LIFE News: Issue 10

Welcome to LIFE News - June 2010. In this edition LIFE focuses on suicide prevention in culturally and linguistically diverse (CALD) communities, taking a look at the latest research and projects including CALD Community Connections, Making My Living, and The Mt Theo Program. LIFE warmly encourages feedback on LIFE News - please contact us with your comments or suggestions.

Comment: the challenges facing suicide prevention in CALD communities

By Georgia Zogalis

Georgia Zogalis

Above: Georgia Zogalis

In this sector comment Georgia Zogalis, National Program Manager of Multicultural Mental Health Australia (MMHA), discusses suicide prevention in CALD communities, addressing many of the risk factors associated with CALD people while exploring opportunities to greater address mental health awareness and suicidal behaviour.

Research suggests that migration and acculturative stress significantly predict depression and suicidality (Roberts & Chen, 1995; Ponizovsky, Ritsner & Modai, 1999; Hovey, 2000; Khavarpour & Rissel, 1997). Series of events that can readily be defined as risk factors for depression amongst immigrants, spanning pre-migration experiences, include acute and ongoing bereavement due to loss of social supports and cultural identity, and ongoing settlement issues such as inadequate housing, unemployment, and family dysfunction.

The Framework for Implementation of the National Mental Health Plan 2003-2008 in Multicultural Australia identifies groups at particular risk of suicide because of trauma and loss. People who have either been victims of torture and trauma, or who have witnessed their family members as victims, can be at particular risk of future mental illness.

Between January 2000 and June 2006 almost 63,000 people arrived in Australia under the Humanitarian Migration Stream (arrivals coming as refugees under special assistance and special humanitarian programs). Most of these people were from countries experiencing war, dislocation and natural disasters, including the Sudan (30% of arrivals), Iraq (15%) and Afghanistan (10%). Despite this we do not know the prevalence of depression and other mental health outcomes associated with trauma in people from refugee communities, because it has not been investigated in Australia.

While we know that societal and cultural frameworks on coping skills and resilience at the individual level are commonly recognised as playing an important role in suicide prevention, as do a number of protective factors including beliefs such as:

  • being able to see value and meaning in life, self-esteem and belief in survival and coping;
  • moral objections to suicide;
  • skills such as stress management, communication and problem solving skills; and supports such as family responsibilities, community support networks, and a sense of belonging.
However, the absence of information on the scope and nature of the problem regarding immigrant suicide means it is difficult to develop and implement effective evidence-based prevention and response programs for this population.

The MMHA Capacity Building and Stigma Reduction project aims to develop a sustainable national model of mental health awareness via training of CALD community agencies to conduct education on mental health in their communities, supported by nationally developed multilingual information.

What we know:

  • Suicide by people born overseas represents around 25% of all suicides in Australia.
  • One of the main reasons for the lack of attention to the needs of immigrant populations in Australia, and also for the perception that immigrant suicide is not an issue, is due to a lack of serious and updated epidemiological investigations into immigrant suicidal behaviour in Australia.
  • There are no reliable studies in Australia on epidemiology within this population group, and few studies have investigated risk factors within well-defined acculturating groups. Moreover, these studies date back even 20 years.
  • Existing information on immigrant suicidal behaviour is mostly anecdotal, and limited by the lack of evidence-based studies.
  • Those few studies that have looked at suicide and immigrant populations have usually focused on the larger population of immigrants (i.e. in a universal sense), as opposed to investigating specific ethnic groups of immigrants or categories of migrants such as skilled selected migrants.
What we need:

