Luận Văn Risk And Protective Factors For Suicidal Behaviors In Mexican Youth Evidence For The Interpersonal Theory Of Suicide.pdf

Risk and protective factors for suicidal behaviors in Mexican youth evidence for the interpersonal theory of suicide The University of Toledo The University of Toledo Digital Repository Theses and Dis[.]

The University of Toledo The University of Toledo Digital Repository Theses and Dissertations 2013 Risk and protective factors for suicidal behaviors in Mexican youth : evidence for the interpersonal theory of suicide Maria Gabriela Alvarado The University of Toledo Follow this and additional works at: http://utdr.utoledo.edu/theses-dissertations Recommended Citation Alvarado, Maria Gabriela, "Risk and protective factors for suicidal behaviors in Mexican youth : evidence for the interpersonal theory of suicide" (2013) Theses and Dissertations Paper This Thesis is brought to you for free and open access by The University of Toledo Digital Repository It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of The University of Toledo Digital Repository For more information, please see the repository's About page A Thesis entitled Risk and Protective Factors for Suicidal Behaviors in Mexican Youth: Evidence for the Interpersonal Theory of Suicide by Maria Gabriela Hurtado Alvarado Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Arts Degree in Psychology _ Dr Joseph D Hovey, Committee Chair _ Dr Jon Elhai, Committee Member _ Dr Laura D Seligman, Committee Member _ Dr Patricia R Komuniecki, Dean College of Graduate Studies The University of Toledo May, 2013 Copyright 2013, Maria Gabriela Hurtado Alvarado This document is copyrighted material Under copyright law, no parts of this document may be reproduced without the expressed permission of the author An Abstract of Risk and Protective Factors for Suicidal Behaviors in Mexican Youth: Evidence for the Interpersonal Theory of Suicide by Maria Gabriela Hurtado Alvarado Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Arts Degree in Psychology The University of Toledo May, 2013 According to the 2009 Youth Risk Behavior Survey, Latino youth reported engaging in suicidal ideation and attempts more frequently when compared to African American and Caucasian youth These findings have remained a consistent trend in epidemiological studies for the past 15 years (Duarte-Velez & Bernal, 2007) Building on this knowledge base, it is important to examine specific factors related to suicidal behaviors in Latino youth The main focus of this study was twofold First, we aimed to examine suicidal behavior among Mexican youth in the context of well-established predictors of suicide, as well as cultural risk and protective factors that are relevant to their experience Second, we aimed to examine suicidal behavior among Mexican youth within the framework of the interpersonal theory of suicide (Joiner, 2005) This theory is particularly relevant to Mexican youth For example, in the presence of the high levels of family conflict Mexican youth may experience a lack of belongingness and an increased sense of perceived burdensomeness Family cohesion is a core-value of the Latino culture, and thus, family conflict can lead to the loss of important social support systems for Mexican youth iii A total of 152 Mexican adolescents participated in the study The participants completed a questionnaire packet containing a demographic questionnaire; the Family Environment Scale (Moos & Moos, 1993), the Personal Resources Questionnaire (Weinert, 1987), the Coping Competence Questionnaire (Schroder, 2004), the Interpersonal Needs Questionnaire (Van Orden , Witte, Gordon, Bender, & Joiner, 2008), the Beck Hopelessness Scale (Beck, Weissman, Lester & Trexler, 1974), the Reynolds Adolescent Depression Scale-2 (Reynolds, 1987), and the Suicidal Behaviors Questionnaire-Revised (Osman, Bagge, Gutierrez, Konick, Kopper, & Barrios, 2001) Family conflict, perceived burdensomeness, thwarted belongingness, hopelessness and depression had a positive association with suicidal behaviors On the other hand, coping competence and social support were negatively associated with suicidal behaviors Furthermore, those individuals that reported at least one previous suicide attempt reported greater levels of depressive symptomatology, hopelessness, and perceived burdensomeness Hierarchical regression analyses revealed that family conflict and depression were significant predictors of suicidal behaviors In addition, perceived burdensomeness and thwarted belongingness were significant moderators in the relationship between depression and suicidal behaviors The findings of this study can aid in the understanding of factors that are relevant to the experience of Latino youth, and may