Religious involvement and suicidal behavior among African Americans and Black Caribbeans

Measuring Whether Gratitude and Loneliness Mediate the Link Between Non-organizational Religiosity and Suicidal Ideation: Evidence From Black Adults During COVID-19

OBJECTIVES

Suicides among Black adults in the United States increased nationally during the COVID-19 pandemic, although limited empirical evidence documents the pathways that explain how suicide risk may develop in this population. We examined experiences of non-organizational religious involvement, gratitude, and loneliness and their relation to suicidal ideation among Black adults in the United States.

METHODS

We analyzed data from a probability-based sample of 995 Black adults in the United States who completed online surveys from April through June 2022. We recruited participants from the AmeriSpeak panel at the National Opinion Research Center. We applied structural equation modeling techniques to measure direct and indirect associations among religiosity, positive psychology, and mental health variables. We tested whether non-organizational religiosity was indirectly associated with suicidal ideation via feelings of gratitude and COVID-19-specific forms of loneliness during the pandemic.

RESULTS

The measurement model demonstrated a good fit to the data. Structural model results indicated that non-organizational religious involvement was positively related to gratitude (β = 0.51; P < .001); in turn, feelings of gratitude were associated with reduced suicidal ideation (β = -0.12; P = .02). Moreover, COVID-19-specific forms of loneliness were positively associated with past-year suicidal ideation (β = 0.11; P = .01). Non-organizational religious involvement, however, was not directly associated with feelings of COVID-19-related loneliness or suicidal ideation.

CONCLUSIONS

Public health officials should account for feelings of gratitude and loneliness as mechanisms that can be leveraged to inform the development of evidence-based suicide prevention interventions for Black adults during public health emergencies such as the COVID-19 pandemic and beyond.

Faith in Crisis: An Exploratory Qualitative Study of the Role of Faith Community Leaders and Faith Community Nurses in Balancing Public Health Guidance and Spiritual Leadership During COVID-19 in the United States

The COVID-19 pandemic significantly impacted healthcare and community dynamics. This study explores the roles of faith community nurses and faith community leaders in Johnson City, Tennessee, during the pandemic. Using an ethnographic qualitative approach, we interviewed pastors, FCNs, and other FC leaders to understand their strategies and challenges. FCNs provided crucial health education and addressed vaccine hesitancy, while FC leaders navigated health guidance and spiritual care. The findings highlight innovative measures such as virtual services and health protocols. This study underscores the critical role of FCs in public health, indicating the potential benefit for health training for faith leaders to enhance community resilience.

Research on Religion and Aging Among Black Americans and Mexican Americans: The Impact of the National Institute on Aging

For 50 years, the National Institute on Aging (NIA) has supported and promoted research on religious involvement among older adult populations. NIA funding of research on religious involvement has (i) broadened our understanding of how religious involvement is conceptualized and measured; (ii) explored the important role of social networks and interactions within religious communities in relation to congregants' health; (iii) supported research on national samples of the U.S. population that explore demographic variability in religious practices and beliefs, as well as their social correlates; and (iv) examined health-relevant frameworks and topics in relation to religion's association with physical and mental health and well-being. This article focuses on research on African Americans and Mexican Americans as well as comparative work involving non-Latino Whites. Selected topics in religion and aging include Conceptualization and Measurement of Religious Participation; Religious Participation; Religion and Mental Health; Religion and Physical Health, Church-Based Informal Support, Church Support, and Mental and Physical Health; Religious Coping; and the Use of Clergy for serious problems. NIA's long record of support for scholarship and research has significantly enriched our understanding of why and how religion matters for the health and social well-being of diverse populations of older adults.

A Systematic Review and Meta-Analysis: Psychotherapy Interventions for Reducing Suicidal Thoughts and Behaviors Among Black Youth

OBJECTIVE

Suicides continue to increase among youth, with substantial disparities among Black youth. Culturally responsive evidence-based interventions for Black youth are urgently needed to disrupt these inequities. This study aimed to identify evidence-based psychotherapy interventions for suicidal thoughts and behaviors among Black youth and examine how existing intervention manuals have integrated culturally relevant content to Black youth.

METHOD

Literature searches were conducted to identify relevant articles comparing the effectiveness of interventions for suicidal thoughts and behaviors in study populations including >30% Black youth and youth participants up to age 25. Published articles and therapy manuals were analyzed on cultural adaptation and on 7 content domains for cultural adaptation. Meta-analysis used a random-effects model and explored potential moderators.

RESULTS

Of 755 screened records, 13 studies met eligibility criteria and featured 8 manualized interventions. Meta-analysis revealed significant effects in reducing suicidal thoughts and behaviors between treatment groups (Hedges g = 1.08 with 95% CI [0.07, 2.09]), but low-quality evidence, significant heterogeneity, small sample sizes, and inconsistencies in outcome measures. Only 1 intervention, Adapted Coping With Stress (A-CWS), specifically focused on Black youth. Culturally relevant content was predominantly absent or contained brief descriptions. The most frequently included content was provider cultural competency training.

