Skip to main content

Cultural attributes of suicidal ideation among older immigrants: a qualitative study

Abstract

Background

Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants.

Methods

A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month.

Results

In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness.

Conclusions

Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.

Introduction

Suicide was the 10th leading cause of death for all ages in the United States and approximately one person died by suicide every 11 min in 2019 [1]. Suicidal behaviors (SBs) are classified into three categories: suicidal ideation (SI), suicide plan, and suicide attempt (SA) [2]. SI refers to thoughts of engaging in behavior intended to end one’s life [2]. Evidence has shown that 90% of unplanned and 60% of planned first suicide attempts occurred within 1 year of the onset of SI [3]. Continued efforts are needed to increase outreach to untreated individuals with SI before the occurrence of attempts and to improve treatment effectiveness for such cases [4]. Globally, 9.2% of adults have lifetime SI, and women have a higher risk of SI than men [5]. Prevention of suicide may be improved by enhancing the understanding of SI. A study showed that 77% of those who committed suicide visited at least one health professional 3 months prior to death [6]. Research on the etiology of SB may help health professionals identify individuals at a high risk of suicide and connect them with relevant prevention and intervention programs.

Different age groups are associated with different risks for suicide. In the United States, suicide is the second leading cause of death for people aged 10–34, the fourth leading cause among people aged 35–44, the fifth leading cause among people aged 45–54, and the eighth leading cause among people aged 55–64 in 2019 [1]. Suicide rates among older adults declined substantially over the twentieth century, which may be owed to the improved social welfare system, better access to healthcare services, and effective treatments for depression [7]. Existing research on SI focus on adolescents and young adults, while older adults have received little attention [8, 9]. The risk factors for suicide vary across age groups. The younger the age at suicide, the higher the likelihood of increased comorbidity, particularly with personality and substance disorders [10]. Potential attributes of SI and behaviors among older adults include social isolation, family problems, loneliness, stressful life events, and physical illness [11, 12]. Existing research on SI of older adults focused on the group with life-limiting conditions, such as terminal cancer [13, 14]. The extant literature suffers from a lack of research examining SI among an immigrant population, older immigrants in particular. Older immigrants from ethnic minority populations (e.g., U.S. Chinese older adults) have linguistic and cultural barriers in the receiving country and heavily rely on their adult children to have access to healthcare and social services. Their social networks predominantly consist of family members, and they are isolated from the community [15]. Their perceived burdensomeness to children and their social isolation may lead to SI. In addition, despite significant progress made through epidemiological research on SI, the majority of the prior research is quantitative, and there is a dearth in the literature understanding the subjective experiences of older adults with SI in sociocultural contexts [16].

Suicide rates also vary by race/ethnicity, with the highest rates among non-Hispanic American Indian/Alaska Native, followed by non-Hispanic White populations [1]. However, SI has been understudied in racial and ethnic minority populations. Among these populations, existing mental health disparities might be exacerbated by institutional barriers faced by them. Asian Americans have lower rates of using mental health services than other populations, which might be due to stigma associated with mental illness and linguistic and cultural barriers in using healthcare services [17]. According to the estimated number of Asian Americans in 2017, the Chinese population (5.2 million) constitute the largest segment of the Asian American population [18]. Depression is the principal risk factor for SI in late life [19, 20]. The prevalence rates of depressive symptoms in community-dwelling older Chinese Americans range from 17.1 to 28% [21, 22], which is substantially higher than the prevalence rates reported in older Americans (4.9 to 16%) [23, 24]. Given the relatively high prevalence rates of depressive symptoms in older Chinese Americans, their risks of SI may also be high. Meanwhile, little is known about the attributes of SI among older Chinese immigrants. Research on attributes of SI could inform interventions to reduce SI in this high suicide risk population. Guided by the interpersonal theory of suicide, this study will examine the attributes of SI among U.S. Chinese older adults.

