By Jacquie Rahm, CCLS, CTRS-C, YMHFA
Culture is a set of values and beliefs influenced by personal identities and life experiences, including race, religion, political affiliation, immigration status, education, sexuality, family structure, and more (SPRC, n.d.). Culture influences biases, social interactions, perception of acceptability, and coping with everyday life experiences. Cultural values significantly influence how individuals perceive and respond to certain characteristics. This contributes to variations in behavioral health presentation and treatment needs based on culture, and may cause what is considered a protective factor for some to be a risk factor and/or trigger for others.
Despite this knowledge, United States healthcare practices generally reflect Euro-American, middle-class culture, including suicide assessment and intervention methods used today (SAMHSA, 2012). These culturally biased care practices contribute to missed diagnoses and ineffective care. Recognizing cultural differences when assessing child suicidality is vital for improved outcomes for all.
Risk and protective factors
Cultural values and beliefs affect whether something may have a more positive, neutral, or negative influence. For example, family involvement is often considered supportive and protective for many immigrant families. Conversely, "Americanized" children may view family involvement as overbearing or implementing unattainable expectations due to the cultural value of independence and self-discovery.
Triggers
Similar to risk and protective factors, culture can influence what is more triggering for suicidality for an individual. In cultures where peer influence is highly valued, social difficulties and suicide contagion may be of increased concern for triggering suicidality. In cultures where there is a stronger influence on the family unit, not meeting parent expectations and/or consistent fighting might be more of a trigger for suicidality.
Recognition and expression of warning signs
Culture influences acceptable forms of emotional expression and social interactions. For example, children from cultures that value stoicism might express their mental health struggles through their general behavior more than their verbal and non-verbal communications.
Help-seeking
Behavioral health stigmas also vary by culture and can heavily influence help-seeking. Depending on cultural norms, a child might seek help only from those within the culture, or they may avoid expressing emotions around “insiders” for fear of judgement. For cultures that value self-reliance, help-seeking may be avoided altogether due to fear of stigmatization.
Trust
Children and families may be more hesitant to receiving, and resistant to cooperating with, care if they are from a culture with a history of oppression, generational trauma, and mistrust in authority professionals, including doctors.
Recommendations to Accommodate Culture in Suicide Prevention:
- Show respect for cultural differences and a willingness to learn about specific values and influences of each individual family.
- Incorporate culture-specific strengths and protective factors into interventions.
- Involve families actively in care, emphasizing partnership for child safety in all aspects of life.
- Respect and build upon religious and spiritual beliefs and influences.
- Tailor practices to consider and respectfully address cultural influences on risk factors, expression (or concealment) of warning signs, and overall understanding, especially for assessment and identification of need.
- Be sensitive to societal and cultural stigma related to behavioral health and suicidality for the child and make appropriate accommodations whenever possible (ex: offering services in non- behavioral health setting, such as school or church).
To learn more about suicide prevention in children and adolescents, check out our #ChildLife Blog series on Suicide Prevention Month.
References
SAMHSA (2021) Preventing suicide: A toolkit for high schools. SAMHSA. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/sma12-4669.pdf
SPRC (n.d.). Culturally competent approaches. Suicide Prevention Resource Center. https://sprc.org/keys-to-success/culturally-competent-approaches/