Setting a Course to Protect Indigenous Cultures and Communities in our National Suicide Prevention Agenda.
Setting a Course to Protect Indigenous Cultures and Communities in our National Suicide Prevention Agenda.
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DOI：
10.1037/cps0000113
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发表时间：
2022-09
影响因子：
5.8
通讯作者：
Allen, James
中科院分区：
文献类型：
--
作者：
Rasmus, Stacy;Wexler, Lisa;Allen, James
目前临床心理学和精神病学领域更广泛地认识到，美国的自杀不仅仅是一个心理健康问题（Barnhorst et al., 2021, p. 299），健康的社会决定因素是自杀死亡率上升的关键驱动因素（Dev & Kim, 2021），对于少数族裔青年来说，结构性种族主义构成了一个关键的社会决定因素（Alvarez et al., 2022）。作为回应，外科医生办公室发布了一项行动呼吁（美国卫生与公众服务部，2021 年），以全面实施国家预防自杀战略。解决包括健康问题社会决定因素在内的上游因素现已成为预防自杀的六项核心国家战略行动之一。这些进展代表了最近的、可以说是姗姗来迟的焦点从个人精神病理学作为自杀行为的主要驱动因素转向认识到自杀的多层次影响，特别是认识到社会层次结构和系统对自杀结果的影响。这一转变是在原住民社区进行了数十年的自杀预防研究之后进行的，这些研究特别关注风险和保护因素的社会生态模型。 Wiglesworth 等人（2022）的系统回顾反映了原住民自杀预防科学处于十字路口的现状。土著自杀预防文献中正在形成的共识包括关注保护因素以及跨多个相互作用的生态水平的风险。尽管这种观点扩展了主流自杀预防的狭隘焦点，超出了其典型的三级或指示性预防、个人层面的风险降低努力，但持续强调量化保护因素及其离散关联，而不深入研究激活保护机制的复杂动态是有问题的。简而言之，以这种方式考虑保护性因素忽略了这些因素本质上是与背景相关的基本事实。保护因素作为相互加强、相互依存的层面的交叉点而不是孤立的机制发挥作用。
It is now more widely acknowledged within the current fields of clinical psychology and psychiatry that suicide in the United States is more than a mental health problem (Barnhorst et al., 2021, p. 299), that social determinants of health are key drivers of increasing suicide death rates (Dev & Kim, 2021), and that for ethnoracially minoritized youth, structural racism constitutes a key social determinant (Alvarez et al., 2022). In response, the Surgeon General's office has released a Call to Action (US Department of Health and Human Services, 2021) to fully implement the National Strategy on Suicide Prevention. Addressing upstream factors including social determinants of health is now one of six core National Strategy actions to prevent suicide. These developments represent a recent, and arguably long overdue shift in focus from individual psychopathology as primary driver of suicide behaviors toward recognition of multilevel influences in suicide, and in particular, recognition of the impact of societal level structures and systems on suicide outcomes. This shift follows decades of suicide prevention research in Indigenous communities that has specifically focused on socio-ecological models of risk and protective factors.The systematic review by Wiglesworth et al.(2022) reflects the current status of Indigenous suicide prevention science at a crossroads. An emerging consensus in the Indigenous suicide prevention literature now includes attention to protective factors as well as risk across multiple interacting ecological levels. Although the perspective expands on the narrow foci of mainstream suicide prevention beyond its typical tertiary or indicated prevention, individual-level risk-reduction efforts, a continuing emphasis on quantifying protective factors and their discrete associations without delving deeper into the complex dynamics that animate protective mechanisms is problematic. In short, considering protective factors in this way ignores the essential fact that these factors are inherently contextual. Protective factors function as mechanisms at the intersection of mutually reinforcing, interdependent levels rather than in isolation.