  1. More funded programs for CALD community groups across Australia, providing them with the skills and support to build resilience and prevent depression and suicide. The National Suicide Prevention Strategy (NSPS) currently funds CALD-focused projects such as CALD Community Connections.
  2. Studies on the full range of suicidal behaviours, which examine specifically defined cultural risk and protective factors, combining both quantitative and qualitative methods to better understand suicidal risk in acculturating populations in Australia.
  3. An increased understanding of the problem of immigrant suicide so that we can inform the development and implementation of tailored suicide prevention initiatives for immigrants.
  4. A study that addresses the above issues and get outcomes that will benefit the vulnerable or at-risk migrants in Australia with the intent of reducing and preventing suicidal behaviours. This should increase understanding about whether there is a problem regarding immigrant suicide, and if so what the scope and nature of the problem is.
There are many challenges pertaining to the manner with which data about suicide in immigrant communities can be considered. It is important, for example, to increase understanding about the differences between immigrants who have chosen to migrate to Australia (e.g. for improved living, work etc) and immigrants who were obliged to leave their country of origin (e.g. refugees, victims of torture etc).

Some CALD population groups that require special attention include youth, the elderly, people living in rural and remote areas and other demographics identified as at-risk populations by the Living is for Everyone (LIFE) Framework.

  • For more information about Multicultural Mental Health Australia visit their website.
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CALD Community Connections: connecting with CALD communities in Tasmania

By LIFE Communications

CALD Community Connections participants

Above: Gone fishing - Members of Hobart's Bhutanese Community learning new skills and enjoying life in Tasmania, May 2010

CALD Community Connections is a community-based National Suicide Prevention Strategy project that aims to develop and increase community capacity to work with, support and assess CALD individuals who live in Tasmania. Funded in 2009 by the Commonwealth Department of Health, the project works to increase wellbeing, reduce suicide risk and enhance capacity for individuals to respond to suicidal crises within CALD communities. It achieves this through a range of services and activities which includes information packages, workshops, training programs and support groups.

CALD Community Connections is managed by the Phoenix Centre, a support service for survivors of torture and trauma, auspiced by the Migrant Resource Centre situated in Southern Tasmania. The project targets all CALD clients in the state, with a particular focus on specific groups identified as being at need such as the Chinese, Burmese, Sierra Leone, Sudanese and Farsi speaking communities. These groups were identified through consultation with a wide range of communities and service providers as well internally conducted community needs assessment.

In April the project began rolling out mental health stigma reduction workshops using Multicultural Mental Health Australia's (MMHA) Stepping Out of the Shadows program. At the conclusion of the program participants are then capable of delivering it to local community members. Stepping Out of the Shadows aims to reduce the negative impact of stigma by exploring how CALD individuals and communities can deal with mental health issues in practical ways.

'Stepping Out of the Shadows is a really great package but we recognised that it didn't include any information on suicide prevention,' says Phoenix Centre Manager Dr Gillian Long. 'We decided to modify how that package is delivered so that it includes suicide prevention information. We have trained eight bicultural community trainers in this mental health stigma reduction package and they are now delivering that information to their communities.'

CALD Community Connections will continue delivering workshops over the next 18 months, including workshops geared towards service providers which aim to increase their capacity to work with CALD clients. In May the project begins rolling out alcohol sector related workshops to look at ways organisations and individuals can 'feel more comfortable making referrals for clients who are having alcohol related problems.'

A major component of the Community Connections program involves the development of support groups for men, women and youth. For example, the project's youth oriented activities include an on-going forum for school aged youth with activities to raise cultural awareness and understanding among school aged-youth especially; and a school holiday youth camps that aim to build connectedness, increase self-esteem and provide a comfortable environment where CALD youth can talk about issues they face in their lives and different ways to address them. Each camp will be attended by approximately 20 young people from refugee and humanitarian entrant backgrounds. The project has recently started developing other wellbeing groups including an African elders women's group, which aspires to build confidence and social interaction among African women.

'We have lots of exciting group-based events that we are implementing or in the process of planning,' says Long. 'These include specialised yoga classes for people who've experienced trauma. A lot of our clients have experienced torture and trauma prior to coming to Australia, so this form of yoga specifically targets these people and addresses expression of that trauma in their bodies.'

