USCRI Urges Continued Commitment to...
On September 30, President Biden set the refugee admissions ceiling at 125,000 for the coming fiscal year. The Fiscal Year...
READ FULL STORYby: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert
September is National Suicide Prevention Month and we, at USCRI, recognize suicide as a global and complex public health problem that touches the lives of millions of people across every community. We hope to raise awareness of this urgently important crisis, spread hope to those who need it, and focus on strategies that save lives by preventing suicide.
Approximately 800,000 people commit suicide every year, making it one of the leading causes of death worldwide (Haase et al., 2022). Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die. Suicidal ideation, often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death that may vary in intensity and duration from passive and fleeting to a complete preoccupation with wanting to die. Whether planned over a period of time or impulsively in a moment of crisis, it is important to understand that suicidal behavior is often an attempt to end overwhelming pain or distress and usually occurs when a person feels helpless and hopeless and cannot see any other way to stop their suffering.
Suicide and suicidal behavior are influenced by negative conditions in which people live, work, play, and learn. People who live in war zones, experience armed conflicts, displacement, persecution, traumatization, social isolation, and somatic and mental illnesses are particularly at risk (Hasse et al., 2022). Refugees and other forcibly displaced populations face a multitude of losses before, during, and after fleeing their homelands, including family and friends, status, homeland, language and culture, community, income, and financial assets and security (Cogo et al., 2022). In addition, refugees and other forcibly displaced populations face post-migration stressors after they have arrived in secure host countries, such as perceived discrimination, poor social and living conditions, language barriers, separation from and worry about family back home, employment and educational challenges, acculturative stress, lack of access to community resources and health care, social exclusion and isolation, and visa insecurity. For example, research has shown that refugees living on temporary visas experience higher levels depression, posttraumatic stress disorder (PTSD), and suicidality than those on permanent or secure visas (Ingram et al., 2022). Therefore, these factors that are specific to forcibly displaced populations place them at a high risk for any kind of suicidal ideation and attempts, before, during, and/or after flight (Cogo et al., 2022; Haase et al., 2022; Ingram et al., 2022).
In addition to factors related to forced displacement and resettlement, it is important to consider and incorporate culturally relevant contributors to suicide risk for refugees and other forcibly displaced populations. Factors that may protect or predispose individuals to suicidality differ between country of origin and ethnic and cultural groups (Forte et al., 2018). Cultural sanctions may dictate the acceptability or unacceptability of suicide as a viable solution to one’s problems (Chu et al., 2010). For example, a vast majority of the research literature suggests that religiosity is a protective factor against suicide (Poorolajal et al., 2022) and that appraisal of suicide as unacceptable or amoral predicts lower risk for suicidal behavior (Chu et al., 2010). Cultural sanctions may also shape which life events or experiences are considered shameful and therefore may trigger suicidal ideation or behaviors, particularly among cultural groups high in interdependence or collectivism (Chu et al., 2010). For example, in some cultures, suicide may be viewed as an acceptable solution to alleviate the burden of shame, sin, or loss of face incurred on one’s family or community.
Cultural idioms of distress – cultural variations in the manifestations or expression of psychological symptoms – are also important to consider for refugees and other forcibly displaced populations. Cultural idioms of distress include the likelihood of expressing suicidality, the way symptoms of suicide are expressed, and the chosen methods or means of attempting suicide (Chu et al., 2010). Because suicidal ideation and behaviors are highly stigmatized among certain cultural groups, migrants and refugees belonging to these cultures are less likely to report suicidal ideation, a concept referred to as “hidden ideation,” or more likely to express symptoms somatically (Meyerhoff & Rohan, 2020). For example, in a study that examined psychological autopsies of resettled Bhutanese refugees who died by suicide in the U.S., 46% of friends and family of the deceased were unable to recall any warning signs of suicide (as cited in Meyerhoff & Rohan, 2020). It was also found that among Bhutanese refugees in the U.S., the desire to be dead was an idiom of distress that was more readily endorsed than suicidal ideation (as cited in Meyerhoff & Rohan, 2020).