CONCLUSION

The lack of representation of Black youth in treatment studies and sparse literature on culturally responsive treatments for Black youth and their families continue to stall significant advancements to disrupt current suicide trends disproportionately impacting Black youth. This study identified several opportunities for implementing cultural adaptations of suicide interventions among Black youth.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as living with a disability. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Intersections of Racial/Ethnic and Religious Identities on Bodily Well-Being for Black College-Attending Emerging Adults

Black undergraduates face threats to healthy weight and body image (i.e., bodily well-being). Having a strong racial/ethnic identity can promote health during emerging adulthood. However, less is known about the intersections of racial/ethnic and religious identities on the bodily well-being of Black college-attending emerging adults, despite evidence to indicate that aspects of religiosity are also associated with health. We use quantitative data from 767 Black college-attending emerging adults in the Multi-University Study of Identity and Culture to examine the independent contributions of racial/ethnic and religious identity for bodily health, and test a potential interaction between racial/ethnic and religious identity on bodily health outcomes. Results from a multivariate linear regression model indicate that Black college-attending emerging adults with both high religious identity and high racial/ethnic identity exploration had higher body mass index and less positive body image. Findings suggest ways to strengthen the development of culturally appropriate public health prevention and intervention efforts that target body image and weight for Black college-attending emerging adults. IMPACT STATEMENT: Black college-attending emerging adults face challenges to their health, particularly threats to healthy weight and body image during this period of psychosocial transitions. The developmental process of navigating racial/ethnic and religious identities during this time raises challenges and opportunities for health promotion for this population. Yet, research that explores the role of these identities remains scarce. We found that Black college-attending emerging adults had higher body mass index and more negative body image when they reported more racial/ethnic identity exploration coupled with higher religious identities. Results shed light on the complex ways that navigating both racial/ethnic and religious identities may put some Black college-attending emerging adults at greater health risk. Health education and promotion practice focused on improving Black emerging adult health in college contexts should ensure that behavioral interventions are appropriately nuanced and situated in these populations' developmental and cultural considerations.

Is Irreligion a Risk Factor for Suicidality? Findings from the Nashville Stress and Health Study

Suicide is a public health problem and one of the leading causes of death in the United States. Research exploring the linkages between religion and spirituality has received intermittent attention. Data was derived from the Nashville Stress and Health Study (2011-2014), a cross-sectional probability survey of black and white adults from Davidson County, Tennessee (n = 1252). Results indicate that those with no perceived belief in divine control had a higher likelihood of suicidality. This study provides a fresh perspective on the links between religious factors and suicidality by (a) considering multiple religious and spiritual domains and (b) focusing on the association between irreligion and suicidality.

Risk of suicide among stroke survivors in the United States

BACKGROUND

Stroke is the largest cause of disability and the 5th leading cause of death in the United States. Suicide is the 12th leading cause of death in the United States. However, little is known about the risk of suicide among people with a prior stroke.

OBJECTIVES

Using Multiple Cause of Death data (1999-2020) from the Centers for Disease Control and Prevention WONDER database, we examined via cross-sectional analysis the risk of suicide among survivors of stroke as compared to the general U.S. population and among subgroups within the United States.

METHODS

We assessed disparities in suicide rate among patients with stroke stratified by sex, race, urbanization levels, and census regions using the CDC WONDER multiple cause of death database. Standardized mortality rates were calculated to compare the suicide rate of stroke patients with the rates among demographic-matched cohorts and the general United States population.

RESULTS

As compared to the general population, stroke survivors had an elevated risk of suicide. Black stroke survivors had a lower rate of suicide as compared to the general population, while White stroke survivors and those in nonmetropolitan areas had an elevated risk compared to the general population.

CONCLUSION

There was a slightly elevated risk of suicide among people with a prior stroke in the United States. This risk may be elevated among White people and among people living in nonmetropolitan areas.

The Role of Religious Coping on Suicidality Among Latinx and Black/African American Individuals with Schizophrenia Spectrum Disorders

Introduction

The suicide rate for individuals with schizophrenia spectrum disorders (SSDs) is over 20 times greater than that of the general population. Many people turn to religion in times of illness or stress. Religiosity is also deeply embedded into the culture, community life, and identity of many Latinx and Black/African American (B/AA) individuals. Religiosity has historically been associated with a lower risk of suicide. However, research also finds that, adaptive and maladaptive religious coping differentially impact mental health. Therefore, it is pertinent to examine religious coping's role on suicidality among Latinx and B/AA individuals with SSDs.

Methods

This study examined relationships between adaptive and maladaptive religious coping, depression/anxiety, and suicidality among 91 Latinx and B/AA individuals with SSDs (M= 38.05 years old, SD = 11.92 years).

Results

Maladaptive religious coping was positively associated with suicidality and was partially mediated through depression/anxiety. Moreover, adaptive religious coping moderated the relationship between maladaptive religious coping and depression/anxiety. Only when adaptive religious coping was at the mean observed level or below was maladaptive religious coping positively associated with depression/anxiety and suicidal ideation.

Conclusion

Findings underscore the need to take religiosity into account when shaping therapies for Latinx and B/AA individuals with SSDs.

The Association Between John Henryism and Depression and Suicidal Ideation Among African-American and Caribbean Black Adolescents in the United States

PURPOSE

The aim of this study is to investigate the relationship between John Henryism (JH), a psychological construct indexing repeated high effort coping, and depression and SI among Black adolescents, and to explore whether these relationships vary by sex.