CALD Community Connections promotes their events via newsletter, attendance at service provider forums and other events, and extends invitations through the Phoenix Centre's extensive network of local and service provider contacts. Promotion also spreads through CALD communities via word of mouth. The project maintains formal partnerships with MMHA, MAITRI and ASPIRE and informal relationships with Lifeline, the Alcohol Tobacco and Other Drugs Council and a range of community sector organisations across Tasmania.

Major ongoing challenges include those associated with low levels of English comprehension, which is common among CALD communities.

'Many of the people we are targeting are not literate in their first language,' says Long. 'Many also do not speak English. Therefore the effectiveness of written communication about the project is limited and overcoming that poses some challenges.'

  • For more information about CALD Community Connections, email Phoenix Centre Manager Dr Gillian Long or telephone (03) 6234 9138.
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Making My Living - increasing capacity to work with young refugees

By LIFE Communications

Making My Living project image

The Making My Living Project, formerly The Young Refugee Suicide and Self-Harm Awareness and Support Initiative, is a Queensland-based community suicide prevention project that seeks to provide awareness education and engagement strategies to government and non-government youth service providers and community members who have contact with young refugee people.

One of the core aims of the project is to develop a training package targeted at service providers in areas located to the South of Brisbane, where there are large refugee communities.

Having successfully implemented training workshops, follow-up sessions and social activities last year, the project is currently in the process of refining its training materials and is exploring ideas for shaping them in new directions.

Project Coordinator Chris Chicoteau believes there are many suicide prevention and mental health concerns unique to young refugee people as well as plenty of unique opportunities and challenges.

Says Chicoteau: 'One of the challenges for CALD families, for example, can be that children become interpreters for their parents. Young people might find themselves having to go to Centrelink or having to approach various doctors, lawyers and professional services and be the interpreter. That increases their position of power in the family, which can be quite confronting for parents who are used to the idea of living back home where the father or the mother have all of the decision making control.'

Chicoteau says the Making My Living staff have learned a great deal through trial and error.

'Like a lot of other projects we got into this sort of work with a field of dreams philosophy: if you build it they will come. We fell into that and when it didn't work what we decided to do was implement a community development approach and actually find out what young people were doing themselves in their communities. We got involved that way.'

The project sought to enhance the capacity of people who might be working with young people from a refugee background, particularly in terms of suicide prevention. Staff worked with the philosophy that better cultural understanding and better understanding of intergenerational dynamics are important in ensuring young people don't become disconnected.

'There are a lot of good cultural awareness training programs across the country but some can tend to follow a bit of a recipe approach,' says Chicoteau.

'You can get a checklist of, say, this is Sudanese culture - the language, the food, the customs etcetera. I don't want to discredit this approach, because it can be useful and it alerts people that there might be some differences when they come across different people. However, we view culture through a much more dynamic model.'

The Making My Living training materials cover topics such as 'The Refugee Experience,' 'Culture and Transition,' Mental Health and Wellbeing' and 'Suicide, Self-Harm and Risk Assessment.' Short descriptions of all training topics can be found on the Making My Living LIFE project profile page.

  • For more information email project coordinator Chris Chicoteau.
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Reducing petrol sniffing and building community resilience: an update from The Mt Theo Program

By The Mt Theo Program

Mt Theo Substance Misuse Program
Above: Program founders Johnny Miller OAM and Peggy Brown OAM, who set up the Mt Theo Outstation as a place of respite for petrol sniffers in 1993.

The Beginning of the Mt Theo
The Mt Theo Program is a community organisation based in Yuendumu, a remote community on the Warlpiri lands about 300km northwest of Alice Springs. The Mt Theo Program was initially formed back in 1994 to respond to the petrol-sniffing crisis that plagued Yuendumu at that time, with community members taking the crucial step of sending their young people out to the Mt Theo Outstation if they were sniffing. There, they received cultural rehabilitation and support from Warlpiri elders, who helped them get back on track and become strong young community members. From these beginnings has grown an amazing program that now responds to the needs of young people across the Warlpiri region, and is to this day fundamentally owned and directed by the Warlpiri people.

