Do neoliberal values provide a fertile soil for suicidal ideation?

BACKGROUND: Values associated with neoliberal ideologies are blamed for damaging the social fabric. They may also have deleterious effects on suicidal ideation. OBJECTIVE: We investigated whether neoliberal values were associated with the risk for suicidal ideation through a set of mediating factors (suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability). METHODS: A total of 508 (249 female) adults from the U.S. responded to a self-administered questionnaire that contained measures of suicidal ideation, neoliberal values, suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability. We tested a path model that linked neoliberal values to suicidal ideation through multiple mediators. We tested total versus partial mediation models. RESULTS: We found empirical evidence for a full mediation of the association of neoliberal values with perceived stress. Neoliberal values were associated with suicide stigma; suicide stigma was associated with negative attitudes towards help-seeking, which, in turn, were associated with high levels of perceived stress. The association of neoliberal values with suicide acceptability was partially mediated. Perceived stress was positively associated with suicide risk directly and indirectly through suicide acceptability. CONCLUSION: Our findings suggest that values related to neoliberal ideologies prepare a context that fosters the risk for suicide. For a contextualized understanding of suicidal behavior, more research is needed that explores the role of social, cultural, political, and economic ideologies in the suicidal process.

Are Nonfatal Suicide Attempts Instrumental in Achieving Personal and Interpersonal Goals?

This study focused on the well-being of the survivors of suicide attempts and the well-being of their interpersonal relationships after the attempt. The data came from a sample of 392 college students from 10 Muslim majority countries who reported having attempted suicide in the last 4 years. Suicide was conceptualized as a goal-directed behavior embedded in a sociocultural context and motivated by personal or interpersonal goals. We tested a process that linked culturally shaped self-construal to the postsuicidal personal and interpersonal well-being. We posited that this process would operate through the attitudes towards suicide, motives for suicide, the strength of the intention to die. Our model indicated that the acceptability of suicide was positively associated with escape motives, and this association was even stronger for the individuals with interdependent self-construals. Escape motives were negatively associated with postsuicidal personal and interpersonal well-being, but communication motives were not associated with these outcomes. We also found evidence that having an interdependent self-construal might be beneficial for postsuicidal personal and interpersonal well-being. Our results further suggested that the postsuicidal personal and interpersonal well-being of highly interdependent individuals may depend on the interpretation of their act of suicide by their close others.

Cultural and interpersonal risk factors for suicide ideation and suicide attempts among Muslim college students from 11 nations.

BACKGROUND: Research on suicidality in low to middle-income countries is scarce. We addressed this issue by investigating suicidality in a cross-national college student samples from 11 predominantly low to middle-income majority Muslim countries. METHODS: The sample consisted of 7427 college students (56% female) who reported to be affiliated with Islam. Data on self-construal, social support, negative life-events, acceptability of suicide, suicidal ideation, and suicide attempts were collected with self-administered questionnaires. RESULTS: Acceptability of suicide and the experience of negative life-events were positively, and perceived social support was negatively associated with suicidal ideation. Interdependent self-construal was negatively related to the acceptability of suicide and positively associated with perceived social support, implying a negative indirect effect on suicidal ideation although its direct effect was positive. The number of negative life-events was the strongest positive predictor of ever attempting suicide. The interdependent self-construal moderated the association of negative life-events with suicide attempts. LIMITATIONS: Cross-sectional and self-report nature of the study were its major limitations. Participants may have suppressed their responses about suicide because of religious and legal reasons. CONCLUSION: Remarkable similarities across 11 country samples emerged in the linkages between cultural and interpersonal factors with suicidality. Our findings highlight the value of a nuanced approach to suicidality, that can recognize the differences in the processes associated with suicidal ideation and suicide attempts, as well as the need to consider the interplay of a broad range of personal, interpersonal, and cultural influences.

Associations of religiosity, attitudes towards suicide and religious coping with suicidal ideation and suicide attempts in 11 muslim countries.

OBJECTIVE: The study investigated the associations of religiosity, religious coping and suicide acceptance to suicide ideation and attempts in 7427 young adults affiliating with Islam from 11 Muslim countries. METHOD: A self-administered questionnaire was used to collect the data. We used F and χ2 tests and correlation analyses to report descriptive statistics. Multi-group path models with (i) a zero-inflated Poisson distribution and, (ii) a Binomial distribution were used to model the number of occurrences of suicidal ideation, and occurrence of a suicide attempt, respectively. RESULTS: Religiosity was negatively associated with acceptability of suicide, but it was positively related to punishment after death across the 11 countries. Religiosity was negatively associated with ever experiencing suicidal ideation, both directly and indirectly through its association with attitudes towards suicide, especially the belief in acceptability of suicide. Neither positive nor negative religious coping were related to suicidal ideation. However, religiosity was negatively related to suicide attempts among those who experienced suicidal ideation at least once. This association was mediated through the belief in acceptability of suicide and religious coping. Negative religious coping was positively associated with suicide attempts probably because it weakened the protective effects of religiosity. CONCLUSIONS: Findings from this study suggest that the effects of religiosity in the suicidal process operate through attitudes towards suicide. We therefore conclude that clinical assessment as well as research in suicidology may benefit from paying due attention to attitudes towards suicide.