contribute to suicidal behaviors in this group The primary implication of these findings is to inform the development of appropriate suicide prevention efforts iv Table of Contents Abstract iii Table of Contents v List of Tables vii List of Figures viii I Introduction A Interpersonal Theory of Suicide B Risk and Protective Factors in Mexican Youth a Family and Social Support b Coping Mechanisms a Coping Competence c Depression in Mexican Youth d Hopelessness in Mexican Youth C Mexican Adolescent Suicide Studies a Limitations of Previous Studies 10 11 12 D The Present Thesis Study 12 a Hypotheses 12 II Method 15 A Participants 15 B Measures 16 C Procedures 19 D Exploratory Data Analysis 21 III Results 22 v a Descriptive Statistics 22 b Multiple Regression Analysis of Suicidal Behaviors 23 c Moderation Analyses of Interpersonal Needs 23 d Logistic Regression Analyses of Suicidal Behaviors 24 IV Discussion 25 a Interpersonal Theory of Suicide 27 b Limitations 28 c Clinical Implications 29 d Future Directions 29 References 31 Appendices A Demographic Form 55 B SAFE 57 C SBQ-R 59 D Handout: Suicide and Depression in Latino Adolescents 61 vi List of Tables Table Means, Standard Deviations, and Correlations 49 Table Means and standard deviations of mental health measures in attempters compared to non-attempters………………………… …………….……50 Table Means and standard deviations of low level intent compared to moderate to high level of intent among attempters …………… ……….… ……51 Table Multiple Regression Analysis Predicting Suicidal Behaviors ………….52 Table Logistic Regression Analyses Predicting Suicide Attempts .………….53 Table Logistic Regression Analyses Predicting Level of Intent Among Attempters .…………………………………………………… ….54 vii List of Figures Figure Interaction between Perceived Burdensomeness and Depression in Suicidal Behaviors …………………………………………………… 55 Figure Interaction between Thwarted Belongingness and Depression in Suicidal Behaviors ……………………………………………………………….56 viii Chapter One Introduction According to the 2010 Fatal Injury Reports and Violent Death (NVDRS) from the Center for Disease Control and Prevention (CDC) (Fatal Injury Reports and Violent Death [NVDRS], 2010), suicide is the second leading cause of death in individuals between the ages of 15 to 24 in the United States The Youth Risk Behavior Survey (YRBS), a national survey of high school students, provides detailed information of suicidal behaviors among adolescents The results of the survey show that 6.3% of adolescents reported having attempted suicide one or more times within the last 12 months; 1.9% of the participants reported having a suicide attempt that required serious medical attention; and 10.9% reported having made a specific suicide plan (Youth Risk Behavior Survey [YRBS], 2009) These data suggest that adolescents appear to be at an increased risk for suicide There are important differences in suicidal behaviors among ethnic groups In 2009, 8% of Latino youth engaged in suicidal ideation compared to 7% of African American and 5% of Caucasian youth In particular, Latina adolescents reported the highest rates of suicide attempts (11.1%) (Youth Risk Behavior Survey [YRBS], 2009) To further highlight the high prevalence of suicidal ideation and attempts among Latino adolescents, Garcia and colleagues (2008) conducted a study with Puerto Rican and Mexican high school students (N = 3178) derived from the Minnesota Student Survey (MSS) The MSS is a population-based study that includes almost all 6th, 9th, and 12th graders in the school districts of Minnesota In this study, one in five Latino adolescents reported having experienced suicidal ideation within the past year Moreover, 6% to Table Means and standard deviations of low level intent compared to moderate to high level of intent among attempters Moderate to High Low Intent t p Intent Depression 76.25 (18.28) 61.50 (12.36) 1.85 04 94 Hopelessness 5.50 (1.95) 2.63 (2.90) 1.18 12 78 Perceived burdensomeness 2.81 (1.88) 2.53 (1.11) 365 36 18 Thwarted belongingness 3.28 (1.45) 3.15 (1.48) 272 39 15 51 d Table Multiple Regression Analysis Predicting Suicidal Behaviors Predictors Social Support Family Conflict Coping Competence Perceived Burdensomeness Thwarted Belongingness Depression Hopelessness B -.02 25 01 30 03 06 -.01 Suicidal Behaviors SE B 02 11 02 33 23 02 08 Note R2= 31 52 β -.14 21 07 12 01 32 -.01 t -1.51 2.56 76 1.04 18 2.71 -.15 p 058 007 215 14 45 004 439 Table Logistic Regression Analyses Predicting Suicide Attempts Variable Depression Hopelessness Perceived Burdensomeness Thwarted Belongingness Attempt B 80 54 57 06 SE 87 63 79 70 OR 2.23 1.72 1.77 1.06 53 Wald 86 73 51 006 p 30 92 46 98 Table Logistic Regression Analyses Predicting Level of Intent Among Those with Previous Suicide