The current study demonstrates ethnic variations in suicide method and suicide location in a sample of 1,145 suicide deaths from 2009 to 2016 in a Northern California county. Firearms were the most common suicide method for White and African American decedents, and hanging was the most common suicide method for Latino/a/x and API suicide decedents. In fact, when considering the data in aggregate, hanging–not firearms–represented the most prevalent method of suicide death, which is consistent with other data from California (Matthay et al., 2017). Regarding the under-studied variable of suicide location, data suggest that White decedents were more likely to die-by-suicide at home than API decedents and African American decedents.
The ethnicity-location-method analysis revealed a notable variation in suicide pattern: compared to White firearm suicide deaths, API firearm suicide deaths were more likely to occur outside the home. Although the dataset is limited in its ability to fully explain this disparity, shame and collectivism may play a role. Specifically, API individuals who die-by-suicide may choose their suicide location to shape the grief experience of their surviving family members. This hypothesis extends the established role of shame on suicide acceptability, suicide method, and the expression of suicidality within API individuals (Chu et al., 2018). A collectivistic lens suggests that suicide can be conceptualized as a purposeful, social act as opposed to an individual one (e.g., Shiang et al., 1998). Subsequently, after a suicide death, members of the API community may question whether the decedent’s family contributed to the decedent’s death. As such, decedents who chose to die-by-suicide in their homes may have intended for their family to experience some level of public shaming for their suicide. Alternatively, those who chose to die-by-suicide outside of the home may have done so in an attempt to shield their family from the shame of finding their body and being blamed by the wider API community. This post-hoc explanation is hypothetical in nature; future research is needed to understand the disparity between White and API firearm suicide death locations.
The current study yields implications and future directions for culturally-informed suicide risk assessment, management, and prevention at the clinical, community, and systems levels. First, future work should consider the cultural processes that explain ethnic variations in suicide method and suicide location. This line of research would likely benefit from interviews with survivors of suicide attempts who can explain the rationale behind their chosen suicide location (e.g., likelihood of being found, shame).
Second, clinicians should strongly consider including ideated suicide location as part of risk assessment efforts. After assessing for any suicidal ideation and a suicide plan, clinicians can assess for ideated suicide location with a simple question, such as “When you’re thinking about this method, does the plan take place in a specific location?” The answer to this question will allow clinicians to include the ideated location as a warning sign and to use collaterals (e.g., family) to reduce the likelihood that the suicidal person is alone in the ideated location. Third, clinicians should consider hanging means restriction to items that could be used as ligatures (e.g., belts, ropes) and locations that could be used for hanging (e.g., closets, exposed beams).
Finally, the current results demonstrate the need for additional work on hanging means restriction. There is a disparity in means restriction efforts, such that there has been significant work on restricting access to firearms, the most prevalent suicide method for White and African American individuals; however, there has been minimal work on restricting access to hanging, the most prevalent suicide method for Latino/a/x and API individuals. Currently, the literature holds that hanging cannot be restricted due to the ubiquitous nature of ligatures and hanging points (Yip et al., 2012). However, the current findings highlight the need for the field of suicide prevention to study the feasibility and effectiveness of hanging means restriction. As an example, future research can investigate the efficacy of hanging means restriction counseling, in an effort to empower clients and supportive others to restrict access to ligatures and hanging points (Bryan et al., 2011).
These findings should be understood within the context of the study’s limitations. First, African American individuals are under-represented (n = 27). Second, sub-group analyses of API and Latino/a/x populations were not possible, as these data were not available in this archival dataset. Third, other ethnic groups were absent from the current analysis due to low numbers (e.g., Native American/Alaskan Native decedents). Although representative of only one county in the United States, this analysis contributes to the suicide prevention literature by highlighting ethnic variations in suicide method and suicide location. In turn, these findings offer guidance for the prevention of suicide deaths across all ethnic identities.