Transactional associations of maternal depressive symptoms with child externalizing behaviors are small after age 3.

A large and growing body of research suggests that maternal depressive symptoms and child externalizing behaviors are strongly associated. Theoretical arguments supported by these findings led to the question of whether maternal depressive symptoms are transactionally associated with child externalizing behaviors. Using 5-year nationally representative longitudinal data from Turkey (N = 1,052), we estimated a transactional bivariate autoregressive latent trajectory model addressing this question. This model disaggregated the association of the two processes into two components: (a) the association of the interindividual differences in the trajectories; and (b) the intradyad association of the changes in maternal depressive symptoms with the changes in child externalizing behaviors. Although maternal depressive symptoms were robustly associated with child externalizing behaviors at age 3, the transactional associations of the two processes were small prior to age 5 and absent at ages 5 to 7. Furthermore, maternal harsh parenting did not have a mediating role in the limited transactional association of maternal depressive symptoms with child externalizing behaviors.

Reciprocal Relations between the Trajectories of Mothers' Harsh Discipline, Responsiveness and Aggression in Early Childhood.

Theoretical advances in the study of the development of aggressive behaviors indicate that parenting behaviors and child aggression mutually influence one another. This study contributes to the body of empirical research in this area by examining the development of child aggression, maternal responsiveness, and maternal harsh discipline, using 5-year longitudinal data from a nationally representative sample of Turkish children (n = 1009; 469 girls and 582 boys). Results indicated that: (i) maternal responsiveness and harsh discipline at age 3 were associated with the subsequent linear trajectory of aggression; (ii) reciprocally, aggressive behaviors at age 3 were associated with the subsequent linear trajectories of these two types of parenting behaviors; (iii) deviations from the linear trajectories of the child and mother behaviors tended to be short lived; and, (iv) the deviations of child behaviors from the linear trajectories were associated with the subsequent changes in mother behaviors after age 5. These findings are discussed in the cultural context of this study.

"It takes a village" to support the vocabulary development of children with multiple risk factors.

Data from a nationally representative sample from Turkey (N = 1,017) were used to investigate the environmental factors that support the receptive vocabulary of 3-year-old children who differ in their developmental risk due to family low economic status and elevated maternal depressive symptoms. Children's vocabulary knowledge was strongly associated with language stimulation and learning materials in all families regardless of risk status. Maternal warmth and responsiveness supported vocabulary competence in families of low economic status only when maternal depressive symptoms were low. In families with the highest levels of risk, that is, with depression and economic distress jointly present, support by the extended family and neighbors for caring for the child protected children's vocabulary development against these adverse conditions. The empirical evidence on the positive contribution of extrafamilial support to young children's receptive vocabulary under adverse conditions allows an expansion of our current theorizing about influences on language development.

Changes in the health burden of a national sample of children with asthma.

This paper focused on the extent to which factors that are modifiable by health policies or provider recommendations influenced the level and changes in the burden of childhood asthma. Demographic factors, access to health care services, and asthma control activities were posited to potentially influence the level and changes in health burden of children with asthma. The Medical Expenditure Panel Survey data from 1996-1999 on 3-11 year old U.S. children with asthma (N=784) were used. The findings of multilevel models of perceived burden indicated unfavorable trajectories among those families who had public health insurance. Asthma control activities were associated with favorable trajectories of both perceived and objectively measured burden. These findings emphasized the significance of asthma control and access to high quality and stable health care services as health policy targets.

Health care utilization by children with asthma.

INTRODUCTION: We examined how differences in health service utilization among children with asthma are associated with race/ethnicity, socioeconomic status (family income, mother's education), and health insurance coverage. METHODS: We analyzed Medical Expenditure Panel Survey data from 1996 through 2000 (982 children younger than 18 years with asthma). We calculated percentages and mean distributions, odds ratios, and incidence rate ratios. RESULTS: Non-Hispanic black children used more urgent care services and fewer preventive health services. Children in low-income families (125%-199% of the poverty line) had the lowest levels of prescription fills and general checkups. Children whose mothers had more education had more checkups and fewer emergency department visits. Children who were insured during the 2-year study period used more health services for asthma, not including emergency department visits. CONCLUSION: Minority children and children of socioeconomically disadvantaged families use more urgent care and less preventive care for asthma. Children without health insurance use fewer health services overall. Future research should address how related factors might explain health services utilization in effectively managing asthma in children.