Attempts Variable Depression Hopelessness Perceived Burdensomeness Thwarted Belongingness Intent B 58 1.96 69 84 SE 2.25 1.54 1.78 1.62 OR 1.75 7.07 1.99 2.31 54 Wald 061 1.62 151 269 p 25 04 22 38 Figure Interaction between Perceived Burdensomeness and Depression in Suicidal Behaviors 55 Figure Interaction between Thwarted Belongingness and Depression in Suicidal Behaviors 56 Appendix A Demographics Form Age: Day of birth: _ Grade: _ Gender:  Female  Male Ethnicity:  Caucasian / White  Hispanic / Latino If yes, please specify:  Mexican  Puerto Rican  Cuban  Central American  South American  Other:  African American / Black  Asian  American Indian  Pacific Islander  Biracial/Multiracial  Other: Religion:      Christian Catholic Jewish Muslim Other: Country of birth: _ Parents’ country of birth: Mother: Father: _ If not from the U.S, please specify: Years residing in the U.S How often you visit your country of origin? 55 Mother’s level of education: _ Father’s level of education: Family income (within the last year):         $0 to $4,999 $5,000 to $14,999 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $44,999 $45,000 to $60,000 $60,000 to $80,000 $80,000 or more Number of people living at home (within the past year): Mother’s type of work: _ Father’s type of work: _ 56 Appendix B SAFE Below are a number of statements that might be seen as stressful For each statement that you have experienced, circle only one of the following numbers (1, 2, 3, 4, or 5), according to how stressful you find the situation If the statement does not apply to you, circle number 0: Have Not Experienced = HAVE NOT EXPERIENCED = NOT AT ALL STRESSFUL = SOMEWHAT STRESSFUL = MODERATELY STRESSFUL = VERY STRESSFUL = EXTREMELY STRESSFUL 10 11 12 13 14 15 16 17 18 19 20 21 I feel uncomfortable when others make jokes about or put down people of my ethnic background I have more barriers to overcome than most people It bothers me that family members I am close to not understand my new values Close family members have different expectations about my future than I It is hard to express to my friends how I really feel My family does not want me to move away but I would like to It bothers me to think that so many people use drugs It bothers me that I cannot be with my family In looking for a good job, I sometimes feel that my ethnicity is a limitation I don't have any close friends Many people have stereotypes about my culture or ethnic group and treat me as if they are true I don't feel at home People think I am unsociable when in fact I have trouble communicating in English I often feel that people actively try to stop me from advancing It bothers me when people pressure me to become part of the main culture I often feel ignored by people who are supposed to assist me Because I am different I not get the credit for the work I I bothers me that I have an accent Loosening the ties with my country is difficult I often think about my cultural background Because of my ethnic background, I feel that others often 57 5 5 0 0 1 1 2 2 3 3 4 4 5 5 5 5 5 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 22 23 24 25 26 27 28 29 30 31 32 33 exclude me from participating in their activities It is difficult for me to "show off" my family People look down upon me if I practice customs of my culture I have trouble understanding others when they speak I feel guilty because I have left family or friends in my home country I feel that I will never gain the respect that I had in my home country People treat me unfairly because of my ethnicity My family and friends are treated unfairly because of their ethnicity I get upset because my parents not know American ways My family dislikes that I prefer American customs If I had a choice, I would rather be more American I feel uncomfortable when I have to choose between non-Latin and Latin ways of doing things I believe I have the same chance of doing well in life as everyone else 58 0 0 1 1 2 2 3 3 4 4 5 5 5 0 0 1 1 2 2 3 3 4 4 5 5 Appendix C SBQ-R Instructions: Please circle the number beside the statement or phrase that best applies to you Circle the statement that best describes how you have been feeling for the past week, including today: I have a moderate to strong wish to live I have a weak wish to live I have no wish to live I have no wish to die I have a weak wish to die I have a moderate to strong wish to die My reasons for living outweigh my reasons for dying My reasons for living or dying are about equal My reasons for dying outweigh my reasons for living Have you thought about or attempted to kill yourself? (Circle only one): Never It was just a brief passing thought 3a I have had a plan at least once to kill myself but did not try to it 3b I have had a plan at least once to kill myself and