Self-directed violence, which includes suicidal behavior, can be defined as threatened or actual use of physical force against oneself, which results in or has a high likelihood of resulting in injury or death (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Suicide or completed suicide is defined as a “death from injury, poisoning, or suffocation where it is explicitly or implicitly evident that the injury was self-inflicted and intended to be fatal. Suicidal ideation refers to self-reported thoughts of engaging in suiciderelated behavior” (O’Carroll et al., 1996, pp. 247-248). Injury from suicidal behavior is a major public health problem in the United States (Goldsmith, Pellmar, Kleinman, & Bunney, 2002).
“Some of the Paradigms and Underlying Assumptions That Have Made it Difficult to Address the Problem of Suicidal Behaviors in The African American Community.”
Despite the widespread impact of self-directed violence in the United States, the problem has frequently been viewed as a one solely affecting European American males (Davis, 1979) and the affluent (Earls, Escobar, & Manson, 1990). Among non-European Americans, only the incidence of suicide among Native Americans has been widely noted (U.S. Department of Health and Human Services [USDHHS], 1986).
“Suicide was the 16th-Leading Cause Of Death Overall in 2003 For African Americans.”
Suicide was the 16th-leading cause of death overall in 2003 for African Americans. On an average day in the United States, 1 African American dies by suicide every 4.5 hours. There were 28,177 suicides recorded among African Americans from 1990 to 2003. The yearly number of suicides among African Americans (unless otherwise noted, figures cited for African Americans represent those for non-Hispanic African Americans) in the United States increased slightly by 2.1% from 1,879 in 1990 to 1,918 in 2003 (Centers for Disease Control and Prevention [CDC], 2005).
“Suicide was the Third-Leading Cause of Death Among African American People Aged 15 to 19 Years.”
African American adolescents and young adults have the highest number and the highest rate of suicide of any age group of African Americans. Suicide was the third-leading cause of death among African American people aged 15 to 19 years, fourth among those aged 20 to 29 years, and eighth among those aged 30 to 39. Among African American adolescents and young adults, it is particularly the males that have the highest rates. During the early 1990s, the suicide rates among African American males aged 15 to 24 years were rising. The rates peaked in 1993 at 20.2, then began a steady decline to 11.6 (42.6% decrease) in 2002.
“African Americans Received Scant Attention Because Of The Belief That Very Few African Americans Completed Suicide.”
This special edition of the Journal of Black Psychology brought together a group of suicidologists—scientists who study suicide—to begin to look at the scope of the problem of suicidal thoughts and behaviors in the African American community. Historically, suicidal behaviors among African Americans received scant attention because of the belief that very few African Americans completed suicide; it was also assumed that they did not experience depression. Blacks were historically viewed as a psychologically unsophisticated race that were naturally high spirited and unburdened with a sense of responsibility (Prudhomme, 1938; Prange & Vitols, 1962). For example, in the first edition of the American Journal of Psychiatry, Bevis (1921) wrote that “most of the race are carefree, live in the here and now with limited capacity to recall or profit by experiences of the past. Sadness and depression have little part of his psychological makeup” (p. 11).
Some African American scholars also believed that suicide was not a problem in the African American community. Early and Akers (1993) did a qualitative study of African American ministers who felt that suicide was a “White thing” that was an anathema to a culture that was noted for its resiliency in the face of racial discrimination and oppression.
Yet an examination of slave narratives and ship logs from the antebellum period quickly dispels the notion that Blacks rarely completed suicide or were too “happy” in their state of oppression to contemplate suicide. Lester (1998) noted that suicide was very common among slaves when they were captured in Africa, when they were being transported to the Americas, and immediately after their arrival. Many African tribes believed that their souls would return to Africa after death, so suicide was viewed as an attractive alternative. Lester speculated that slave owners often mutilated the bodies of those who committed suicide because the slaveholders knew that the slaves believed their dismembered bodies could not return home.
Another factor that contributed to the dearth of research in this area is the assumption of universal expression of behaviors across cultures, what Nobles (1989) referred to as “transubstantiative error.” Hence, until 1979, ethnic differences in suicide rates were depicted as “White” and “non-White.” It was common practice to make no mention of the racial composition of the sample or to use White, middle-class control groups as though African Americans and Whites experience the same cultural and social reality. The assumption of universality makes it difficult to explore cultural differences in suicidal behaviors.