Breastfeeding attitudes and reported problems in a national sample of WIC participants.

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed.

Does your child have asthma? Filled prescriptions and household report of child asthma.

INTRODUCTION: Surveys are central for information on asthma prevalence. Recently, the validity of parental reports of pediatric asthma has been questioned. Confidence is examined in the report of asthma for children, obtained in a survey from the adult household member most knowledgeable about household health care (MKA). METHOD: MKA reports of asthma are compared with pharmacy records of prescriptions beneficial in asthma treatment ("asthma medications") for children 0 to 17 years old in the 1996 Medical Expenditure Panel Survey. RESULTS: "Asthma medications" were filled for 6.5% of children, yet the MKA did not report asthma for 47.3% of them. However, for 61.2% of these children, the MKA reported plausible alternative medical conditions. For 9.0%, diagnosis information was missing. Among children with an "asthma medication," the MKA was less likely to report either asthma or a plausible alternative diagnosis for girls and for children 0 to 5 years of age. Reporting was not statistically different by child race/ethnicity, household income, education level, and MKA English language proficiency. DISCUSSION: Surveys do not overlook as many children with asthma as previously reported. Among children with "asthma medications," only sex and age appear to be different for children whose MKA reported either asthma or a plausible alternative diagnosis versus those whose MKA did not report either.

Family perceptions of the usual source of care among children with asthma by race/ethnicity, language, and family income.

A usual source of care (USC) can serve as the foundation for good primary health care and is critical for children living with a chronic health condition. This study applies national data to the following objectives: (1) describe family reports of the presence and characteristics of the USC for children with asthma; (2) examine evidence of systematic differences in the USC for these children with asthma by race/ethnicity, English language proficiency in Hispanic respondents, and family income; and (3) conduct multivariate analysis adjusting for possible confounding factors to examine independent effects of race/ethnicity, language, and income. Data from the 1996-2000 Medical Expenditure Panel Survey (MEPS) were analyzed. Overall, 95% of children with asthma had a USC, with Spanish-speaking Hispanics least likely to report a USC (89%). There were significant differences in USC attributes by race/ethnicity, language, and income, with the largest differences by type of provider and accessibility. Hispanics with poor English language proficiency had the greatest accessibility barriers.

Presence and characteristics of medical home and health services utilization among children with asthma.

INTRODUCTION: Having a medical home is advocated by the National Association of Pediatric Nurse Practitioners and others, yet there is limited research that documents desired health benefits. We examine the presence of medical home characteristics and describe relationships between medical home and health services utilization in a national sample that includes children with asthma. METHOD: Medical home is represented by: (a) the presence of a usual source of care (USC), (b) identification of a named person as USC, and (c) a 10-item index of other medical home characteristics. Health services utilization over a calendar year is measured by (a) emergency department visits for asthma, (b) wellness examination, and (c) rescue bronchodilator fill/refill. Analyses include chi-square and logistic regression. RESULTS: A USC was reported for 95% of participants. Children with a USC were more likely to have a wellness examination (odds ratio, 2.10; 95% confidence interval, 1.15-3.81). Overall, 51% reported the USC to be a facility versus a named person. Identifying a person as the USC was related to higher scores on the 10-item medical home index but not to other outcomes. DISCUSSION: Most parents were satisfied with the USC. Benefits of having a USC, but not necessarily a named person, appear in preventive actions.

Halting the development of conduct problems in head start children: the effects of parent training.

We examined parent and child moderators of outcome, program engagement effects, and predictors of engagement in the Incredible Years Parent Training Program. Head Start classrooms (N = 882 children) were randomly assigned to an intervention condition (that received the Incredible Years program) or to a control condition (that received usual Head Start services). Structural equation modeling (SEM) was used to model the effects of the training program on child outcomes. The analyses showed differential program effects depending on children's initial levels of conduct problems and mothers' initial levels of critical parenting. Children with high baseline levels of conduct problems and children of mothers with high initial levels of critical parenting benefited most from the program. Changes in children's conduct problems were also related to maternal engagement in the program and to intervention mothers' success at reducing their critical parenting.

The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers.

Head Start centers were randomly assigned to intervention (parent training) or control conditions, and the role of maternal mental health risk factors on participation in and benefit from parent training was examined. Parenting was measured by parent report and independent observation in 3 domains: harsh/negative, supportive/positive, inconsistent/ineffective parenting. Structural equation modeling showed that parent engagement training was associated with improved parenting in a dose-response fashion. Mothers with mental health risk factors (i.e., depression, anger, history of abuse as a child, and substance abuse) exhibited poorer parenting than mothers without these risk factors. However, mothers with risk factors were engaged in and benefited from the parenting training program at levels that were comparable to mothers without these risk factors.

Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed.