(PS11-28) Don’t Talk to Me About My Suicide: Cultural Differences in the Willingness to Seek Talk Therapy Following a Suicide Attempt

Background: Suicide is a important public health concern. Being willing to talk about suicidality is beneficial, both in terms of lessening in severity of underlying mental health conditions such as depression (Frey et al., 2016) as well as by addressing suicide risk factors (Van Ordenet al., 2008).  Antidepressants may also reduce suicidality, largely via the reduction of depressive symptoms (Möller, 2006). However, some individuals are reluctant to discuss suicidality with providers for a variety of reasons, such is fear of hospitalization or forced treatment and avoidance of stigma and shame that may come with such disclosures (Blanchard & Farber, 2020). Cultural factors may likewise influence the perception of stigma as well as general attitudes about suicide (Chu et al., 2020). Thus, the goal of this investigation was to understand whether the experience of recent suicidality impacts interest in treatments (i.e., talk or antidepressant therapies), and whether culture moderates this relationship.

Methods: Participants were individuals invited to take part in an online survey on decisions about depression treatments after screening positive for current depression via a parent study (Leykin et al., 2012). Participants included in this report were either Spanish speakers from Latin America (n = 152) or English speakers from English-speaking Western countries (n =105) (Goodmann et al., 2022). Participants completed a depression screening measure (MDE Screener; Muñoz, 1998), which included questions about current and past suicidality, and answered a number of questions about depression treatment preferences.   

Results: Controlling for demographic variables and past treatment-seeking, after experiencing a recent (past month) suicide attempt, participants from Western English speaking countries reported a markedly lower interest in talk therapy compared to those without a recent attempt and compared to participants from Latin America with or without a recent attempt (p = 0.04). No such effect was found for antidepressant medication, where interest remained similarly high after an attempt in the past month (p = 0.98). Similarly, interest in both talk therapy and antidepressant medication was similar for individuals from both cultures regardless of whether they have experienced a lifetime (rather than recent) suicide attempt. Furthermore, examining the effects of recent (past month) suicidal ideation (rather than an attempt), interest in both talk therapy and medication was high for both Western and Latin participants, and did not differ between cultures (all ps = ns). 

Conclusions: The results highlight the contribution of culture to the complexity of delivering interventions to individuals who have experienced a suicide attempt. Though the finding that interest in antidepressants remains high for all groups after experiencing suicidality is encouraging, the observation that some individuals at highest risk (those who recently made an attempt) may be reluctant to pursue talk therapy after a suicide attempt is concerning. Understanding differences in treatment preferences is important for making targeted recommendations for treatment.