Theoretical framework

The interpersonal theory of suicide proposes two important psychological states as attributes of SI: 1) thwarted belongingness (unmet needs for social connectedness and belongingness) and 2) perceived burdensomeness (the perceptions of burdensomeness to others) [25,26,27]. The theory asserts that when people hold the two psychological states in their minds simultaneously, and when they do so for long enough, they develop the desire for death [28].

Thwarted belongingness is what people feel they are alienated from others, not an integral part of family and friend networks, or other valued groups. Thwarted belongingness is a multidimensional construct, comprised of loneliness and absence of reciprocal care (ones in which individuals both feel cared about and demonstrate care of another). Thwarted belongingness has been highlighted in multiple suicide theories and plays a central role in the etiology of SB. According to Durkheim (1987), dysregulation of social forces, degrees of social integration in particular, results in suicide [29]. Perceived burdensomeness is the view that “my death will be worth more than my life to family, friends, and society” [28]. Perceived burdensomeness is comprised of liability and self-hate. The relationships between thwarted belongingness, perceived burdensomeness, and SI have been tested in diverse populations, including young adults [28], adults [30], psychiatric patients [31], older adults [32, 33], and immigrants (see a review [34]).

With emerging theoretical frameworks on the etiology of SI, more empirical studies among minority immigrant populations are needed to reflect the attributes of SI in an immigration context for better prevention and intervention strategies. This study aims to use a qualitative approach to understand the attributes of SI among U.S. Chinese older immigrants with recent SI.

Method

Sample

The participants of the seed program were recruited in conjunction with community partner organizations and outreach through the Population Study of Chinese Elderly (PINE). The PINE Study is a representative study of Chinese older adults in Chicago, and it screens for recent SI. One goal of ​the seed program is to understand suicidal ideation and behaviors in U.S. Chinese older adults. The recruitment criteria of the seed program include: 1) self-identified as Chinese, 2) age 50 and above, 3) SI was evaluated by one item “thoughts that you would be better off dead, or of hurting yourself in some way in the past month”), and 4) no significant cognitive impairment with Mini-Mental State Examination (MMSE) score > 20. The eligibility for the seed program was screened between 2014 and 2018 among PINE participants. Eighty one older adults were eligible for the seed program and fifty seven of them consented to participate in this program. The institutional review board at Rush University approved this study.

Data collection

In order to maximize cultural and linguistic sensitivity of this investigation, a semi-structured interview guide was developed by the investigative team. The review of the suicide literature, evidence-based practice, and the interdisciplinary team (e.g., psychologists, sociologists, clinicians, and community partners) provided the justification and rationale to develop the interview guide of merit and worth with implications for improving practice regarding U.S. Chinese older adults with SI. Core research questions of the interview guide included attributes of SI, maladaptive and adaptive coping with SI, and barriers to help-seeking behaviors (Additional file 1: Appendix).

As SI is a sensitive topic in Chinese communities and stigma is associated with SI among this population, we took a culturally relevant approach to interview participants with SI. In the interview guide, we de-emphasized the participant’s own SI to prevent the participant from feeling uncomfortable or blamed. Instead, we started with a broad conversation on SI in Chinese communities, and the participants were willing to share with their own life stories and SI. All intervention sessions and evaluations were conducted in private settings by the preferred language and dialect of participants (e.g., Mandarin, Cantonese).

Interviews were conducted by research assistants (RAs). RAs were jointly trained by the investigative team through an in-depth orientation and by our academic institution and community partners through training sessions. RAs training focused on the research protocol, approaching sensitive questions, framing culturally relevant questions, etc. The investigative team further conducted mock interviews and in-depth interviews for RAs prior to field interviews, ensuring standardization of the protocol and training in relevant cultural issues embedded in the research.

To monitor quality of our RAs, our research team conducted random visits to observe RAs on 1) ability to communicate; 2) knowledge and understanding of the interview questions; 3) understanding of the protocol; and 4) understanding of the community and cultural settings. In addition, audio of the interviews was reviewed for quality and RAs were given feedback on further probing. RAs who had areas for improvement received additional training by the interdisciplinary team.

