grants in Sweden had a higher rate of suicide (similar to that in Finland) than native-born Swedes and other immigrants. Social isolation and low social class acted as confounding factors, although they do not completely account for the increased rates (Ferrada-Noli et al., 1995). A comparison of suicide rates in high- and low-income areas of Stockholm county revealed the highest suicide rates in the low-income areas, regardless of ethnicity, though low-income immigrants still completed suicide at higher rates (Ferrada-Noli and Asberg, 1997). In contrast, immigrants to the United State have lower or comparable rates to native-born individuals. In their review of death certificates from 1970 to 1992 in California for 15– 34 year olds, Sorenson and Shen (1996) found that although foreign-born individuals had significantly higher rates of homicide deaths, they had fewer suicides. This study did not control for demographic variables, however. Singh and Siapush (2001) reviewed national death certificate data investigating all-cause and cause-specific mortality of foreign-born versus native-born in the United States, controlling for the demographic factors sex, race/ethnicity, age, income, and education. They found that foreign-born males had 52 percent lower suicide rate than U.S.-born males when demographic variables were controlled. On the other hand, demographically adjusted suicide rates for foreign-born females did not significantly differ from that of native-born U.S. females. While some studies in Britain and Australia found a similar concordance of foreign- versus native-born suicide rates in women (e.g., Morrell et al., 1999), others have found increased suicides and suicide attempts in female immigrants compared to their male counterparts or to native-born females (Merrill and Owens, 1988; Patel and Gaw, 1996).

Research on immigration and suicide has initiated contextual psychological studies on the stresses of immigration as related to suicidality. These studies all involved immigrants to the United States unless otherwise noted. Hovey and King (1997) for example, expanded previous models of acculturation (i.e., Williams and Berry, 1991) to include the development of depression and suicidality. Aspects of acculturative stress include disrupted social support and family support networks, low education and income, lack of knowledge of the language and culture of the new country, motives for immigrating, spiritual beliefs, tolerance of the host country toward immigrants, and positive or negative views of the acculturative process itself. Studies of various Hispanic and Asian immigrant groups demonstrate that lack of English skills predicts distress, depression, and suicidal ideation among immigrants, sometimes over and above the effects of pre-arrival trauma (Hinton et al., 1997; Hovey, 2000a; Hovey, 2000b). Spiritual beliefs, social support, and marital status, protective factors and processes (see Chapter 6), appear to buffer the effects of



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