METHODS

Data came from the National Survey of American Life-Adolescent Supplement, a cross-sectional, multistage probability sample of African-American and Caribbean Black adolescents aged 13-17 (N = 1,170). JH was measured using a 12-item scale (alpha = 0.71) and dichotomized at the median. Lifetime history of major depression (MD) and SI were assessed using the Composite International Diagnostic Inventory and self-report, respectively. Logistic regression was used to assess the relationship between JH and likelihood of MD and SI, adjusting for demographic and psychosocial characteristics and accounting for the complex survey design. Moderation by sex was assessed using interaction terms.

RESULTS

Lifetime prevalence of MD was 6.3% (N = 87) and lifetime history of SI was 7.6% (N = 91). In unadjusted models, high JH was inversely associated with MD (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.34-0.90) and SI (OR: 0.45, 95% CI: 0.23-0.91). In adjusted models, the relationship between JH and MD was attenuated (OR: 0.68, 95% CI = 0.39-1.18, p = .16) and remained marginally significant for SI (OR: 0.55, 95% CI: 0.28-1.06, p = .07). These relationships were similar by sex.

DISCUSSION

Consistent with prior work in adults, JH was inversely associated with MD and SI among Black adolescents. Findings illustrate the importance of considering culturally salient protective factors for mental health among Black adolescents.

Cultural Considerations in Working with Black and African American Youth

This article seeks to provide an exploration of the contributors to the mental health of Black and African Americans. We explore the foundations of racism in this country as well as factors leading to systemic racism. It is important to gain an understanding of the multifaceted contributors to disparities in health care and mental health care. Black children and adolescents experience more poverty, discrimination, marginalization, and racism compared with their white counterparts in the United States (APA, 2017). These are factors that greatly impact the mental health of this population. In addition to exploring examples of disparities in diagnosis, treatment, and research on Black youth, we also provide recommendations for clinicians seeking to provide exemplary culturally sensitive care that recognizes the diverse and multifaceted nature of this population.

Religious Involvement and DSM-IV Anxiety Disorders Among African-Americans

ABSTRACT

This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.

Systematic Review of Religiosity's Relationship with Suicidality, Suicide Related Stigma, and Formal Mental Health Service Utilization among Black Americans

Rates of suicide have increased among Black Americans. Suicide is now the 3^rd leading cause of death for Black Americans between the ages of 1-19 and the 4^th leading cause of death for Black Americans aged 20-44. Due to the increasing need in the community, a marked increase in literature focusing on suicide in the Black community has been published since 2018. To build a better understanding of the current state of the literature on suicidality among Black Americans and to offer suggestions for further areas of research, a systematic review was conducted. Spirituality and religious beliefs are often an important cultural focus in the Black community. Some religious beliefs pose potential unintended regarding the sanctity of life among Black Americans. The focus of this systematic review was religiosity's effect on suicidality among Black Americans. Religiosity was found to have a protective effect against suicidality among Black Americans while discouraging formal mental health services utilization. This systematic review also reveals a dearth of research on the relationship between religiosity and suicide related stigma. Areas for further research are mentioned, and religious institutions as mental health intervention centers are encouraged.

Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health

After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.

Hope, Purpose, and Religiosity: The Impact of Psychosocial Resources on Trajectories of Depressive Symptoms Among Middle-Aged and Older Blacks

Objective: We assessed the effects of hope, purpose in life, and religiosity on trajectories of depressive symptoms among middle-aged and older Blacks, with a focus on age differences in these associations. Methods: Data come from 1906 respondents from the 2006-2016 Health and Retirement Study. Linear mixed models were estimated and included interactions between age and time and between age and each psychosocial resource. Results: Depressive symptoms decreased for Blacks ages 51-64, did not change for those 65-74, and increased among Blacks age 75+. Hope and purpose in life were inversely associated with symptom levels but were not associated with change over time in symptomology. Associations were stronger among the youngest age group and weakest among the oldest. Religiosity was unrelated to depressive symptoms. Discussion: Psychosocial resources protect against depressive symptoms in age-dependent ways among middle-aged and older Blacks. Differences in these effects may be related to aging, cohort, and selection effects.

Religious Involvement and Sleep Among Older African Americans

Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.

Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: a meta-analysis

BACKGROUND

Suicide is a significant public health problem and one of the leading causes of death worldwide. The effect of religion on suicidal behaviors (i.e., ideation, plan, attempt, and death) is an important issue worthy of consideration.

METHODS

Major electronic databases, including MEDLINE, Web of Science, and Scopus, were searched for the articles published until 26 April 2021. Reference lists were also screened. Observational studies addressing the associations between religion and suicidal behaviors were also examined. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The probability of publication bias was explored using the Begg and Egger tests, as well as trim-and-fill analysis. The effect size was expressed as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS

Out of 11 389 identified studies, 63 articles were eligible, involving 8,053,697 participants. There was an inverse association between religion and suicidal ideation OR  =  0.83 (95% CI: 0.78, 0.88; P &lt; 0.001), suicidal plan OR  =  0.93 (95% CI: 0.83, 1.04; P =  0.200), suicide attempt OR  =  0.84 (95% CI: 0.79, 0.89; P &lt; 0.001), and completed suicide OR  =  0.31 (95% CI: 0.14, 0.72; P =  0.006). There was a no evidence of publication bias.

CONCLUSIONS

The results of this meta-analysis support the notion that religion can play a protective role against suicidal behaviors. Nonetheless, the effect of religion on suicidal behaviors varies across countries with different religions and cultures. Although this association does not necessarily imply causation, an awareness of the relationship between religion and suicide risk can be of great help in suicide prevention policies and programs.