Beyond sniffing
As the program has grown, so too has the scope of the problems it can address. With the formation of the Jaru Pirrjirdi ('Strong Voices') youth development project in 2002, young people in Yuendumu began finding a voice to express their fears, concerns and hopes for the future. One of the issues that continued to affect them was suicide and suicidal behaviour, and what could be done to prevent these. The Jaru Pirrjirdi response was to form a team of youth peer mentors, who worked closely within strong existing structures of family and community to provide a crucial 'safety net' for young people at risk of suicide and suicidal behaviours. This initiative saw the rate of suicide attempts among young people drop from 28 in 2006 to 4 in 2009*, and also helped to address many of the other personal issues that contribute to suicidal behaviour in Yuendumu - for example, substance misuse, family violence, grief, trauma, and depression. Perhaps most importantly, the other elements of the Jaru Pirrjirdi Project supported these young people to continue to move forward on positive pathways towards work, education and personal development opportunity.

Warra-Warra Kanyi
In early 2009, as reported by LIFE News, the Mt Theo Program received funding from the Commonwealth Government's Personal Helpers and Mentors (PHaMS) project, and used these resources to further strengthen and establish the mentoring element of Jaru Pirrjirdi. This element was given the Warlpiri name Warra-Warra Kanyi (WWK), which describes the correct Warlpiri way of looking after a young person at risk, while maintaining respect for their autonomy. With this extra funding, 'proper' jobs were established for two Warlpiri staff members who had long been involved with the program - Jean Brown, now the WWK Senior Cultural Advisor, and Sherman Spencer, now the WWK Youth Mentor. Gina Spencer, Sebastian Watson and Michael Wayne are also employed on a casual basis in a Mentor role, and continue to provide wonderful mentoring support for their at-risk peers. They are supported in this role by Ruth Bignell, the WWK Counsellor, who brings to the team an academic background in therapeutic approaches.

WWK has grown enormously during its first year of life. We continue to work hand-in-hand with the community and its young people to prevent suicide and suicidal behaviours, and are continually refining and searching for the best ways of doing this. Jean Brown, our WWK Senior Cultural Advisor, has recently completed a beautiful artwork demonstrating the basis of our WWK model of caring for young Warlpiri people; her painting shows a young person experiencing hardship, and the unique way in which professional, community and family supports all come together through WWK to help that young person.

Our mentors continue to develop in expertise and experience; indeed Sherman Spencer, our WWK Youth Mentor, recently received a certificate from the Mental Health Association of Central Australia commending his major contribution to their newly developed, remote-specific Indigenous suicide prevention training, 'Suicide Story'. We anticipate that this training will soon be available to community members in Yuendumu, and will be really valuable in increasing community knowledge and action about preventing suicide.

The Big Picture
Initiatives that deal directly with the problem of youth suicide in the remote central Australian region, such as WWK, are of obvious importance in reducing the rate of suicide and suicidal behaviours. So too are projects that address related youth risk issues like substance misuse, such as the Mt Theo Outstation. For the Warlpiri communities of the Tanami desert, it's equally important to recognise the value of a holistic, coordinated and comprehensive youth service that helps to prevent these risk issues from occurring in the first place. Over the past 12-18 months, the Mt Theo Program has been invited to coordinate diversionary youth programs in the three other Warlpiri communities of Lajamanu, Nyirrpi and Willowra. Crucially, these youth programs have been funded by the Warlpiri people through the Warlpiri Education and Training Trust, a trust funded by Walrpiri mining royalties, of which Warlpiri people are the directors. This allows us to continue in our proud tradition of being a Warlpiri-owned, Warlpiri-controlled organisation that is now able to provide youth services across the Tanami desert. Our presence in these other communities allows us to contribute to the development of healthy, happy Warlpiri children and young people, and mobilise professional resources much more quickly to those who may be at risk. Through these measures, as well as the targeted suicide- and risk-prevention activities we continue to undertake and expand in Yuendumu, we hope to continue working well in a Warlpiri way for the wellbeing of Warlpiri youth.