Data analysis

Descriptive analyses (proportions) characterized study participants. Audio recordings were transcribed for analysis. Two bilingual coders used an integrated approach of grounded theory (deductive) [35] and thematic (inductive) techniques [36,37,38,39] to analyze the transcripts. In initial coding, one coder identified observable themes guided by theoretical constructs pertaining to our key research question.

Another coder contrasted and revised the initial codes against the theoretical constructs and original data to improve comprehensiveness. The coders also used thematical analysis techniques to identify themes emerging from the transcripts that are beyond existing constructs. Disagreements in coding were discussed and resolved among all investigators and to reach consensus on a final codebook. Last, the two coders selected representative quotes from the transcripts and translated independently. The coders reached consensus on a final version of translation, which was verified by another bilingual research assistant. All transcripts were analyzed using Nvivo 12.

Results

Table 1 presents sociodemographic characteristics of the 57 U.S. Chinese older adults with past-month SI. Among participants, 37 (64.9%) are women, 42 (73.7%) were over 70 years old, and 41 (73.2%) had less than 13 years of education. Many (59.6%) were married and most (71.9%) were living with at least one person. Most (83.9%) had been to the United States for more than 10 years. Tables 2 and 3 summarize key qualitative findings and representative quotations.

Table 1 Sociodemographic Characteristics of US Chinese Older Adults Participants with Past-Month Suicidal Ideation
Table 2 Thwarted Belongingness from Qualitative Interviews with US Chinese Older Adults with Past-month Suicidal Ideation
Table 3 Perceived Burdensomeness from Qualitative Interviews with US Chinese Older Adults with Past-month Suicidal Ideation

Thwarted belongingness

Based on the narratives, we regard thwarted belongingness as the unmet need to belong. Thwarted belongingness includes “social isolation” and “an absence of reciprocal care” (Table 2). Social isolation is categorized by a lack of contact with others. Social isolation is multidimensional, manifesting by restricted social networks (structural), low social support (functional), seasonal reductions in social interactions (behavioral), low integration to the receiving communities (cultural), and perceived loneliness (emotional). During interviews, having low social support was frequently mentioned in this population. As described by one participant, “My daughter is busy. She has her own family. Nobody can help me. All my friends are old. How can they help?” Loneliness was commonly reported. One participant felt “very lonely”, and “My son and daughter live far from me. When they didn’t come to see me, I feel lonely”. Linguistic and cultural barriers of being integrated to the receiving communities was mentioned as potential attributes of psychological distress and SI among this immigrant population. One participant reported “I’m lonely so that it’s easy for me to have this thought (suicidal). Because I have nothing, I’m lonely here, especially at night. I don’t speak the language here.” Other participants reported “I don’t speak English. I will get lost if I go outside by myself. I have limited social engagement”; “I can’t adapt to the life here. I don’t speak English. I have no friend”; and “The life in the US is like a birdcage. The door is closed. The window is closed. I watch TV at home. I don’t see anybody”. Other themes aligning with the theoretical constructs of thwarted belongingness are restricted social networks, manifesting by small numbers of children and friends, and seasonal variation.

An absence of reciprocal care describes the absence of reciprocal relationships in which individuals both feel cared about and provide care to others. Conflicts in family norms appear as one manifestation of the absence of reciprocal care. An older participant referred to a Chinese proverb meaning “one can hardly expect someone filial enough to persist care of his long-ill parent” to describe strained relationships with the children that might have been exacerbated by the older participant’s declining health conditions. Acculturation gaps in intergenerational support was identified in this population. Chinese culture emphasizes interdependence between generations, while American culture values independence. Immigrants are affected by both traditional culture and receiving culture. Different levels of acculturation in aging parents and adult children could lead to gaps in intergenerational support. Some participants described the feeling of not being connected or understood with children and grandchildren because of different life experiences and acculturation levels among generations of immigrants: “They (son and daughter-in-law) ask us to go there, and we take care of grandchildren. They seem to take it for granted. In the US, American grandparents do not have to take care of their grandchildren. If you want them to, you must pay them money.” A few participants revealed loss through death.