Considering religion and spirituality in precision medicine

The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.

Distinct employment interference profiles in patients with breast cancer prior to and for 12 months following surgery

PURPOSE

To identify subgroups of female breast cancer patients with distinct self-reported employment interference (EI) profiles and determine which demographic, clinical, and symptom characteristics, and quality of life outcomes were associated with subgroup membership.

METHODS

Women with breast cancer (n = 385) were assessed for changes in EI over ten times, from prior to, through 12 months after breast cancer surgery. Latent profile analysis (LPA) was used to identify subgroups of patients with distinct EI profiles.

RESULTS

Three distinct EI profiles (i.e., None - 26.2% (n = 101), Low - 42.6% (n = 164), High - 31.2% (n = 120)) were identified. Compared to the None and Low groups, patients in the High group were more likely to be younger. Higher proportions in the High group were non-White, pre-menopausal prior to surgery, had more advanced stage disease, had received an axillary lymph node dissection, had received neoadjuvant chemotherapy, had received adjuvant chemotherapy, and had a re-excision or mastectomy on the affected breast within 6 months after surgery. In addition, these patients had lower quality of life scores. Compared to the None group, the High group had higher levels of trait and state anxiety, depressive symptoms, fatigue and sleep disturbance and lower levels of cognitive function.

CONCLUSIONS

This study provides new knowledge regarding EI profiles among women in the year following breast cancer surgery. The non-modifiable risk factors (e.g., younger age, being non-White, having more advanced stage disease) can inform current screening procedures. The potentially modifiable risk factors can be used to develop interventions to improve employment outcomes of breast cancer patients.

Suicide, Race, and Social Work: A Systematic Review of Protective Factors among African Americans

Purpose: Suicide among African Americans has increased significantly in the past 15 years, yet it remains a neglected topic in social work research. This systematic review examines social work's contribution to suicide research while focusing on the social context in which African Americans live.Method: Using a critical race theory, we examine protective factors specific to African Americans that may mitigate suicide risks. Results reveal that the social work profession has produced 20 suicide-related studies between 1980 and 2018.Results: Identify three types of protective factors against suicide among African Americans. These are: micro-level factors (private regard / strong African American identity and impulsive response to discrimination), mezzo-level factors (family support and the role of women), and macro-level factors (social support, poverty and lack of awareness, religion, access to care, and internal response to community violence).Conclusion: Finding demonstrate evidence of the relationship between protective factors and suicide among African Americans. Implications for the use of Critical Race Theory in Social Work research and practice are provided along with implications to advance suicide training in social work education programs.

Anxiety sensitivity and suicide risk: Mindfulness as a psychological buffer for Black adults

BACKGROUND

Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors.

METHODS

The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; M_age = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk.

RESULTS

After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness.

LIMITATIONS

Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures.

CONCLUSIONS

These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans.

"What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults

A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.

A Social-Ecological Perspective of Spiritual Resilience and Suicidality among African-American Men

Despite their minoritized status research has shown that suicide among African-American men has steadily increased. Research has also discussed generalized protective factors that have been found to mitigate suicide risk. What lacks is a more culturally nuanced definition of spiritual resilience which has been found to protect against suicide for African-American men. Using Socio-Ecological Resiliency Theory (S-ERT), The Theory of Intersectionality (TOI), and Critical Race Theory (CRT) as our theoretical lens, this article draws on the lived experiences of social workers working with suicidal African-American men. It examines the social ecologies of African-American men and seeks to understand how these experiences can help to mitigate suicide risk. Implications are provided for social work research, policy and education programs to ensure that practitioners are well versed in working with this population.

Distinct financial distress profiles in patients with breast cancer prior to and for 12 months following surgery

BACKGROUND

Study purposes were to identify subgroups of patients with breast cancer with distinct self-reported financial distress (FD) profiles and determine which demographic, clinical and symptom characteristics, as well as quality of life (QOL) outcomes were associated with subgroup membership.

METHODS

Patients (n=391) who were assessed for changes in FD a total of 10 times from prior to through 12 months after breast cancer surgery. Latent profile analysis was used to identify subgroups of patients with distinct FD profiles.

RESULTS

Three distinct FD profiles (ie, None (14.6%), Low (52.7%), High (32.7%)) were identified. Compared with None and/or Low subgroups, patients in the High subgroup were more likely to report a lower annual household income and performance status; had a higher body mass index, axillary lymph node dissection and more advanced stage disease; had a longer time from cancer diagnosis to surgery; and had received neoadjuvant or adjuvant chemotherapy. In addition, patients in the High subgroup reported higher fatigue, sleep disturbance, state/trait anxiety, depressive symptom scores, and lower attentional function and QOL scores.

CONCLUSION

This study provides new insights on risk factors for and evidence of a higher symptom burden associated with FD. Findings from this study provide clinicians with information on how to identify high-risk patients and to recommend appropriate interventions for both symptom management and FD. Additional research on the mechanisms that underlie the relationships among FD and common physical and psychological symptoms may inform future interventions.

