-up in female victims of IPV.

METHODS

Women (n = 91) who participated in our previous cross-sectional study, and who had been either physically/psychologically (n = 33) or psychologically abused (n = 23) by their male partners, were evaluated three years later. A nonabused control group of women (n = 35) was included for comparison. Information about mental health status and lifestyle variables was obtained through face-to-face structured interviews.

RESULTS

Results of the follow-up study indicated that while women exposed to physical/psychological IPV recovered their mental health status with a significant decrease in depressive, anxiety and PTSD symptoms, no recovery occurred in women exposed to psychological IPV alone. The evolution of IPV was also different: while it continued across both time points in 65.21% of psychologically abused women, it continued in only 12.12% of physically/psychologically abused women while it was reduced to psychological IPV in 51.5%. Hierarchical multiple regression analyses indicated that cessation of physical IPV and perceived social support contributed to mental health recovery, while a high perception of lifetime events predicted the continuation of PTSD symptoms.

CONCLUSION

This study shows that the pattern of mental health recovery depends on the type of IPV that the women had been exposed to. While those experiencing physical/psychological IPV have a higher likelihood of undergoing a cessation or reduction of IPV over time and, therefore, could recover, women exposed to psychological IPV alone have a high probability of continued exposure to the same type of IPV with a low possibility of recovery. Thus, women exposed to psychological IPV alone need more help to escape from IPV and to recuperate their mental health. Longitudinal studies are needed to improve knowledge of factors promoting or impeding health recovery to guide the formulation of policy at individual, social and criminal justice levels.

Optimism and well-being in older adults: the mediating role of social support and perceived control

To investigate how psychosocial resources may improve well-being for older adults, this study explored the relationship among questionnaire measures of optimism, social support and perceptions of control in predicting subjective well-being (measured with the positive affect subscale of the Affect Balance Scale) (Bradburn, 1969) and psychological well-being (measured with the purpose in life scale of the Ryff Psychological Well-being scales) (Ryff, Lee, Essex, & Schmutte, 1994) among older adults. The potential mediating roles of perceived social support and perception of control were also explored. Participants were 225 adults aged from 65 to 94 years. Optimism was found to be a predictor of both subjective and psychological well-being, and perceived social support was found to mediate the relationship between optimism and subjective well-being, but not psychological well-being. In contrast, perception of control was found to mediate the relationship between optimism and psychological well-being, but not subjective wellbeing. Longitudinal research is needed to confirm these pathways.

Appraisals and suicidality: the mediating role of defeat and entrapment

This study tested whether feelings of defeat and entrapment mediated the effects of negative appraisals upon suicidal ideation and behavior. A sample of 93 university students who reported some degree of suicidal ideation completed questionnaires of negative appraisals of social-support and problem-solving, defeat, entrapment, hopelessness and suicidality. The results supported a model whereby defeat and entrapment fully mediated the effect of appraisals of social support and problem-solving ability upon suicidality. Furthermore, controlling for hopelessness had no substantive impact upon this model. The findings support socio-cognitive models of suicidal behavior and highlight the key role of defeat and entrapment in suicide. The clinical implications of these findings are discussed.

Suicide attempts among people living with HIV in France

This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide.

The impact of psychoticism on perceived hassles, depression, hostility, and hopelessness in non-psychiatric African Americans

Psychotic symptoms are distributed along a continuum that extends from normality to diagnosable psychotic disorders and the presence of psychoticism among individuals in the general population may lead to morbidity and social impairment. This study examined a model in which psychoticism leads to several important psychological consequences. The analysis included 134 African Americans with no psychiatric history who were being seen in medical walk-in clinics for non-emergency medical problems. Psychoticism, perceived hassles, depression, hostility, and hopelessness were measured. The Linear Structural Relations Program (LISREL) was used to test the fit of the data to the proposed model, a trimmed hierarchical version, and two alternative models. The data supported a model in which psychoticism has substantial effects on several important characteristics: perceived daily hassles, depression, and hostility. Depression mediated the association between psychoticism and hopelessness. Goodness-of-fit indices for a final trimmed model that eliminated one path from the initial postulated model revealed good fit to the data, and the two alternative models were found not to fit the data. Like psychosis itself, psychoticism appears to cause meaningful dysfunction even among non-psychiatric individuals from the general population. Additional research is needed to further characterize the detrimental effects of psychoticism or self-reported psychotic symptoms in the general, non-psychiatric population.

