(PS9-9) Is past suicide a universal predictor of future suicide risk? Cultural differences in self-perception and beliefs about future suicide.

Abstract Text:

Background: Suicide is a universal public health concern (Teo et al., 2021). History of suicide attempts is one of the strongest predictors of future suicidal thoughts and behaviors (Ribeiro et al., 2016). However, recent work has demonstrated that common predictors of suicide may differ depending on one’s culture (Liu et al., 2024), and attitudes regarding suicidality are strongly influenced by culture (Troya et al., 2022). Thus, the goal of this study is to understand whether previous suicide attempt(s) influences one’s self-perception and beliefs regarding likelihood and lethality of a future attempt, and whether culture moderates these relationships.

Methods: Participants (N=14942) were recruited to an international quintilingual online depression/suicide screening study (Leykin et al., 2012). Following Goodmann et al. (2021), broad cultural groups were created by jointly considering language and country of residence, resulting in 6 groups: Spanish speakers from Latin America (n = 5812), English speakers from South Asia (n = 805), Russian speakers from the former Soviet Bloc (n = 3090), Chinese speakers from China (n = 610), Arabic speakers from the countries of the Arab World (n = 2821), and English speakers from English-speaking Western countries (n = 1804). Participants completed a demographic questionnaire, a screener for current and lifetime depressive episodes (Muñoz et al., 1999), and the Suicide Behavior Questionnaire (Linehan et al., 1981). Ordinal regressions models were used to understand the relationship between the main predictors of interest and their interactions with the cultural group, controlling for age, gender, depression status, education, and religiosity.

Results: Culture moderated the relationship between past suicide attempt and self-perception as someone is capable of future suicide (Wald chi-square(5) = 28.5, p < .001). Though in all cultures those with a history of past attempts were more likely to see themselves as someone who can imagine killing themselves compared to those without such history, in the Arab World group the difference was particularly pronounced. Culture likewise moderated the relationship between past attempt and perceived likelihood of attempting suicide in the future (Wald chi-square(5) = 76.9, p < .001). Among those with no past attempt, the Chinese group was most likely to report a likelihood of future attempt, and the Arab group – least likely to do so, however, there was little difference in belief strength among those with past attempts. Finally, culture also moderated the relationship between past attempt and perceived likelihood of dying as a result of future attempt (Wald chi-square(5) = 69.6, p < .001). As above, though in all cultures those with past attempts reported a higher perceived likelihood, the difference between those with and without past attempts was especially pronounced in the Arab World group, but far less pronounced in the Soviet Bloc and Western English groups.

Conclusion: Findings add to the literature suggesting that common risk factors for suicidality may not be universal but rather influenced by culture. The results should inform clinical care in increasingly diverse clinical practices, to better understand and reduce suicide risk across cultures.