really wanted to die 4a I have attempted to kill myself, but did not want to die 4b I have attempted to kill myself, and really hoped to die How often have you thought about killing yourself in the past year? (Circle only one): Never Rarely (1 time) Sometimes (2 times) Often (3-4 times) Very Often (5 or more times) Have you ever told someone that you were going to commit suicide, or that you might it? (Circle only one): No 2a Yes, at one time, but did not really want to die 2b Yes, at one time, and really wanted to it 3a Yes, more than once, but did not want to it 3b Yes, more than once, and really wanted to it 59 3 How likely is it that you will attempt suicide someday? (Circle only one): Never Likely No chance at all Rather Likely Rather Unlikely Very Likely Unlikely How many times have you ever attempted to kill yourself? Never Once Twice Three or more times 60 Appendix D Suicide and Depression in Latino Adolescents    In 2009, suicide was the third cause of death among Latino adolescents (15 to 24 years of age) In the same year, 31.6% of all Latino high school students reported having feelings of sadness or hopelessness within the last year This percentage was higher among Latina adolescents (39.7%) In addition, 15.4% of Latino youth reported that they have seriously considered attempting suicide within the last year These numbers are higher than those reported by Non-Latino adolescents The following information was obtained through the American Association of Suicidology (2009) at http://www.suicidology.org/c/document_library/get_file?folderId=262&name=DLFE-529.pdf For more information you can visit www.suicidology.org The good news is that suicide can be prevented Most suicidal people desperately want to live; they are just unable to see alternatives to their problems Most suicidal people give definite warning signals of their suicidal intentions, but other are often unaware of the significance of these warning or unsure what to about them                Common symptoms of depression, reoccurring almost every day: Depressed mood (e.g feeling sad or empty) Lack of interest in previously enjoyable activities Significant weight loss or gain, or decrease or increase in appetite Insomnia or hypersomnia Agitation, restlessness, irritability Fatigue or loss of energy Feelings of worthlessness, hopelessness, guilt Inability to think or concentrate, or indecisiveness Recurrent thoughts of death, recurrent suicidal ideation, suicide attempt or plan for completing suicide Individuals who are depressed and exhibit the following symptoms are at particular risk for suicide: Extreme hopelessness A lack of interest in activities that were previously pleasurable Heightened Anxiety and/or panic attacks Insomnia Talk about suicide or have a prior history of attempts Irritability and agitation 61                 Be Aware of the Warning Signs A suicidal person may: Talk about suicide, death and/or no reason to live Be preoccupied with death and dying Withdraw from friends and/or social activities Have a recent sever loss (esp relationship) or threat of a significant loss Experience drastic changes in behavior Lose interest in hobbies, work, school, etc Prepare for death by making out a will (unexpectedly) and final arrangements Give away prized possessions Have attempted suicide before Take unnecessary risks; be reckless, and/or impulsive Lose interest in their personal appearance Increase their use of alcohol or drugs Express a sense of hopelessness Be faced with a situation of humiliation or failure Have a history of violence or hostility Have been unwilling to “connect” with potential helpers Be Aware of Feelings, Thoughts, and Behaviors            People in the midst of a crisis often perceive their dilemma as inescapable and feel an utter loss of control Frequently, they: Can’t stop the pain Can’t think clearly Can’t make decisions Can’t see any way out Can’t sleep, eat, or work Can’t get out of the depression Can’t make the sadness go away Can’t see the possibility of change Can’t see themselves as worthwhile Can’t get someone’s attention Can’t seem to get control If you experience any of these feelings, get help! If you know someone who exhibits these feelings, offer help!    Talk to Someone – You are not Alone Contact: A community mental health agency A school counselor or psychologist A suicide prevention/crisis intervention center 62    A private therapist A family physician A religious/spiritual leader If you or someone that you know is suicidal, please call a mental health professional or the National Suicide Prevention Lifeline (24/7) 1-800-273-TALK(8255) In an emergency case, please call 911 To obtain psychological services you can call the University of Toledo Psychology Clinic at (419) 530-2721 63