Religion and Mental Health in Racial and Ethnic Minority Populations: A Review of the Literature

Religion has been an important source of resiliency for many racial and ethnic minority populations. Given the salience, sociohistorical context, and importance of religion in the lives of black and Latino Americans, this literature review focuses on the mental health and well-being outcomes of religion among black and Latino Americans across the adult life course and specifically in later life. This review provides an overview of religious participation and religiosity levels and an in-depth discussion of extant research on the relationship between the multiple dimensions of religiosity and mental health in these 2 populations. Racial differences between blacks, Latinos, and non-Latino whites are also examined. Suggestions for limitations of the current literature and future directions for research on religion and mental health in racial/ethnic minority populations, especially older minorities, are proposed.

Major discriminatory events and suicidal thoughts and behaviors amongst Black Americans: Findings from the National Survey of American Life

BACKGROUND

Risk for suicide is growing among certain groups of Black Americans, yet the topic remains understudied. Discrimination appears to increase risk for suicidal thoughts and behaviors, but the evidence has been mixed for Black Americans. This study aimed to examine the association between major discriminatory events and suicidal thoughts and behaviors among Black American adults.

METHODS

We drew data from the National Survey of American Life, a representative sample of Black Americans, and used multivariable logistic regression to examine the associations between nine major discriminatory events and suicidal thoughts and behaviors (ideation, plan, attempt), adjusting for sociodemographic characteristics and psychiatric disorders.

RESULTS

We found that some major discriminatory events increased odds of reporting suicidal thoughts and behaviors, while others did not. Further, findings suggest the mediating role of psychiatric disorders.

LIMITATIONS

The study drew from cross-sectional data and did not allow for causal inferences.

CONCLUSIONS

Major discriminatory events have important implications for clinical practice, as well as diagnostic criteria when considering race-related stressors as a precipitator of suicidal thoughts and behaviors.

Black Caribbean Emerging Adults: A Systematic Review of Religion and Health

Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.

Racial Variation in the Association between Suicidal History and Positive and Negative Urgency among American Children

BACKGROUND

Positive and negative urgency reflect specific facets of impulsivity and correlate with several health-related risk behaviors such as aggression, substance use, and suicide. Less is known about how positive and negative urgency are associated with suicidal behaviors of diverse racial groups.

AIM

To investigate racial differences in the positive associations between positive and negative urgency and suicide in children in US.

MATERIALS AND METHODS

This longitudinal study used the Adolescent Brain Cognitive Development (ABCD) study. Participants were 10535 American children between ages 9 and 10 years old who were followed for up to one year. The independent variable was suicide history. The primary outcomes were the positive and negative urgency measured by the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). Mixed-effects regression models were used for data analysis.

RESULTS

In the overall sample, suicidality was associated with positive and negative urgency in children. Race showed a statistically significant interaction with suicidality on children's positive and negative urgency, indicating stronger effects of suicidality on positive and negative urgency for White, compared to Black and Other/Mixed race children respectively.

CONCLUSION

The effects of positive and negative urgency for suicidality of American children depend on race. White American children show the strongest links between positive and negative urgency and risk of suicide, while the effects of positive and negative urgency on children suicide are weaker for Black and Other/Mixed race children.

Is Religiosity Related to Suicidal Ideation Among Tunisian Muslim Youth After the January 14th Revolution?

Religiosity has been hypothesized to play protective roles against suicide. In Tunisia, despite the gravity of the issue after the 2011 Revolution and the rise of suicide rates among adolescents and young adults, a significant lack of data remains. The present work aimed to evaluate the associations between suicide and religiosity in university students. The Suicidal Ideations Questionnaire and The Arabic Religiosity scale were used to determine associations between suicidality and religiosity. We found a strong negative correlations found between suicidal ideations and the three sub-scores of religiosity after controlling for the associations between psychosocial variables and suicidal ideations scores. Our findings emphasize the importance of assessing the role of religiosity to the subject and understanding how suicide is conceptualized and perceived in the subject's religion when dealing with suicidal ideation and behaviors among college students. A better knowledge of religious beliefs and even an integration of Islamic beliefs and practices in the psychotherapeutic process of Muslim youth may be helpful to cope with suicide.

Faith leaders' messaging is essential to enhance HIV prevention among black Americans: results from the 2016 National Survey on HIV in the black community (NSHBC)

Background

To investigate whether religious service attendance and faith leaders’ messages about HIV and same-sex relationships are associated with acceptance of HIV prevention strategies.

Methods

Multivariable Poisson regression assessed whether attending religious services, faith leaders’ messages about HIV and same-sex relationships, and supportiveness of those messages were associated with HIV testing, as well as knowledge of and willingness to use pre-exposure prophylaxis (PrEP) among 868 Black Americans [45% men; M (SD) = 34 (9) years-old] in the 2016 National Survey on HIV in the Black Community, USA.

Results

Participants who reported attending services monthly and/or hearing faith leaders’ messages that were supportive of same-sex relationships had a significantly higher likelihood of willingness to use PrEP (adjusted Rate Ratio[ARR] = 1.76; 95% confidence interval [CI] = 1.09, 2.48) and aRR = 2.19; 95% CI = 1.35, 3.55, respectively), independent of HIV risk. Homophobia was significantly associated with higher likelihood of being aware of PrEP and testing for HIV testing in the past 12 months.

Conclusions

Faith leaders’ messaging can influence Black Americans’ perceptions and uptake of HIV prevention strategies. Faith institutions and faith leaders should be involved in designing and disseminating HIV prevention strategies.

