A Community-Engaged Approach to Understanding Suicide in a Small Rural County in Georgia: A Two-Phase Content Analysis of Individual and Focus Group Interviews.

Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development.

Understanding Past Experiences of Suicidal Ideation and Behavior in the Life Narratives of Transgender Older Adults.

Transgender people (collectively referred to here as trans) experience disproportionate rates of suicidal ideation and behavior (plans and attempts) attributed to complex constellations of structural and individual factors. Interpretive methods in suicide research elucidate and contextualize intricate patterns of risk factors and strategies for recovery. The life narratives of trans older adults offer unique insights into past suicidal behavior and recovery after distress has diminished and perspective has been gained. This study aimed to illuminate the lived experiences of suicidal ideation and behavior in the biographical interviews of 14 trans older adults as part of the project To Survive on This Shore (N=88). Data analysis was conducted using a two-phase narrative analysis. Trans older adults contextualized suicide attempts, plans, ideation, and recovery as navigating impossible to possible paths. Impossible paths were seen as hopelessness in their life direction, often after a significant loss. Possible paths were described as pathways to recovery from crises. Transitions from impossible to possible paths were narrated as a turning point or moment of strength combined with outreach to family, friends, or mental health professionals. Narrative approaches hold the potential to illuminate pathways to well-being among trans persons with lived experiences of suicidal ideation and behavior. For social work practitioners, therapeutic narrative work around past suicidal ideation and behavior with trans older adults holds promise for suicidal prevention by identifying important supportive resources and previously used coping skills in crises.

Implicit and Explicit Spirituality in the Lives of Transgender and Gender Expansive Older Adults.

Religion and spirituality for transgender and gender expansive people (whom we refer to collectively as trans) are complicated by mainstream religions' history of stigmatizing and marginalizing sexual and gender minorities. We conducted an interpretive content analysis of biographical interviews with 88 trans older adults from across the United States, applying six tenets of spiritual psychotherapy to their life narratives. Our findings suggest that some trans older adults' spirituality is experienced both implicitly and explicitly. Implicit spirituality reflects the ways in which meaning, purpose, and connection in one's life are nurtured with respect to one's gender identity. Explicit spirituality reflects the process of consciously renegotiating one's spiritual beliefs and religious practices to validate one's gender identity and place in society. This knowledge is potentially helpful for gerontological social workers who seek to nurture trans people's spirituality and well-being as they age.

Authenticated social capital: conceptualising power, resistance and well-being in the lives of transgender older adults.

Trans people experience social marginalisation, stigmatisation and violent oppression in US society and worldwide. Given the importance of social capital for wellbeing, this study sought to illuminate the ways in which trans people build social capital throughout their lives and to use this knowledge to promote new and helpful ways of thinking about social capital concerning the human life course in the 21st century. We conducted a secondary interpretive content analysis of 86 in-depth interviews with trans older adults generated as part of the arts project To Survive on This Shore. Trans older adults confront social marginalisation and stigmatisation by generating what we call authenticated social capital, a form of social capital built by re-negotiating social constraints and developing alternative social networks and supports that affirm identity and foster authenticity and wellbeing. These networks and supports are often embedded in social worlds created by trans people that facilitate gender affirmation and social activism through community organising. The concept of authenticated social capital integrates and expands upon paradigmatic understandings of social capital. In addition to enhancing theorising and interventions aimed at improving the lives of trans people, the approach may be well suited to conceptualising the life experiences and liberation of other oppressed groups.

The manifestation of multilevel stigma in the lived experiences of transgender and gender nonconforming older adults.

Transgender and gender nonconforming (TGNC) people experience disparities in mental health when compared with non-TGNC sexual minorities and the general population. One line of inquiry with respect to these disparities is the examination of stigma and its connection to emotional and psychological well-being. Recent conceptualizations of stigma draw attention to multiple levels-individual, interpersonal, and structural-that are thought to impact well-being for TGNC people. However, little is known about how multilevel stigma is experienced by TGNC older adults, who navigate stigmatizing environments over a lifetime and who may be especially vulnerable to its cumulative effects. We conducted an interpretive content analysis of biographical interviews with 88 TGNC adults aged 50 and older, from across the United States, obtained from the photography and interview project To Survive on This Shore. Our analyses suggest that TGNC older adults' mental health is indeed impacted by multiple levels of stigma. Individual level stigma is experienced as ongoing vigilance about aspects of oneself that break gender norms, often manifesting in internal conflicts. At the interpersonal level, TGNC older adults navigate unpredictable relationships marked by conflicting expressions of love, acceptance, strain, and exclusion. Structural stigma manifests in constraints brought about by transphobic policies and social norms but also sparks intentional action on the part of TGNC older adults to resist and change these social forces. Clinical interventions to combat stigmatization can use life narratives and a focus on consciousness-raising to promote empowerment and well-being for this group of older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Improving mental health among ultra-poor children: Two-year outcomes of a cluster-randomized trial in Burkina Faso.

