Thread by @drlouisehansen

The Nature of Aboriginal Suicide:

“It is widely accepted that the causal pathways to Indigenous and non-Indigenous suicide differ, although the precise nature of the differences is so far unclear (see, for example, Ridani et al., 2015).” 1/30 #UluruStatement #AusUPR20 #Auspol

“Westerman (2003) in her Doctor of Philosophy (PhD) research explored this issue via the development of a unique screening tool, the Westerman Aboriginal Symptom Checklist (WASC-Y: Westerman, 2003, Westerman, 2007, in preparation),” 2/30

“to identify Aboriginal youth at risk of suicide, depression, alcohol, and drug use, impulsivity, and anxiety. This enabled the exploration of whether there were factors unique to Aboriginal youth (aged 13–17) that could account for suicide risk.” 3/30

“The WASC-Y also importantly includes a subscale that determines cultural resilience, an important focus in this field given that prevention often requires the ability to not only target known risk factors for suicidal behaviours” 4/30

“but to also develop protective factors within individuals as a more effective long-term strategy of managing risk. Cultural resilience encompasses the holding of common beliefs and values, with core elements including” 5/30

“‘language, conventions, socialization, social institutions, enhancing survival, comfort, and psychological needs for meaning and significance.’ (Spence, Wells, Graham, & George, 2016, p. 300).” 6/30

“Cultural resilience is generally regarded as being associated with positive social and psychological outcomes. In addition, Westerman (2012, in preparation) finalised the Westerman Aboriginal Symptom Checklist—Adults,” 7/30

“further contributing to understanding the specific nature of Aboriginal suicide. The exploration of a different aetiology for Indigenous suicide and a unique set of protective factors (as cultural resilience) has failed to occur at a population level” 8/30

“based upon unique, culturally validated psychometric tests. WASC-A and WASC-Y provide this opportunity. They also provide significant opportunity to inform the focus (content) of Indigenous-specific intervention programmes and importantly,” 9/30

“provide a unique opportunity to measure programme and clinical impacts of treatment....Findings indicated that 42% of youth (N = 323) acknowledged frequent thoughts of suicide, with 23% of the overall sample considered to be at clear risk for suicide.” 10/30

“Of these, approximately 20% had made a previous attempt on their life. In addition, while depression was linked w/ ideation, impulsivity provided the strongest relationship with suicide risk w/ a correlation of 0.8 as opposed to only 0.2 between depression & suicide risk.” 11/30

“In the adult sample, there was a similarly strong correlation (0.63) between impulsivity and suicide risk. This relationship increased for participants from increasingly urbanised environments.” 12/30

“Impulsivity was also associated w/ a lack of appropriate coping mechanisms, & this was quite specific to a proximal trigger (predominantly relationship breakdowns), the absence of effective coping skills & the use of alcohol & drugs as an enabler to suicidal behaviours.” 13/30

“This is important that in non-Aboriginal populations, suicide risk is best explained by the presence of depression. As w/ youth sample, while depression was an important contributing factor, the relationship between suicide risk & impulsivity was significantly stronger.” 14/30

“Other key risk indicators included the impact of contagion, which has already been determined as a high-risk event by other research (e.g., Hanssens, 2016; Hillman, Silburn, Zubrick, & Nguyen, 2000).” 15/30

“A high percentage of the sample that was considered at risk for suicidal behaviours had knowledge of someone who had died by suicide (29.3% of the youth sample and 48.1% of the adult sample).” 16/30

“There was a moderate correlation (.45) between those individuals who had previously attempted suicide and knowledge of someone who died by suicide.” 17/30

“In addition, those who reported knowing someone who had ended their lives had higher mean scores on the suicide subscale than those who did not.” 18/30

“This relationship was further explored via the adult scale.... there needed to be established impairment as a result of knowing someone who ended their lives which meant that there was a direct relationship between the exposure and the person's own suicide risk.” 19/30

“Exposure alone was not enough to increase suicide risk. This is an important distinction to make, given the high percentage of adults and youth who knew someone who ended their lives.” 20/30

“The most relevant correlation (0.78) related to ‘knowing someone who ended their life and made me think about suicide’ (impairment).” 21/30

“It is important to note that the virtual absence of intervention to those exposed to suicide risk is a strong contributor to overall ‘clusters’ of suicide risk.” 22/30

“The need for practitioners to be able to assess the impact of suicide exposure and respond accordingly is possible using WASC-Y and WASC-A.” 23/30

“Just as trauma frequently becomes a central organising principle in the psychological structure of the individual, trauma has become a central organising principle in the psychological structure of whole communities.” 24/30

“This is known as ‘repetition compulsion’, that those individuals who have had a previous traumatic event are at increased risk for future trauma experiences. Suicide ‘clusters’ are an obvious and common consequence of trauma repetition compulsion.” 25/30

“Both studies also demonstrated that the cultural resilience subscale had a negative relationship with risk thus demonstrating a link between cultural resilience as a moderator of suicide risk for the first time.” 26/30

“While, unfortunately, levels of cultural resilience, or protective factors, were characteristically low with only 16.9% of the youth sample having high to very high levels, this provides a crucial opportunity for suicide prevention.” 27/30

“Consistent with this, the adult data showed that high levels of cultural resilience were reported in only 16.7% of the sample. However, a sole focus on risk factors alone offers limited opportunity for prevention.” 28/30

“The WASC-Y and WASC-A in operationalising cultural resilience as protective of suicide risk enable treatment to be focused upon those factors that ultimately provide a better opportunity for the prevention of Indigenous suicides.” 29/30

Source: Westerman T, Sheridan L. Whole of community suicide prevention forums for Aboriginal Australians. Aust Psychol. 2020;55:363–374. doi.org/10.1111/ ap.12470 @TracyWesterman
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