Suicide Attempts in Michigan HealthCare System; Racial Differences

BACKGROUND

Community-based studies have documented racial differences in social, psychiatric, and medical determinants of suicidal ideation; however, less is known about racial differences in the profile of suicide attempts in clinical settings.

AIM

The current study aimed to compare Blacks and Whites who attempted suicide for demographic factors, socioeconomic status, medical history, psychiatric disorders, and outcomes.

METHODS

This retrospective study was a retrospective chart review of DataDirect, which is an electronic data repository of the Michigan Health Care System, 2014 to 2017. This analysis included 6147 suicide attempts (5388 Whites and 759 Blacks). Race, sociodemographic factors, medical history, psychiatric disorders, and outcomes were measured.

RESULTS

Blacks and Whites with suicide attempt did not differ in age or gender, but varied by insurance type. Blacks were more commonly under Medicare and Medicaid, while Whites were more commonly under private insurance or self-pay (p < 0.05). Blacks with suicide attempt were more likely to be obese, while Whites with suicide attempt were more likely to be underweight. Frequency of psychiatric disorders, including depression, alcohol abuse, drug abuse, and psychosis, were not different between Whites and Blacks with suicide attempt; however, medical conditions showed a different profile across racial groups. When compared to Whites, Blacks had higher prevalence of uncomplicated hypertension, renal failure, chronic obstructive pulmonary disease, coagulopathy, and obesity (p < 0.05 for all comparisons). In contrast, Whites had higher prevalence of other neurological disorders than Blacks. There were no differences in in-patient survival rate between Whites and Blacks who attempted suicide.

CONCLUSION

There are considerable differences between Blacks and Whites with at least one suicide attempt. Although their psychiatric diagnoses seem to be similar, Blacks who have attempted suicide attempt have more medical comorbidities than their White counterparts. Lack of racial disparities in in-patient mortality rate of suicide attempts in the Michigan Health Care System is promising news given the higher physical health needs of Blacks when compared to Whites.

Church and Family Support Networks and Depressive Symptoms among African Americans: Findings from the National Survey of American Life

Aims:

We examined the associations between informal social support from church members and social support from extended family members and depressive symptoms within a national probability sample of African American adults ranging in age from 18 to 93.

Methods:

This analysis used data from the National Survey of American Life and accounted for religious service attendance and various demographic variables that have known associations with and are consequential for mental health.

Results:

Frequency of contact with church and family members and emotional support from family were inversely associated with depressive symptoms, and negative church and family interactions were positively associated with depressive symptoms. Emotional support from church members, however, was unrelated to depressive symptoms.

Conclusion:

This study underscores the important contributions of church relationships to depressive symptoms among African Americans across the adult life span, and confirms that these associations are independent of family relationship factors and religious service attendance.

Does Religious Involvement Mitigate the Effects of Major Discrimination on the Mental Health of African Americans? Findings from the Nashville Stress and Health Study

Several decades of scholarly research have revealed the significant toll of discrimination experiences on the well-being of African Americans. Given these findings, investigators have become increasingly interested in uncovering any potential resources made available to African Americans for mitigating the psychosocial strains of discrimination. The current study contributes to this literature by testing whether various indicators of religious involvement—e.g., church attendance, prayer, and religious social support—buffer the noxious effects of major discrimination experiences on the mental health outcomes (i.e., depression and life satisfaction) of African Americans. We analyze data from the African American subsample (n = 627) of Vanderbilt University’s Nashville Stress and Health Study, a cross-sectional probability sample of adults living in Davidson County, Tennessee between the years 2011 and 2014. Results from multivariate regression models indicated (1) experiences of major discrimination were positively associated with depression and negatively associated with life satisfaction, net of religious and sociodemographic controls; and (2) religious social support offset and buffered the adverse effects of major discrimination on both mental health outcomes, particularly for those respondents who reported seeking support the most often. We discuss the implications and limitations of our study, as well as avenues for future research.

Suicidal ideation and hopelessness in PTSD: spiritual well-being mediates outcomes over time

Background There is an increased interest in understanding the mechanisms through which post-traumatic stress disorder (PTSD) relates with hopelessness and suicidal ideation. Spiritual well-being could help explain the link between PTSD and both hopelessness and suicidal ideation in African Americans. However, no study has examined the mediational role of existential and religious well-being among these variables. Objectives To examine if initial levels of existential and religious well-being mediated the relation between levels of PTSD symptoms and prospective levels of hopelessness and suicidal ideation in a sample of African American females. Design The study used a longitudinal design with a 10-week time interval. Methods The sample comprised of 113 disadvantaged African American women survivors of a recent suicide attempt recruited from a southern hospital. Self-report measures of PTSD symptoms, hopelessness, suicidal ideation, and spiritual well-being were administered to examine the variables of interest. Bootstrapping techniques were used to test the mediational models. Results Existential, but not religious well-being, mediated the relationship between levels of PTSD symptoms severity and both levels of hopelessness and suicidal ideation over time. Conclusions Existential well-being appears to play a promising protective role against the negative effects of PTSD on both hopelessness and suicidal ideation.