RATIONALE: There is limited evidence about interventions improving child mental health in francophone West Africa. Behavioral mental health interventions alone may have limited effects on children's emotional well-being in families living in abject poverty, especially in low-income countries. OBJECTIVE: This study tests the effects of economic intervention, alone and in combination with a family-focused component, on the mental health of children from ultra-poor households in rural Burkina Faso. METHODS: The three-arm cluster randomized trial included children in the age range of 10-15 years old (N = 360), from twelve villages in Nord region of Burkina Faso (ClinicalTrial.gov ID: NCT02415933). Villages were randomized (4 villages/120 households per arm) to the waitlist arm, the economic intervention utilizing the Graduation approach (Trickle Up/TU arm), or to the economic strengthening plus family coaching component (TU + arm). Intervention effects were tested using repeated-measures mixed-effects regressions that account for the clustered nature of the data. RESULTS: Children from the TU + arm showed a reduction in depressive symptoms at 12 months (medium effect size Cohen's d = -0.41, p = .001) and 24 months (d = -0.39, p = .025), compared to the control condition and the economic intervention alone (at 12 months d = -0.22, p = .020). Small effect size improvements in self-esteem were detected in the TU + group, compared to the control arm at 12 months (d = 0.21) and to the TU arm at 24 months (d = 0.21). Trauma symptoms significantly reduced in the TU + group at 12 months (Incidence Risk Ratio/IRR = 0.62, 95% CI = 0.41, 0.92, p = .042), compared to the control group. CONCLUSION: Integrating psychosocial intervention involving all family members with economic empowerment strategies may be an innovative approach for improving emotional well-being among children living in extreme poverty.

An Integrated Approach to Increasing Women's Empowerment and Reducing Domestic Violence: Results of a Cluster-Randomized Controlled Trial in a West African Country.

OBJECTIVE: This is the first experimental study testing the effects of an economic intervention alone and in combination with a family-focused component, on women's empowerment status and family violence in Burkina Faso. METHOD: The three-arm cluster randomized controlled trial with baseline and one-year follow-up included 360 ultra-poor married women from 12 villages. Villages were randomized to the three study arms: economic intervention for women (Trickle Up/TU), a combination of economic intervention and family coaching (Trickle Up Plus), and waitlist (Control arm). Analysis utilized repeated-measures mixed effects regressions. RESULTS: Compared to the control group, there was a significant improvement in both the TU arm and the TU Plus arm in women's financial autonomy and in quality of marital relationships. In addition, women in both intervention arms reported a significant reduction in emotional spousal violence in the past year, with the effect size greater for the combined intervention (TU group OR=0.28, 95% CI 0.10,0.82 p=0.02 and TU+ group OR=0.19, 95% CI 0.06,0.64, p=0.007). CONCLUSIONS: Economic intervention shows benefits that go beyond changes in financial wellbeing and may increase women's status and improve family relationships. Integrating psychosocial components with economic strategies may be more effective for improving women's empowerment status in West Africa.

Maltreatment and Mental Health Outcomes among Ultra-Poor Children in Burkina Faso: A Latent Class Analysis.

OBJECTIVES: Research about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso. METHODS: This paper utilizes baseline data collected from 360 children ages 10-15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages. RESULTS: About 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, p<0.05) and lower symptoms of trauma (b = -3.90, SE = 1.52, p<0.05). CONCLUSIONS: This study offers insight into the psychological well-being of children in the context of ultra-poverty in Burkina Faso and associated context-specific adverse childhood experiences. Identifying specific sub-groups of children with increased exposure to life stressors has implications for program developers. Study findings indicate a further need to explore the mental health consequences of traumatic experiences within the context of ultra-poverty and to develop integrated economic and psychosocial interventions that prevent or mitigate childhood adversities linked with the family-level poverty and violence in the family.

Social support for South Asian Muslim parents with life-limiting illness living in Scotland: a multiperspective qualitative study.

OBJECTIVE: To explore experiences of social support needs among South Asian Muslim patients with life-limiting illness, living in Scotland, who are parents of young children. DESIGN: Secondary analysis of data from a multiperspective, longitudinal Scottish study involving in-depth semistructured interviews with patients, their nominated carers and healthcare professionals. Data were analysed using interpretive phenomenological analysis. SETTING: Edinburgh, Scotland. PARTICIPANTS: South-Asian Muslim patients with life-limiting illness with children under the age of 18 (n=8), their carer (n=6) and their healthcare professional. MAIN OUTCOME MEASURES: Access and provision of social support in palliative care. RESULTS: Open-ended qualitative interviews identified four main themes: (1) parental sadness over being unable to provide tangible support; (2) parental desire to continue to provide emotional support; (3) limited availability of informal social support networks; and (4) differing perspectives between healthcare professionals and patients on patient access to social support sources, with a subtheme being the capacity of male carers to provide social support. South-Asian parents at the end of life had limited access to extended-network support. Gender roles appeared as challenging for healthcare providers who at times overestimated the amount of support a female carer could provide and underestimated the amount of support male carers provided. Implications for practice include the need for greater awareness by healthcare providers of the social support needs of ethnic minority and migrant parents with life-limiting illnesses and especially an awareness of the importance of the role of male and female carers. Further research is needed to explore how the timing of migration impacts the need for and availability of tangible and emotional informal social support among ethnic minority parents with life-limiting illness.