A study led by Joan M. Cook, Ph.D., a geriatric psychologist at the Department of Veterans Affairs (VA) Medical Center in Philadelphia and the University of Pennsylvania, found that African Americans with strong religious and social ties were the least likely to have suicidal thoughts.
"The good news is that there are protective factors in the community, and we can work to facilitate and maintain the strengths that are already there," said Cook.
She said the findings may be helpful to providers of geriatric mental-health and social services both in and outside the African American community, as they look to design interventions to prevent suicide.
Older Americans are particularly at risk for suicide, although the rates among African Americans—especially women—are remarkably lower. In 1998, white men age 65 or older died by suicide at a rate of 33.1 per 100,000, compared to a rate of 11.7 for black men in the same age group. The rate for older white women was 4.85. So few black women died by suicide—fewer than 20 in 1998—that a reliable rate cannot be figured.
Cook's study was based on interviews with 835 public-housing residents in Baltimore during the early 1990s, part of a larger study funded by the National Institute of Mental Health. Participants were asked questions focusing on suicide—such as whether they had ever thought life was not worth living, or whether they had considered taking their own life—along with a battery of questions on mental and physical health, social support, alcohol use, life satisfaction, and religion. They were also tested for cognitive function.
Of those interviewed, about 3 percent reported thoughts of suicide, either passive or active. While factors such as depression, anxiety and lack of life satisfaction showed a relation to suicidal thinking, the key areas that emerged as "protective" were respondents' religious and social support. Social support was defined as getting help with daily tasks if they needed it, or having a friend they could confide in and depend on.
"We found that 90 percent [of the participants] reported they obtained a great deal of support and comfort from their religion, and that this support from religion and friends was related to overall lower mental health problems—including thoughts of suicide," said Cook.
She added that the study focuses attention on a group—older African Americans—that is often overlooked by researchers, and whose needs and strengths may be misunderstood.
Cook noted that 60 percent of those interviewed were living at or below the poverty line. In past research on older African Americans, Cook and her colleagues found, curiously, that objective hardships such as poverty and social inequality had little if any impact on participants' subjective satisfaction with their own lives.
The researchers believe that in these seniors, being disadvantaged over a lifetime may lead to increased adaptation and resourcefulness. These factors may play a positive role in mental health as they age.
"Support from religion and relationships may be one way of adapting to lifelong hardships," said Cook.
Co-authors on the study were Jane I. Pearson, Ph.D., of the National Institute of Mental Health; Richard Thompson, Ph.D., of VA and the University of Pennsylvania; and Betty Smith Black, Ph.D., and Peter V. Rabins, M.D., of The Johns Hopkins University.
Drs. Cook and Thompson conduct research through the Mental Illness Research, Education and Clinical Center (MIRECC) at the Philadelphia VA Medical Center. The program aims to improve care, health outcomes and quality of life for veterans with mental illness.
Judi Cheary
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Journal
American Journal of Geriatric Psychiatry