Religion as a Risk Factor for Suicide Attempt and Suicide Ideation Among Depressed Patients

We aimed to examine the relationship between religion and suicide attempt and ideation. Three hundred twenty-one depressed patients were recruited from mood-disorder research studies at the New York State Psychiatric Institute. Participants were interviewed using the Structured Clinical Interview for DSM Disorders, Columbia University Suicide History form, Scale for Suicide Ideation, and Reasons for Living Inventory. Participants were asked about their religious affiliation, importance of religion, and religious service attendance. We found that past suicide attempts were more common among depressed patients with a religious affiliation (odds ratio, 2.25; p = 0.007). Suicide ideation was greater among depressed patients who considered religion more important (coefficient, 1.18; p = 0.026) and those who attended services more frequently (coefficient, 1.99; p = 0.001). We conclude that the relationship between religion and suicide risk factors is complex and can vary among different patient populations. Physicians should seek deeper understanding of the role of religion in an individual patient's life in order to understand the person's suicide risk factors more fully.

Religiosity Is a Protective Factor for Suicidal Ideation in European American Students but Not in African American Students

In a sample of 419 college students, intrinsic religiosity scores, but not extrinsic religiosity scores, contributed significantly to the prediction of current suicidal ideation. Religiosity was a protective factor for suicidal ideation in women but not in men and in European American students but not in African American students. The assessment of suicidal risk, therefore, may require different sets of scales depending on the sex and ethnicity of the client.

Association Between Religious Service Attendance and Lower Suicide Rates Among US Women

IMPORTANCE

Previous studies have linked suicide risk with religious participation, but the majority have used ecologic, cross-sectional, or case-control data.

OBJECTIVE

To examine the longitudinal association between religious service attendance and suicide and the joint associations of suicide with service attendance and religious affiliation.

DESIGN, SETTING, AND PARTICIPANTS

We evaluated associations between religious service attendance and suicide from 1996 through June 2010 in a large, long-term prospective cohort, the Nurses' Health Study, in an analysis that included 89 708 women. Religious service attendance was self-reported in 1992 and 1996. Data analysis was conducted from 1996 through 2010.

MAIN OUTCOMES AND MEASURES

Cox proportional hazards regression models were used to examine the association between religious service attendance and suicide, adjusting for demographic covariates, lifestyle factors, medical history, depressive symptoms, and social integration measures. We performed sensitivity analyses to examine the influence of unmeasured confounding.

RESULTS

Among 89 708 women aged 30 to 55 years who participated in the Nurses' Health Study, attendance at religious services once per week or more was associated with an approximately 5-fold lower rate of suicide compared with never attending religious services (hazard ratio, 0.16; 95% CI, 0.06-0.46). Service attendance once or more per week vs less frequent attendance was associated with a hazard ratio of 0.05 (95% CI, 0.006-0.48) for Catholics but only 0.34 (95% CI, 0.10-1.10) for Protestants (P = .05 for heterogeneity). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the association among those occasionally attending services, but not for those attending frequently.

CONCLUSIONS AND RELEVANCE

In this cohort of US women, frequent religious service attendance was associated with a significantly lower rate of suicide.

Religion and Suicide Risk: A Systematic Review

Although religion is reported to be protective against suicide, the empirical evidence is inconsistent. Research is complicated by the fact that there are many dimensions to religion (affiliation, participation, doctrine) and suicide (ideation, attempt, completion). We systematically reviewed the literature on religion and suicide over the last 10 years (89 articles) with a goal of identifying what specific dimensions of religion are associated with specific aspects of suicide. We found that religious affiliation does not necessarily protect against suicidal ideation, but does protect against suicide attempts. Whether religious affiliation protects against suicide attempts may depend on the culture-specific implications of affiliating with a particular religion, since minority religious groups can feel socially isolated. After adjusting for social support measures, religious service attendance is not especially protective against suicidal ideation, but does protect against suicide attempts, and possibly protects against suicide. Future qualitative studies might further clarify these associations.

Religiousness and suicide in a nationally representative sample of Trinidad and Tobago adolescents and young adults

PURPOSE

The present study examines religiousness and its connection to suicidal thoughts, plans, and attempts among Trinidad and Tobago adolescents and young adults.

METHOD

Data are from Trend Research Empowering National Development on adolescents and young adults in Trinidad and Tobago (N = 4448). Religious affiliation, self-perceived religiousness, attendance at religious services, prayer frequency, socio-demographic variables, and suicidal thoughts, plans, and attempts were assessed.

RESULTS

Compared to nonreligious, Catholics (OR 0.63, p < 0.05) and Seventh-day Adventists (OR 0.47, p < 0.01) were less likely to think about suicide, and hindus (OR 5.81, p < 0.05) and other affiliates (OR 7.28, p < 0.01) were more likely to be treated for suicide. Higher self-rated religiosity was related to lower likelihood of thinking about suicide (OR 0.86, p < 0.01) and lower likelihood of planning suicide (OR 0.78, p < 0.001). Attendance at religious services was related to lower likelihood of thinking about suicide (OR 0.94, p < 05) and fewer suicide attempts (β = -0.11, p < 0.01). More frequent prayer was related to lower likelihood of thinking about suicide (OR 0.92, p < 0.01) and lower likelihood of planning suicide (OR 0.90, p < 0.001).

CONCLUSIONS

Religiousness may offer benefits for adolescents and young adults in Trinidad and Tobago by reducing the likelihood that they engage in suicide thoughts and behaviors. Results may hold implications for counselors, clergy, teachers, and others working with adolescents and young adults in Trinidad and Tobago.

