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Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: an Ecological Perspective Sheri A

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Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: an Ecological Perspective Sheri A View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by East Tennessee State University East Tennessee State University Digital Commons @ East Tennessee State University Electronic Theses and Dissertations Student Works 8-2014 Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: An Ecological Perspective Sheri A. Nsamenang East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/etd Part of the Psychology Commons Recommended Citation Nsamenang, Sheri A., "Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: An Ecological Perspective" (2014). Electronic Theses and Dissertations. Paper 2420. https://dc.etsu.edu/etd/2420 This Dissertation - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: An Ecological Perspective _____________________________________ A dissertation presented to the faculty of the Department of Psychology East Tennessee State University ____________________________________ In partial fulfillment of the requirements for the degree Doctor of Philosophy in Psychology ___________________________________ by Sheri Agatha Nsamenang August 2014 __________________________________ Jameson K. Hirsch, Ph.D., Chair Christopher S. Dula, Ph.D Jon R. Webb, Ph.D. Stacey L. Williams, Ph.D. Keywords: Acculturation, African Immigrants, Suicide Attitudes, Ecological, Help Seeking Behavior, Mental Health ABSTRACT Attitudes Toward Suicide, Mental Health, and Help-Seeking Behavior Among African Immigrants: An Ecological Perspective by Sheri A. Nsamenang The population of Africans in the United States is growing, yet little is known about the impact of migration on the attitudes of African immigrants toward suicide, mental health, and help- seeking behavior. Migration entails movement from one cultural environment to another, and the process requires adaptation to the host country. According to Ecological Theory, interactions between the societal structures, values, and beliefs of the host country, cultural values from the country of origin, and individual-level characteristics may affect mental health-related attitudes and behaviors. As such, the current study used mixed methods, administered via online survey, to investigate socio-cultural predictors of attitudes toward suicide, mental health, and treatment seeking among African immigrants in the United States. In the current study the responses of 227 participants were used for qualitative analyses, and responses from 168 participants were used for quantitative analyses. Qualitative results indicated overall negative attitudes towards suicide and positive attitudes towards suicide prevention. Perceived culture-specific causes of suicide included acculturation difficulties, immigration stress, social causes such as home sickness discrimination, and racism, financial causes such as responsibility to kin in Africa, spiritual causes, and deportation risk. Results from quantitative analyses indicated that identification with African values and behaviors were related to lower levels of anxiety, depression, stress, and culture oriented psychological distress. Higher levels of spirituality and religiousness were 2 associated with a negative attitude toward suicide. Implications for population based suicide prevention efforts for African immigrants and for mental health professionals working with African immigrants are discussed. 3 ACKNOWLEDGEMENTS In my dialect, Lamsno, we say “Wir dze Wir bi Wir,” which means I am who I am because of people. First and foremost, my deepest gratitude goes to my Academic Advisor and Dissertation Chair, Dr. Jameson Hirsch, who has contributed to my growth as a researcher and for his support throughout my graduate studies. I would also like to thank members of my committee for their guidance and patience during the time I have spent working towards the completion of this dissertation. Special thanks to members of the Laboratory of Rural Psychological and Physical Health for the immense support I received during the creation of my dissertation and data collection. My parents, family, and friends have been a tremendous support throughout my academic journey. To my mother, the funniest woman I know, your love and encouragement pacified my journey. To my father, the one of the hardest working man I know, your strength gave me perseverance. To my sisters and brother, aunties, uncles, and friends, thank you for your understanding, love, and reassurance; you inspire me in ways I cannot describe. 4 TABLE OF CONTENTS Page ABSTRACT .........................................................................................................................2 ACKNOWLEDGEMENTS ................................................................................................4 LIST OF TABLES ............................................................................................................10 LIST OF FIGURES ..........................................................................................................11 Chapter 1. INTRODUCTION ................................................................................................12 African Immigrants: An Under-Researched and Under-Treated Population ......................................................................................................14 Relevance of Population ......................................................................14 Epidemiology of African Immigrants in the United States .................15 Ecological Theory: A Conceptual Framework to Understand Immigrant Mental Health................................................................................................18 Individual-Level Risk and Protective Factors .....................................19 Microsystem ........................................................................................25 Mesosystem .........................................................................................27 Exosystem ...........................................................................................30 Macrosystem .......................................................................................32 African and African Immigrant Mental Health and Suicide: Behavioral and Attitudinal Characteristics ......................................................................37 Mental illness and suicide in Africans .......................................38 Mental illness and suicidal behavior in African immigrants ......39 5 Cultural manifestation of mental health symptoms in Africa ....40 Attitudes of Africans and African immigrants toward mental health and suicide .......................................................................41 Help seeking behavior among Africans and African immigrants ..................................................................................43 Hypotheses ....................................................................................................46 2. METHODS ...........................................................................................................50 Participants ..........................................................................................50 Procedure .............................................................................................50 Materials ..............................................................................................52 Demographic questionnaire ........................................................52 Open-ended questions ................................................................52 Spirituality ..................................................................................53 Religiousness ..............................................................................53 Mental health ..............................................................................54 Suicidal behavior ........................................................................55 Peer suicide ................................................................................56 Suicide of family member ..........................................................57 Social support .............................................................................57 Social class .................................................................................58 Media exposure to suicide ..........................................................59 Acculturation ..............................................................................60 Ethnic identity ............................................................................61 6 Attitude toward suicide ..............................................................62 Help-seeking behavior ................................................................63 Data Analyses ................................................................................................64 Qualitative Data Analysis ....................................................................65 Content analysis .........................................................................65 Quantitative Data Analysis ..................................................................67
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