care. At an 18-month follow-up, no significant between-group differences emerged in suicidal ideation or the rate of suicide attempts, although lack of power may have obscured treatment effects. Nevertheless, the experimental group showed significantly lower depressive symptoms and higher family cohesion, and these effects were greatest among those with higher suicidal symptomatology at admittance to the emergency department. This intervention also appears to improve treatment adherence among high-risk Latina adolescents (Rotheram-Borus et al., 1996; 1999).
When assessing risk and creating a treatment plan for suicidal individuals, as for any patient with mental illness (US DHHS, 2001), taking their cultural and spiritual views and needs into account emerges as a critical component of effective interventions. Language barriers prevent thousands of immigrants in the United States from receiving proper mental health care (US DHHS, 2001, see also Chapter 9 for discussion of barriers to treatment). Furthermore, racial and ethnic factors may affect how individuals respond metabolically to some common psychoactive medications (US DHHS, 2001). Individuals from ethnic and racial minority populations are far less likely to turn to professional mental health providers than are European Americans; some prefer traditional and/or spiritual methods of healing to mainstream medical and mental health strategies (see US DHHS, 2001, and Chapter 2, section on African Americans). Cultural and spiritual beliefs concerning self, psychobiological functioning (mind-body interactions), and disease causation influence the expression of mental disorders and response to treatment, including treatment adherence (Hsu, 1999; Marsella, 1988; Marsella and Yamada, 2000).
Clergy/spiritual ministers represent key gatekeepers for suicide prevention. In the United States, older adults, African Americans, and Hispanic Americans, in particular, more often turn to clergy than to professional mental health services when facing mental health issues, including suicide (Husaini and Moore, 1994; Starrett et al., 1992; Weaver and Koenig, 1996). Data from a large nationally representative study indicate that clergy see individuals with the same severity of mental disorders as do mental health professionals (Larson et al., 1988). Another study suggests that those who first go to clergy with mental health complaints are least likely to seek professional mental health services (Neighbors et al., 1998). A high percentage of clergy in Australia reported that they had been approached by suicidal adolescents (Leane and Shute, 1998). Studies in the United States document that older adults often seek help from clergy for suicidal crises, as well (Domino, 1985; Weaver and Koenig, 1996).