Perceived burdensomeness

Perceived burdensomeness describes the beliefs that one is so flawed that one’s existence is a burden on family, friends, and society (“liability”) and affectively laden cognitions of self-hatred (“self-hate”; Table 3). With respect to liability, psychological distress causes by illness and functional impairment and perceiving themselves as family burden were frequently mentioned. One older adult described a passive suicidal thought because of chronic physical illness; “Because I get ill often, (I often) think, would it be nice if people die without knowing it? This thought contradicts to suicide. I hope my eyes don’t open by the time I wake up tomorrow. My life would pass, and so do the awful things.” Some Chinese older adults also think of themselves as burden to others: “Older people have no (potentials for) development.” Some participants expressed expendability and being unwanted by children.

Regarding self-hate, older adults blamed themselves; one said, “I think my fate and personality hurt myself”. Some participants appeared low self-esteem. Additionally, expression of feeling useless emerged among Chinese older adults. Immigrants feel useless in the host country. One thinks that “Being old is useless” and “It is meaningless to be alive”.

Discussion

From the perspectives of U.S. Chinese older adults with past-month SI, this exploratory qualitative study identified potential attributes of SI among this population. Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among this population.

Our findings provide empirical evidence for the interpersonal theory of suicide hypothesizing that experiencing facets of thwarted belongingness and perceived burdensomeness are observable among older adults with SI. The findings also expanded the theory by discovering novel potential attributes of SI specific to the aging minority population, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and perceived uselessness.

One prior qualitative study found that family support and interpersonal connectedness are strong factors increasing meaning in life in suicidal patients, and particular emphasis was placed on the protective role of intergenerational relationships [40]. Building upon existing evidence of the close relationship between family support and SI, our findings suggested that acculturation gaps in intergenerational support in the context of immigration might be an underlying cause of SI among older Chinese immigrants. Younger immigrants generally are more acculturated to the mainstream culture in the receiving communities compared to their parents [41]. In Chinese immigrant families, adult children are more prone to the individualistic values of the host culture, whereas their parents are more likely to retain traditional collectivist values and endorse high filial expectation [42, 43]. If adult children are unable to meet the filial expectation of aging parents, older adults are likely to have depressive symptoms, which may result in SI [42, 44].

Consistent with prior studies [28, 34], we found that restricted social networks are a potential attribute of SI. A population-based large-scale study has shown that older Chinese immigrants experience linguistic barriers and restricted social networks in the United States [15, 45]. The restricted social networks in the migration contexts may explain the high prevalence of depressive symptoms in this immigrant population [21, 22]. Additionally, our study provides evidence that restricted social networks may result in SI in this population. Interventions aimed at promoting mental health and reducing SI of older Chinese Americans could reduce their linguistic and cultural barriers and help them to be better integrated to the receiving communities.

Bronfenbrenner’s ecological theory highlights the micro-, meso-, exo-, and macrosystems in which an individual embedded [46]. Family systems and neighborhood contexts represent the microsystem that constitutes the immediate environment in which individuals actively engage in social relations [47]. Our findings support the developmental/system theories that attribute SB to disturbed family systems [48, 49] and social forces [29], the microsystem of an individual’s ecosystem. Immigration has profound effects on the microsystem of immigrants, reshaping their family and social relationships. The dysfunctional microsystem in receiving communities may trigger immigrants’ SB. The macrosystem is the broad ideological values and norms of a particular culture. Our study reveals that the host culture (macrosystem) may influence family and social relationships (microsystem), and in turn lead to SB.