  • For further information contact the Mt Theo Program on (08) 8956 4188 or via email
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Research summary: The Cultural Meaning of Suicide: A Comparison Between Italian, Indian and Australian Students

By Dr Erminia Colucci


Dr Erminia Colucci

Above: Dr Erminia Colucci

Dr Erminia Colucci is a Lecturer in International Mental Health and the Research Program Coordinator at the Centre for International Mental Health (The University of Melbourne). Prior to this, she received training in suicidology research at the Australian Institute for Suicide Research and Prevention at Griffith University, and worked in Italy as a clinical psychologist.

For LIFE News Dr Colucci has contributed a summary of her PhD dissertation. Readers can find information on other projects (such as the development of Suicide First Aid guidelines for India, Japan and Philippines, a multi-method study on suicide and spirituality in India) here or here or by emailing her.


This summary is split into four areas: rationale, methods, results and conclusions and implications.

Rationale
The increase of suicide in young people is a matter of concern in many countries and a priority area for prevention activities and programmes. Italy, as other South European countries, is characterized for having a very low rate of suicide, especially among youth. In contrast, Australia in recent decades has experienced an increase in youth suicide rate, particularly in males. In India suicide is predominantly a problem of the youth, approximately equally distributed between men and females, with some states registering higher female rates.

Given cross-national differences in suicide rates, research has focused on identifying factors that increase suicide risk. As underlined by various scholars, relatively few of these studies have addressed the impact of culture on suicidal behaviour, and cross-cultural research has generally been neglected. In particular there is scarce understanding of the variations in the meaning of suicide across cultures. The present study attempted to redress this deficit, focusing on the social representations, values, beliefs, attitudes and meanings that young Italians, Indians and Australians express in relation to suicide.

The specific aims of the study were to investigate:

  • the similarities and differences in participants' spiritual beliefs on suicide, suicide explanatory models, attitudes towards youth suicide, opinions on suicide deterrents/protective factors, help-seeking behaviour and on youth suicide prevention;
  • participants' feelings towards death, cultural meanings of the words 'suicide' and 'suicide attempt', mental representations and stereotypes of suicidal youth (considering also gender issues); and
  • the impact of participants' previous experience and exposure to suicide, gender, spiritual/religious affiliation, and ethnic identity on these constructs.

Methods
Qualitative methodology, given its phenomenological epistemology, is particularly apposite for the study of cultural meanings. It is also recognized for its exploratory value, namely for examining a topic or problem that has not previously been researched. As the study of cross-cultural meaning of suicide in young people is a hitherto unexplored area that requires an in-depth understanding, a qualitative methodological approach was seen as appropriate for the present project. However, to date various researchers are aware of the advantages of triangulating methods to reach a deeper and multi-perspective understanding of a given phenomenon.

Therefore, the author opted to use a mixture of qualitative and quantitative methods, although the phenomenological-constructivist approach constitutes the epistemology that informed much of the research process (from the initial research questions to the research design, methods of data collection, data analysis and its representation).

With respect to the data collection, the sample consisted of at-least second generation Italian, Indian and Australian University students, 18-24 years old, enrolled in the University of Padua (Veneto, Italy), various colleges in Bangalore (Karnataka, India) and two universities in Brisbane (Queensland, Australia). Veneto, Karnataka and Queensland are among the regions/states of the respective countries with the highest rates of youth suicide. Participants who matched the sampling criteria were given an envelope containing the questionnaires and forms. Almost 700 students across the three countries volunteered to fill in the questionnaire. Of these, 96 also participated in tape-recorded focus groups (two sessions for each group for a total of 24 sessions).