Interestingly, there is some limited evidence that there may be cultural differences in suicidality. Politano, Nelson, Evans, Sorenson, and Zeman (1986) found the behavioral component of depression, especially as it pertains to oppositionality, to be more prominently expressed in African American children. Delinquency has also been associated with suicide attempts among African American adolescent females (King, Raskin, Gdowski, Butkus, & Opipari, 1989; Summerville, Abbate, Siegel, Serravezza, & Kaslow, 1992).
What has compounded the difficulty of studying suicides in African Americans is that their suicides are more likely to be misclassified than any other ethnic group (Phillips & Ruth, 1993; Warhauser & Monk, 1978). Others have wondered whether African American suicides may be “disguised” in the form of “victim-precipitated homicides” (Garrison, Addy, Jackson, McKeown, & Waller, 1991). Victim-precipitated homicide is viewed essentially as an act of suicide because the victim intentionally engages in behavior in a life-threatening context that almost guarantees that another person (e.g., police officer) will kill the victim (Parent, 1999; Wolfgang, 1958). Although it has been estimated that nearly 30% of urban homicides are victim-precipitated (Van Zandt, 1993), it is not formally recognized as a form of suicide.
"Strengths in the African American Community that Might Serve as Protective Factors Against Suicidal Behaviors."
Most of the research that examines suicidal behaviors in the African American community focuses on delineating risk factors that are associated with suicidality. Molock and her colleagues decided to examine some of the strengths in the African American community that might serve as protective factors against suicidal behaviors in the presence of factors that have been known to place youth at risk for suicidality. Thus, Molock and her colleagues looked at whether religiosity (i.e., religious behaviors) and religious coping buffered against suicide risk in a community-based sample of African American adolescents. Their findings that hopelessness and depression were risk factors for suicidal thoughts and behaviors corroborate the general literature on suicide in adolescents. However, they also found that African American adolescents who used collaborative religious coping (the individual and God work together to solve problems) were more likely to attend church, were more active in church, tended to feel less hopeless and reported more reasons for wanting to live than did African American adolescents who used other religious coping styles. In contrast, African American teens who used a self-directed religious coping style (God gives me the skills I need to solve my own problems) were less likely to attend church and were more likely to feel depressed or hopeless and to report fewer reasons for wanting to live. The authors suggest that the use of a self-directed coping style may place African American adolescents at greater risk for depression and suicidality because this coping style may be less culturally compatible for African American teens. The authors also note that this research suggests that adolescents who use a self-directed religious coping style not only may be more vulnerable to stress but also may have access to fewer sources of support.
“Postvention as Prevention”
A postvention is an intervention conducted after a suicide, largely taking the form of support for the bereaved (family, friends, professionals and peers). Family and friends of the suicide victim may be at increased risk of suicide themselves. Postvention is a term that was first coined by Shneidman (1972), which he used to describe "appropriate and helpful acts that come after a dire event." In Schneidman's view, "the largest public health problem is neither the prevention of suicide nor the management of suicide attempts, but the alleviation of the effects of stress in the survivors whose lives are forever altered." Postvention is a process that has the objective of alleviating the effects of this stress and helping survivors to cope with the loss they have just experienced.
The aim is to support and debrief those affected; and reduce the possibility of copycat suicide. Interventions recognize that those bereaved by suicide may be vulnerable to suicidal behaviour themselves and may develop complicated grief reactions.
Postvention includes procedures to alleviate the distress of suicidally bereaved individuals, reduce the risk of imitative suicidal behavior, and promote the healthy recovery of the affected community. Postvention can also take many forms depending on the situation in which the suicide takes place. Schools and colleges may include postvention strategies in overall crisis plans. These strategies are designed to prevent suicide clusters and to help students cope with the emotions of loss that follow the suicide of a friend. Individual and group counseling may be offered for survivors (people affected by the suicide of an individual).
I hope that the information presented here will stimulate others to join in with the important epidemic suicide among African American Youth.
Pamela R. Robinson, BSW, MSW, LLMSW, MDiv., D.Min. Candidate
Emerging HOPE Family Strengthening Program, Co-Director, Founder/CEO