In Berry’s acculturation model, immigrants are divided into four groups: separation (high attachment to culture of heritage and low attachment to the host culture), assimilation (low attachment to culture of heritage and high attachment to the host culture), integration (high attachment to culture of heritage and high attachment to the host culture), and marginalization (low attachment to culture of heritage and low attachment to the host culture) [50]. Our study shows that older adults with low attachment to the host culture (i.e., linguistic and cultural barriers of being integrated to the receiving communities) may have a high risk of SB. However, it remains unclear whether the attachment to the culture of heritage is a risk or protective factor for SB. According to Berry’s acculturation framework, some immigrants with low attachment to the host culture could have high attachment to culture of heritage (separation), while others have low attachment to both the host culture and culture of heritage (marginalization). Future research could explore the relationship between separation or marginalization and SB.

These results should be interpreted with caution. First, the findings may not be able to generalize to older Chinese immigrants in other geographical areas or other ethnic groups. Second, the themes identified in this qualitative study are potential attributes of SI. Future quantitative studies are needed to understand the underlying mechanism of SI. Third, the seasonal suicide is related to the geographical area of the study site. The winter is long in Chicago and restricts social engagement of older adults. Seasonal suicide may not be shown in the suicide research in other geographical areas. Fourth, risk factors may differ in studies adopting different definitions for SI. In our study, SI was evaluated by the question “In the past month, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself in some way”, which represents a range from nearly every day to only once in the past month. It is necessary to pay attention to the definitions of SI when comparing different suicide studies.

Despite these limitations, this study has important theoretical and practical implications. This study connects the interpersonal theory of suicide with an immigration context. Immigration- and acculturation-related attributes were added to the interpersonal theory of suicide. The interpersonal theory of suicide outlines how dysfunctional microsystem invokes SB. Our study advances the interpersonal theory of suicide by identifying that both the microsystem and macrosystem could exert an effect on SB.

This study might inform interventions by identifying immigration- and acculturation-related attributes of SI in immigrant populations. Linguistic and cultural barriers in the receiving community and different paces in acculturation across generations within the family may lead to restricted social networks, low social support, loneliness, uselessness, and family conflicts, which are the attributes of SI. Prevention and intervention programs could help older immigrants to be better integrated to the receiving community to reduce their SI. Social service could target immigrant families to reduce intergenerational conflict to prevent suicide and achieve healthy aging. This study presents a novel framework that outlines immigration- and acculturation-related attributes of SI for researchers and healthcare professionals interested in addressing the complicated but critical problem of SB in racial and ethnic minority aging populations.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Web-based Injury Statistics Query and Reporting System (WISQARS) [https://www.cdc.gov/injury/wisqars/index.html]. Accessed 1 Mar 2021.

  2. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30(1):133–54.

    PubMed  Google Scholar 

  3. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56(7):617–26.

    CAS  PubMed  Google Scholar 

  4. Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA. 2005;293(20):2487–95.

    CAS  PubMed  Google Scholar 

  5. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192(2):98–105.

    PubMed  PubMed Central  Google Scholar 

  6. De Leo D, Draper BM, Snowdon J, Kõlves K. Contacts with health professionals before suicide: missed opportunities for prevention? Compr Psychiatry. 2013;54(7):1117–23.

    PubMed  Google Scholar 

  7. Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant medication use and rate of suicide. Arch Gen Psychiatry. 2005;62(2):165–72.

    CAS  PubMed  Google Scholar 

  8. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin. 2011;34(2):451–68.

    Google Scholar 

  9. Miller JS, Segal DL, Coolidge FL. A comparison of suicidal thinking and reasons for living among younger and older adults. Death Stud. 2001;25(4):357–65.

    CAS  PubMed  Google Scholar 

  10. Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016;387(10024):1227–39.

    PubMed  Google Scholar 

  11. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull. 2017;143(2):187–232.

    PubMed  Google Scholar 

  12. Costanza A, Amerio A, Radomska M, Ambrosetti J, Di Marco S, Prelati M, et al. Suicidality assessment of the elderly with physical illness in the emergency department. Front Psych. 2020;11:940.

    Google Scholar 

  13. Wilson KG, Curran D, McPherson CJ. A burden to others: a common source of distress for the terminally ill. Cogn Behav Ther. 2005;34(2):115–23.