The questionnaire titled 'Exploring the Meaning of Suicide' was developed by the author specifically for this project and it was pilot-tested and back-translated (together with two bilingual psychologists). It included questions about reasons for suicide, exposure to suicide and history of suicidal ideation/behaviour, a suicide attitude questionnaire, case scenarios, and the 'Cultural Identification Battery'. Open-ended questions explored the mental constructions of 'suicide', the meanings of the words 'suicide attempt' and 'suicide', their mental representations and stereotypes on 'the kind of youth' who self-harm or kill themselves, gender-related issues, feelings towards death, their beliefs on suicide deterrents/protective factors, help-seeking behaviour and suggestions for suicide prevention. The focus group questions were similar to the open-ended questions included in the questionnaire, and the aim of the focus groups was to go into those issues in more depth. The session design followed a 'funnel pattern' beginning with a fixed set of core questions and then proceeding to a variable set of issues specific to the group. The focus group also included some activity-oriented questions, such as storytelling.

Quantitative data was analysed using SPSS 13.0 software. Qualitative data was analysed separately and then evaluated by two bilingual psychologists and the author. The categories developed were compared with those of a third psychologist, to create a final list of codes. The coding process was supported with the software for qualitative analysis ATLAS.ti 5.0.

Results
Three sets of data were collected: answers to structured and open-ended questionnaire items, and focus group verbatim transcripts. Quantitative and qualitative findings were presented for the overall sample and compared between countries.

The comparisons highlighted differences and similarities across cultures in meanings and social representations of suicide. First, there were differences on prevalence: more than half of the total sample reported suicide ideation but this was higher among Italian and Australian students, compared to Indians. In contrast, the latter reported more suicide attempts, followed by Australians and then Italians.

Other questions inquired about reasons for young people to attempt suicide or to indeed suicide. There were statistically significant differences on almost all suicide attempt reasons between cultures. For example, Indians agreed more that some youth attempt suicide to force others to do what they want. Compared with the other two samples, Italian students disagreed more that youth who attempt suicide are mentally ill. Another question asked to rank a list of fourteen reasons for youth suicide. Participants presented statistically significant differences on all of them. For example, financial problems were among the most important reasons for Indians. Mental illness, depression or anxiety were more important for Australians and loneliness or interpersonal problems were so for Italians.

The questionnaire also included a 21-item attitudes scale. Both mean scores on the single items and subscales scores showed cross-cultural differences. For example, Indians, followed by Australians, had more negative attitudes towards youth suicide compared to Italians.

The open-ended section of the questionnaire was composed of various parts -word association, questions and case scenarios - investigating participants' mental associations with the word "suicide" and interpretations of both this word and "attempted suicide", feelings about death, stereotypes of the "kind of" youth who attempt suicide or kill themselves, reasons for living and suicide prevention strategies. For instance, when asked for which reasons they would not suicide, students from the three countries wrote similar motivations, referring to the value and love for life, loved ones and the belief that difficulties are part of life and can be overcome. But there were also differences. In India, for instance, participants more frequently mentioned God as a deterrent against suicide compared to participants in Italy and Australia. Italians rarely expressed negative judgments towards suicide (e.g. suicide is selfish) to justify the choice not to suicide, whereas this was quite frequent in Indians, followed by Australians. Furthermore, Australians more often expressed the hope that they would get some help and support compared with the other groups.

In relation to help-seeking, overall the majority of students reported that, if they were thinking about killing themselves they would talk to no one or friends, followed by someone in the family. Some students, especially in Australia, referred to professional help.

Focus group transcripts helped to further understand questionnaire answers and pointed out issues such as altruistic suicide in India (i.e. suicide to not be a burden on the family), the pressure to be "macho" (i.e. conform to the male-role) thus not expressing emotions and sharing problems and the conflict of expectations between friends and adults in Australian men, and the "involvement" in other people's life in Italian youth.