Religiosity and Mental Health Service Utilization Among African-Americans

African-Americans are approximately half as likely as their white counterparts to use professional mental health services. High levels of religiosity among African-Americans may lend to a greater reliance on religious counseling and coping when facing a mental health problem. This study investigates the relationship between three dimensions of religiosity and professional mental health service utilization among a large (n = 3570), nationally representative sample of African-American adults. African-American adults who reported high levels of organizational and subjective religiosity were less likely than those with lower levels of religiosity to use professional mental health services. This inverse relationship was generally consistent across individuals with and without a diagnosable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, anxiety, mood, or substance use disorder. No association was found between nonorganizational religiosity and professional mental health service use. Seeking professional mental health care may clash with sociocultural religious norms and values among African-Americans. Strategic efforts should be made to engage African-American clergy and religious communities in the conceptualization and delivery of mental health services.

Ethnic and Gender Differences in Additive Effects of Socio-economics, Psychiatric Disorders, and Subjective Religiosity on Suicidal Ideation among Blacks

BACKGROUND

This study aimed to investigate the additive effects of socio-economic factors, number of psychiatric disorders, and religiosity on suicidal ideation among Blacks, based on the intersection of ethnicity and gender.

METHODS

With a cross-sectional design, data came from the National Survey of American Life, 2001-2003, which included 3570 African-American and 1621 Caribbean Black adults. Socio-demographics, perceived religiosity, number of lifetime psychiatric disorders and lifetime suicidal ideation were measured. Logistic regressions were fitted specific to groups based on the intersection of gender and ethnicity, while socioeconomics, number of life time psychiatric disorders, and subjective religiosity were independent variables, and lifetime serious suicidal ideation was the dependent variable.

RESULTS

Irrespective of ethnicity and gender, number of lifetime psychiatric disorders was a risk factor for lifetime suicidal ideation (odds ratio [OR] ranging from 2.4 for Caribbean Black women to 6.0 for Caribbean Black men). Only among African-American men (OR = 0.8, 95% confidence interval = 0.7-0.9), perceived religiosity had a residual protective effect against suicidal ideation above and beyond number of lifetime psychiatric disorders. The direction of the effect of education on suicidal ideating also varied based on the group.

CONCLUSIONS

Residual protective effect of subjective religiosity in the presence of psychiatric disorders on suicidal ideation among Blacks depends on ethnicity and gender. African-American men with multiple psychiatric disorders and low religiosity are at very high risk for suicidal ideation.

Religious participation and DSM IV major depressive disorder among Black Caribbeans in the United States

This study examines the relationship between religious involvement and 12-month and lifetime DSM-IV major depressive disorder (MDD) within a nationally representative sample of Black Caribbean adults. MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI). Religious involvement included measures of religious coping, organizational and nonorganizational involvement, and subjective religiosity. Study findings indicate that religious involvement is associated with 12-month and lifetime prevalence of MDD. Multivariate relationships between religious involvement and MDD indicate lower prevalence of 12-month and lifetime MDD among persons who use religious coping and characterize themselves as being religious (for lifetime prevalence only); persons who frequently listen to religious radio programs report higher lifetime MDD. Lower rates of 12-month and lifetime MDD are noted for persons who attend religious services at least once a week (as compared to both higher and lower levels of attendance), indicating a curvilinear relationship. The findings are discussed in relation to previous research on religion and mental health concerns, conceptual models of the role of religion in mental health (e.g., prevention, resource mobilization) that specify multiple and often divergent pathways and mechanisms of religious effects on health outcomes, and the role of religion among Caribbean Blacks.

The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state

This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.

The Racial-Cultural Framework

Suicide-related outcomes are a major public health challenge in communities of color in the United States. To address these challenges, this Major Contribution makes theoretical, empirical, and practice-related contributions to scholarship on suicide-related outcomes among people of color. In this article, the authors present a new framework to conceptualize previous suicidology scholarship, address existing literature gaps, and inform counseling psychologists’ future work on suicide-related outcomes in U.S. communities of color. The framework consists of three components and nine principles that highlight the types of constructs, populations, and preventive interventions that should be emphasized in theory, research, and practice addressing suicide-related outcomes in communities of color. The authors explain why suicide-related outcomes in communities of color deserve attention, describe the framework, and discuss implications of the framework for future practice and training. It is hoped that this framework can serve as a resource and impetus for new paradigms of suicidology work in communities of color.

Suicide, negative interaction and emotional support among black Americans

OBJECTIVES

This study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults.

METHOD

Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older.

RESULTS

Multivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans.

DISCUSSION

Negative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.

Religious involvement and DSM-IV 12-month and lifetime major depressive disorder among African Americans

This study explores relationships between lifetime and 12-month DSM-IV major depressive disorder and religious involvement within a nationally representative sample of African American adults (n = 3,570). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Multivariate findings indicate that reading religious materials were positively associated with 12-month (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.001-1.29) and lifetime (OR, 1.12; 95% CI, 1.03-1.21) MDD, religious service attendance was inversely associated with 12-month and lifetime MDD, and religious coping was inversely associated with 12-month MDD (OR, 0.75, 95% CI, 0.57-0.99). Findings are discussed in relation to the role of religion for African American mental health, prior research on the effects of religious involvement on physical and mental health, and theoretical and conceptual models of religion-health connections that specify multiple and often divergent pathways (e.g., prevention and resource mobilization) by which diverse forms of religious involvement impact mental health.