Nursing Critique Comparison of the Effect of Risk and Protective Factors on Suicide Attempts in a Group of Triethnic Adolescents Divided According to Race, Gender and Age.

This is an critique on a research paper about self-reported suicide attempts in a triethnic group of adolescents. 2 references are given.

The purpose of the following paper is to evaluate and critique a study performed on a group of students pertaining to adolescent suicide. This study attempts to examine the multiple factors affecting recent suicide attempts in adolescents from three different ethnic backgrounds. The resilience model is used to describe and analyze the relationships between these variables categorized according to sex, age and race. A group of 10,059 school children from the 7th, 9th, and 11th grade in Connecticut were surveyed in 1996 and data from the African-American, Hispanic Latino and American Caucasian respondents was analyzed using bi -- and multivariate methods. [Rew, et al., 2001] The study attempted to determine the degree to which each factor had affected the tendency to attempt suicide in this group of subjects. It was found that the tendency to attempt suicide was highest in Hispanic females and least in American Caucasian males. [Rew et al., 2001] The risk factors were identified as a history of previous suicide/attempt in family or friends, physical or sexual abuse and stress or depression while protective variables included social connectedness and spiritual support. [Rew et al., 2001] That significant relationships were found between many of these variables and attempted suicide indicates the validity of applying the resilience model to such behavior and the need for more detailed studies so as to format viable intervention techniques.

Introduction

Adolescent suicide is a major sociological dilemma and one that is growing with time. Past research shows that suicide is amongst the top three causes of death in 15- to 24-year-olds and that this trend is multiplying rapidly in the younger age group. [Rew et al., 2001] Females have been shown to be more prone to attempt suicide and some ethnic minority groups seem to be more affected than others. Not only is this behavior a source of grief to the loved ones but its increasing pattern have also made it an important social, and medical issue. Previous studies have shown that both external and internal factors have a significant effect on the statistics relating to suicide. Data has been collected to show that physical and sexual abuses have a significant relationship to an increase in suicide attempts.[Rew et al., 2001] Feelings of depression, hopelessness and inadequacy are also associated factors to adolescent suicide. It has been seen however that even if these factors are present suicide attempts can be avoided by the influence of social values, religious influences, and peer support or social activities.

This study is an attempt to use this previously gathered information and apply it to ethnic and gender differences. It compares the degree of influence exerted by these variables on adolescent behavior in terms of attempted suicide depending on race and sex. This not only gives insight into patterns in different strata of society but also lays the foundation for further study and perhaps formulation of mechanisms to intervene.

One of the frustrating issues about suicidal behavior is that it is largely preventable given timely intervention and adequate treatment. If the groups more likely to attempt suicide are identified then preventing suicide is made that much easier. It is especially important for medical personnel such as nurses to understand and be able to help apply the principles extracted from this study. These are the people likely to come in contact with adolescents who have been abused, or are under stress. To be able to pick up the signals, or clinical signs particular to adolescents vulnerable to thoughts of suicide and by keeping a high index of suspicion, nurses should be able to provide initial support or facilitate intervention by experts that can deal with this disturbing behavior, such as psychologists.

Purpose

This study was designed to determine the percentage of attempted suicides in adolescents divided according to ethnicity and gender, and to compare the differences in frequency amongst them. Also investigated is the influence of previously identified risk and protective factors on these attempts and to what extent each variable was significant in the different groups.

Problem Statement

This study is an attempt to describe the influence of stress, physical and sexual abuse and history of suicide attempts in family and friends plus protective factors such as religion and social connectedness on frequency of suicide attempts by adolescents from three different ethnic minorities by analyzing data collected from anonymous...

All social strata and backgrounds are effected but not equally implying that many environmental factors must be at the root of this menace. Various studies have been conducted to explore the issue of suicide especially in adolescents and teenagers. Correlated factors that affect this behavior have been studied and various risk factors identified. These include depression, stress, anxiety, and hopelessness. Past or ongoing physical and sexual abuse have been determined to be major factors in causing suicide attempts in all gender and ethnic groups.. [Rew et al., 2001]Other influences are drug and alcohol abuse, and accessibility of lethal weapons and chemicals.
Protective mechanisms such as social and family support, parental expectations, social activities, spiritual influences all counter the effects of the risk factors. It is the interaction of risk and protective factors that ultimately determines what action a child will take. The Youth Resilience Model is a concept which explains and clarifies the factors involved in making the child vulnerable to suicidal thoughts and where and what kind of intervention can be done to prevent these thoughts from being put into action.[. [Rew et al., 2001]

It has been found that young girls are more at risk to attempt suicide as compared to boys. In both groups the presence of sexual abuse was a frequent common factor.. [Rew et al., 2001]Though data is available for different races no actual comparison has been done on the variability produced due to ethnic background. Some data shows that suicide attempts are most common in Caucasian females as compared to least prevalent in Black males. This study however concludes that it is Hispanic girls that have the highest rate of attempted suicide while male Caucasians the lowest.. [Rew et al., 2001]

If culturally sensitive programs are to be designed, aimed at the ethnic groups more at risk, then suicide statistics will have to be studied in context of ethnicity as well. To prevent adolescent suicide, the target population for intervention methods needs to be identified. Awareness needs to be propagated throughout the professional sector, including teachers, nurses, and physicians that come into contact and have the requisite skills for handling at risk adolescents. Recognition of emotional and mental distress in such individuals and awareness and use of referral options to mental health services when suspected cases are encountered is a must.

Theoretical / Conceptual Framework

The analysis of the data collected from this study was based on the formula that attempted suicide amongst adolescents was a result of multiple factors. These included risk factors, protective mechanisms, and sociocultural contextual factors such family dynamics, background, race, other suicides etc.. [Rew et al., 2001]Combined this information formed the Resilience Model which helps identify what intervention can be done to prevent suicide and in which form it would be most beneficial.

Assumptions

The Cronbach's alpha was used as an index of reliability.. [Rew et al., 2001]Using this method it was assumed that certain items (questions) on the survey were actually a measure of a particular factor stated on the Resilience model. Data pertaining to variables affecting attempted suicide was extracted from a survey designed to identify general health needs, health risk behavior and protective mechanisms. Since the attempt was to isolate causes that encourage or prevent suicidal behavior through evaluating an individual's mental and emotional health status extracting information from a non-specific survey is not an unreliable method.

Limitations

The study was confined to adolescents from the Caucasian, Black American and Hispanic Latino backgrounds. These of course are the major ethnic groups in America though Asians are also not far behind. However subsets in these categories also need to be delineated as certain variables such as depression have been found to be more pronounced in Puerto Ricans as compared to Mexican or Cuban Americans. [Oquendo MA, 2001] Thus even the Hispanic Latino category is a generalization. The research was also limited in that it was in the form of a self reported survey obtained from just one area and though the aim was to target all strata of the population how well that was achieved by studying only public schools is yet to be decided. Also the reliability of such variables as stress, depression, family dynamics, and social activities was weak according to the scale indicators.

The source of information was general health status…