    PubMed  Google Scholar 

  14. Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y, Uchitomi Y. Suicidality in terminally ill Japanese patients with cancer. Cancer. 2004;100(1):183–91.

    PubMed  Google Scholar 

  15. Li M, Dong X. Is social network a protective factor for cognitive impairment in US Chinese older adults? Findings from the PINE study. Gerontology (Basel). 2018;64(3):246–56.

    Google Scholar 

  16. Hjelmeland H, Knizek BL. Why we need qualitative research in suicidology. Suicide Life Threat Behav. 2010;40(1):74–80.

    PubMed  Google Scholar 

  17. Kramer EJ, Kwong K, Lee E, Chung H. Cultural factors influencing the mental health of Asian Americans. Western J Med. 2002;176(4):227–31.

    Google Scholar 

  18. 2017 American Community Survey 1-Year Estimates [https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk#]. Accessed 10 Jun 2021

  19. Alexopoulos GS, Bruce ML, Hull J, Sirey JA, Kakuma T. Clinical determinants of suicidal ideation and behavior in geriatric depression. Arch Gen Psychiatry. 1999;56(11):1048–53.

    CAS  PubMed  Google Scholar 

  20. Bruce ML, Ten Have TR, Reynolds Iii CF, Katz II, Schulberg HC, Mulsant BH, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA J Am Med Assoc. 2004;291(9):1081–91.

    CAS  Google Scholar 

  21. Dong X, Chen R, Li C, Simon MA. Understanding depressive symptoms among community-dwelling Chinese older adults in the greater Chicago area. J Aging Health. 2014;26(7):1155–71.

    PubMed  Google Scholar 

  22. Sun F, Gao X, Gao S, Li Q, Hodge DR. Depressive symptoms among older Chinese Americans: examining the role of acculturation and family dynamics. J Gerontol: Ser B. 2018;73(5):870–9.

    Google Scholar 

  23. McGuire LCPD, Strine TWMPH, Allen RSPD, Anderson LAPD, Mokdad AHPD. The patient health questionnaire 8: current depressive symptoms among U.S. older adults, 2006 behavioral risk factor surveillance system. Am J Geriatr Psychiatry. 2009;17(4):324–34.

    PubMed  Google Scholar 

  24. Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):M249–65.

    Google Scholar 

  25. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575.

    PubMed  PubMed Central  Google Scholar 

  26. Joiner T. Why people die by suicide: Harvard University Press; 2007.

  27. Costanza A, Ambrosetti J, Wyss K, Bondolfi G, Sarasin F, Khan R. Prevention of suicide at emergency room: from the «interpersonal theory of suicide» to the connectedness. Revue medicale suisse. 2018;14(593):335–8.

    PubMed  Google Scholar 

  28. Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, et al. Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults. J Abnorm Psychol. 2009;118(3):634–46.

    PubMed  PubMed Central  Google Scholar 

  29. Durkheim É. Le suicide : étude de sociologie. Paris: F. Alcan; 1987.

    Google Scholar 

  30. Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE. Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008;76(1):72–83.

    PubMed  Google Scholar 

  31. Baertschi M, Costanza A, Richard-Lepouriel H, Pompili M, Sarasin F, Weber K, et al. The application of the interpersonal-psychological theory of suicide to a sample of Swiss patients attending a psychiatric emergency department for a non-lethal suicidal event. J Affect Disord. 2017;210:323–31.

    PubMed  Google Scholar 

  32. Jahn DR, Cukrowicz KC, Linton K, Prabhu F. The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging Ment Health. 2011;15(2):214–20.

    PubMed  Google Scholar 

  33. Cukrowicz KC, Cheavens JS, Van Orden KA, Ragain RM, Cook RL. Perceived burdensomeness and suicide ideation in older adults. Psychol Aging. 2011;26(2):331–8.

    PubMed  PubMed Central  Google Scholar 

  34. Forte A, Trobia F, Gualtieri F, Lamis DA, Cardamone G, Giallonardo V, et al. Suicide risk among immigrants and ethnic minorities: a literature overview. Int J Environ Res Public Health. 2018;15(7):1438.