Conclusions and implications
Many culture-related issues were addressed in this project, which concluded with a range of implications and suggestions for future research and the development of youth suicide prevention strategies. For instance, it is vital that suicide prevention strategies consider cultural (and sub-cultural) issues, including gender issues; that such strategies should be based on the voices of the people for whom these services are developed, and that clinically-based approaches should be one option rather than "the" main strategy (also because they might not meet the person's explanatory model and professionals might not be included in the person's "list" of helpers). Suicide prevention also needs to be oriented towards increasing people's reasons for being alive (e.g. organization of creative activities and increasing sense of community are few examples of what some participants requested) rather than just reducing reasons to die. Furthermore, as also suggested by other scholars, spirituality should play a greater role in suicide prevention and gender-related issues (including women's rights) must be considered when addressing suicide in its socio-cultural context.

In conclusion, this work highlighted that cultural determinants, systems of meanings, and beliefs cannot be neglected in suicide research and prevention because they are powerful influences on people's way of approaching suicide, both in regard to their own life and other people's lives.

This PhD dissertation is currently under preparation for a book publication.

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Mini-literature review: suicide prevention in culturally and linguistically diverse (CALD) communities

By LIFE Communications

Very little research on suicide and culturally and linguistically diverse populations within one country has been undertaken. Rather literature searches for this review found that the most common type of research located was cross-national, where large samples from different countries were amalgamated to explore the relationship of suicide with variables such as self-esteem (Chatard, Selimbegović & N'dri Konan, 2009) and suicide attitudes (Stack & Kposowa, 2008).

Given that this type of research may not be as useful to readers, this review will mention only a couple of examples. The first article (Chatard, Selimbegović & N'dri Konan, 2009) found that the national suicide rate was related to individual ratings of self-esteem. This study included data from 55 nations, including those who might be described as 'collective' and those who are seen as being 'individualistic'. In fact self-esteem was found to be the strongest predictor of national suicide rate, ahead of economic affluence, individualism/collectivism, subjective wellbeing and neuroticism.

The next article (Stack & Kposowa, 2008) found there was a strong relationship between the national suicide rate and attitudes towards suicide, with religiosity and life satisfaction appearing to be influential factors across the 31 nation survey. The importance of the former factor has been reported elsewhere (De Leo, 2009).

Another study of this nature reported on an anonymous questionnaire on self-harm and self-harm ideation, which was completed by adolescents in seven countries including Australia (Madge, Hewitt, Hawton, de Wilde, Corcoran, Fekete, va Heeringen, De Leo & Ystgaard, 2008; see De Leo and Heller, 2004 for the Australian sample). They found that the prevalence of self-harm (one event in lifetime: cross-nation average male = 4.3% and cross-nation average female = 13.5%) and thoughts about self-harm (cross-nation average male = 9.9% and cross-nation average female = 21.5%) were higher than previously reported, which the authors suggest is due to previous studies relying on hospital presentations. Additionally, the majority of those who engaged in self-harm never presented for medical attention and reported multiple reasons for their self-harm behaviour (wanting relief from a terrible state of mind followed by wanting to die being the two most common).

One study that differed explored the rate of suicide of elderly migrants in the country of origin as well as the host country (United Kingdom; Shah, Lindesay & Dennis, 2008). Earlier research cited by the authors indicated that the suicide rates of migrants remained similar to that of their country of origin rather than reflecting the suicide rate of the host nation. Shah and colleagues however found a great heterogeneity in the elderly migrant suicide rates, and suggest a number of explanations including the migrant group's socioeconomic status within the United Kingdom and degree of acculturation.

Whilst the above mentioned studies have the potential for understanding suicide and self-harm more generally, it would seem that we do not have much in the way to offer those people working to prevent suicide within one country with culturally and linguistically diverse populations.

If you know of any research that provides some insights into suicide prevention with culturally and linguistically diverse populations you are invited to contact LIFE via email.

References

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