Suicide risk in relation to social class: a national register-based study of adult suicides in Korea, 1999-2001

BACKGROUND

Few controlled studies have examined social class as a risk factor for suicide in Korea.

AIM

The objective of the present study was to investigate the effects of social class on suicide risk in Korea.

METHODS

A case-control design was constructed from cause-of-death statistics for the period 1999 to 2001, in Korea, as published by the Korean National Statistical Office. The cases were defined as people aged between 20 and 64 who died by suicide, while the controls were defined as those who died of natural causes in the same age groups.

RESULTS AND CONCLUSIONS

The proportions and odds ratios for suicide were higher in young people than in elderly people, and higher for divorced subjects than for cohabitants. They were also higher for residents of rural areas, as opposed to residents of Seoul and other metropolitan areas, and for people in social classes III and IV, than they were for those in social class I. To control the variables that influence risk of suicide, such as age, marital status and area of residence, we used multiple logistic regression. Compared with class I, risk of suicide was higher in social classes III and IV, in both sexes. The principal conclusion of this study is that, regardless of sex, lower social class constitutes a high risk for suicide in Korea, even after controlling for variables such as age, marital status and area of residence. We conclude that a well-controlled and balanced social welfare system could reduce suicide risk, especially among people in lower social class.

Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: self-esteem, social support, and religious coping

There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.

Depressive symptoms in women experiencing intimate partner violence

The study was a cross-sectional examination of African American women positive for intimate partner violence (IPV) who presented to the medical or psychiatric emergency department (ED) for treatment. African American women with a recent history of IPV who presented following an attempted suicide (n = 100) were compared to demographically comparable African American women who were IPV positive who had not attempted suicide and presented for treatment of another condition(n= 100). Women completed face-to-face interviews on several measures, including demographics and the Beck Depression Inventory-II (BDI-II). Overall, there were no demographic differences between cases and controls. Attempters reported statistically significant higher scores on all 21 BDI-II items than did nonattempters. Four BDI-II items had effect size values in the medium range: sadness, self-dislike, suicidal thoughts, and feelings of worthlessness. These four items can be used as a brief screen in the ED to detect female patients positive for IPV at increased risk for suicidal behavior.

The future of research on intimate partner violence: person-oriented and variable-oriented perspectives

This article uses the distinction between the person and the variable orientations as a frame for structuring (1) research on IPV, (2) results of this research, and (3) an agenda for future research. The main tenet of this agenda is that causes, processes, and effects of IPV are person and context specific; therefore, results that relate variables to each other are of limited value if it can be shown that the processes that take place, the meaning of the variables, the profile of the transgressors and the women who experience IPV depend on time, environment, and research design. Examples of valuable variable-oriented research are given; examples of the growing contribution made by person-oriented research are given as well. Sample theories are sketched out, for the variable-oriented, the person-oriented, and the theoretical research arenas, the need for future research is derived from inconsistencies and shortcomings in both current research and theory. Sample research questions are proposed. The contributions made by the authors of this Special Section are embedded within the discussion of research and theory of IPV. It is shown that each of the contributions is valuable within a particular segment of the research landscape.

Protective factors against suicide attempt risk among African American women experiencing intimate partner violence

Protective factors (hope, spirituality, self-efficacy, coping, social support-family, social support-friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support-family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.

Social risk and protective factors for suicide attempts in low income African American men and women

A case-control study was conducted to examine a broad array of potential social risk and protective factors for suicide attempt among 200 African American men and women receiving care at a large, public, urban hospital. Specifically, we examined the effect of the following potential risk factors for suicide attempt: life hassles, partner abuse, partner dissatisfaction, and racist events; as well as the following potential protective factors: effectiveness of obtaining resources, social embeddedness, and social support. Using logistic regression, suicide attempter status was predicted by two independently significant social variables: one risk factor (life hassles) and one protective factor (social support). Male versus female suicide attempters were not distinguished by the social variables. These findings, which support the utility of an ecological conceptualization of risk and protective factors for suicide attempt, help to clarify the independently significant social environment risk and protective factors for suicide attempts among economically disadvantaged African Americans in particular. Research on both risk factors and protective factors provide a basis for culturally competent interventions aimed at reducing both the risk of future suicide attempts and completions.

Hopelessness and suicidal ideation among adolescents in two cultures

BACKGROUND

This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents.

METHODS

Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart.

RESULTS

Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively.

CONCLUSIONS

Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.

Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support

BACKGROUND

Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms.

METHOD

Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied.

RESULTS

Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models.

CONCLUSIONS

Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.