Two additional idioms of distress associated with suicidality among refugee populations include thwarted belongingness and perceived burdensomeness. Thwarted belongingness refers to the sense of alienation from family, friends, and/or important social groups and perceived burdensomeness is the feeling that one’s life is a burden to those around them (Brown et al., 2019). Research has found that Bhutanese refugees who reported suicidal ideation had 2.7 times greater likelihood of perceiving themselves as a burden and 2 times greater likelihood of reporting thwarted belongingness than those who did not express suicidal ideation (Ellis et al., 2015). Acculturative and post-resettlement stressors found to contribute to thwarted belongingness and perceived burdensomeness among refugees include, family separation, loss of status, changes in culturally accepted familial roles, cultural loss, poor physical and mental health, language barriers, financial strain, family conflict, and lack of access to health services (Brown et al., 2019; Chu et al., 2010; Meyerhoff & Rohan, 2020).
Suicide assessment, treatment, and prevention programs for refugees and other forcibly displaced populations should take into consideration a combination of pre- and post-migration experiences and challenges, in addition to culturally relevant risk factors and warning signs. A range of multi-tiered programs and services that promote mental health and prevent suicide will likely be the most effective. These programs must incorporate culturally relevant training for service providers and community gatekeepers, strategies that promote access to physical and mental health care, family-focused and school-based interventions, practical support throughout the resettlement process, and community outreach to increase awareness, community cohesion, and social support.
If you or someone you know is thinking about suicide or would like emotional support, call or text 988, the Suicide and Crisis Lifeline that is available 24/7. If you or someone you know is having a life-threatening emergency, please call 911 or go to your nearest hospital emergency room.
For resources or more information about USCRI’s Refugee Health Services program for resettled Afghans, please visit: Refugees.org/the-behavioral-health-support-program-for-afghans
References
Brown, F. L., Mishra, T., Frounfelker, R. L., Bhargava, E., Gautam, B., Prasai, A., & Betancourt, T. S. (2019). ‘Hiding their troubles’: a qualitative exploration of suicide in Bhutanese refugees in the USA. Global Mental Health, 6. https://doi.org/10.1017/gmh.2018.34
Chu, J. P., Goldblum, P., Floyd, R., & Bongar, B. (2010). The cultural theory and model of suicide. Applied and Preventive Psychology, 14(1-4), 25-40. https://doi.org/10.1016/j.appsy.2011.11.001
Cogo, E., Murray, M., Villanueva, G., Hamel, C., Garner, P., Senior, S. L., & Henschke, N. (2022). Suicide rates and suicidal behaviour in displaced people: A systematic review. PloS One, 17(3), e0263797. https://doi.org/10.1371/journal.pone.0263797
Ellis, B. H., Lankau, E. W., Ao, T., Benson, M. A., Miller, A. B., Shetty, S., Lopes Cardozo, B., Geltman, P. L., & Cochran, J. (2015). Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. The American Journal of Orthopsychiatry, 85(1), 43–55. https://doi.org/10.1037/ort0000028
Forte, A., Trobia, F., Gualtieri, F., Lamis, D. A., Cardamone, G., Giallonardo, V., Fiorillo, A., Girardi, P., & Pompili, M. (2018). Suicide risk among immigrants and ethnic minorities: a literature overview. International Journal of Environmental Research and Public Health, 15(7), 1438. https://doi.org/10.3390/ijerph15071438
Haase, E., Schönfelder, A., Nesterko, Y., & Glaesmer, H. (2022). Prevalence of suicidal ideation and suicide attempts among refugees: a meta-analysis. BMC Public Health 22, 635. https://doi.org/10.1186/s12889-022-13029-8
Ingram, J., Lyford, B., McAtamney, A., & Fitzpatrick, S. (2022). Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff. International Journal of Mental Health Systems, 16, 24. https://doi.org/10.1186/s13033-022-00534-x
Meyerhoff, J., & Rohan, K. J. (2020). The desire to be dead among Bhutanese refugees resettled in the United States: Assessing risk. American Journal of Orthopsychiatry, 90(2), 236. https://doi.org/10.1037/ort0000429
Poorolajal, J., Goudarzi, M., Gohari-Ensaf, F., & Darvishi, N. (2022). Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: a meta-analysis. Journal of Research in Health Sciences, 22(1), e00537. https://doi.org/10.34172/jrhs.2022.72
On September 30, President Biden set the refugee admissions ceiling at 125,000 for the coming fiscal year. The Fiscal Year...
READ FULL STORYOn September 30, President Biden issued an Amended Proclamation to the June Presidential Proclamation that temporarily suspended and limited the...
READ FULL STORYThe U.S. Committee for Refugees and Immigrants (USCRI) is alarmed by the recent escalation in xenophobic and racist narratives about...
READ FULL STORY