    PubMed Central  Google Scholar 

  35. Corbin JM, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13(1):3–21.

    Google Scholar 

  36. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Google Scholar 

  37. Boyatzis RE. Transforming qualitative information : thematic analysis and code development. Thousand Oaks: Sage Publications; 1998.

    Google Scholar 

  38. Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1(3):385–405.

    Google Scholar 

  39. Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y. QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. 2012;49(3):360–71.

    PubMed  Google Scholar 

  40. Costanza A, Amerio A, Odone A, Baertschi M, Richard-Lepouriel H, Weber K, et al. Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patients. Acta Biomed Ateneo Parmense. 2020;91(Suppl 3):128–34.

    Google Scholar 

  41. Kyunghwa K. Adolescents and their parents: a review of intergenerational family relations for immigrant and non-immigrant families. Hum Dev. 2003;46(2/3):115–36.

    Google Scholar 

  42. Dong X, Li M, Hua Y. The association between filial discrepancy and depressive symptoms: findings from a community-dwelling Chinese aging population. J Gerontol A Biol Sci Med Sci. 2017;72(suppl_1):S63–8.

    PubMed  PubMed Central  Google Scholar 

  43. Li M, Dong X. Filial discrepancy and mortality among community-dwelling older adults: a prospective cohort study. Aging Ment Health. 2020;24(8):1365–70.

    PubMed  Google Scholar 

  44. Li M, Dong X. The association between filial piety and depressive symptoms among U.S. Chinese older adults. Gerontol Geriatr Med. 2018;4:2333721418778167.

    PubMed  PubMed Central  Google Scholar 

  45. Dong X, Chang ES. Social networks among the older Chinese population in the USA: findings from the PINE study. Gerontology (Basel). 2017;63(3):238–52.

    Google Scholar 

  46. Bronfenbrenner U. The ecology of human development : experiments by nature and design. Cambridge: Harvard University Press; 1979.

    Google Scholar 

  47. Bronfenbrenner U. Ecology of the family as a context for human development: research perspectives. Dev Psychol. 1986;22(6):723.

    Google Scholar 

  48. Richman J. Family therapy for suicidal people. New York: Springer Pub. Co.; 1986.

    Google Scholar 

  49. Sabbath JC. The suicidal adolescent—the expendable CHILD. J Am Acad Child Psych. 1969;8(2):272–85.

    CAS  Google Scholar 

  50. Berry JW. Immigration, acculturation, and adaptation. Appl Psychol. 1997;46(1):5–34.

    Google Scholar 

Download references

Acknowledgements

Not applicable.

About this supplement

This article has been published as part of BMC Geriatrics Volume 22 Supplement 1 2022 : Health and Wellbeing of Asian older adults. The full contents of the supplement are available at https://bmcgeriatr.biomedcentral.com/articles/supplements/volume-22-supplement-1.

Funding

Dr. Dong was supported by National Institute on Aging (P30AG059304, R01AG042318), National Institute of Nursing Research (R01NR014846), National Institute of Minority Health and Health Disparities (R01MD006173), and National Institute of Mental Health (R34MH100443).

Author information

Authors and Affiliations

Authors

Contributions

Dr. Dong had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dong, Li, Bergren, and Simon drafted the main manuscript text and prepared Tables 1, 2 and 3. All authors read and approved the final manuscript.

Corresponding author

Correspondence to XinQi Dong.

Ethics declarations

Ethics approval and consent to participate

The institutional review board at Rush University approved this study. Informed consent forms were obtained from all participants.

All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors report no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, M., Bergren, S., Simon, M. et al. Cultural attributes of suicidal ideation among older immigrants: a qualitative study. BMC Geriatr 22, 678 (2022). https://doi.org/10.1186/s12877-021-02628-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12877-021-02628-6

Keywords

  • Suicidal ideation
  • Immigrant
  • Minority