Gender, race, and culture in risk formulations

I'm trying to think about how to categorize risk factors related to gender, race, culture when presenting about risk and guiding people to make risk formulations. In my initial concept maps, I included "male gender" as one of the "predisposition" factors, following categories offered by Bryan & Rudd (2006). But then when I saw how therapists used this in clinical practice, I noticed that people would list male gender right alongside suicidal ideation or behavior as if one carries risk in the same way as the other. Obviously they don't.

We have factors like race, where risk looks quite different for men and women and over the lifespan (with young black men at greater risk, and older black women much less). Not to mention other unique contours of suicidality among black Americans (Joe et al, 2006). So race is a factor to consider carefully, but not list as a "risk factor" in the same way as others like depression, family history of suicide, past suicidal behavior.

One suicide researcher in our department with whom I shared this dilemma suggested that perhaps demographic and cultural factors are best represented of factors that, if properly considered, decrease likelihood of false negatives (i.e., underestimating risk). That makes sense to me. Being a man, an older adult, or African American doesn't put you at risk of suicide, but if you are working with an older adult male you ought to pay special attention to suicide risk and know that you might be likely to underestimate it.   In this way of understanding this category, a full risk assessment could include:

  • Suicide-specific ideation, behavior and history

  • Risk Factors (history, current sx presentation, hopelessness, impulsivity, identifiable stressor)

  • Demographic and cultural considerations

  • Protective Factors


There's still work to be done, but that seems like a better way than lumping gender, race, and culture in with other risk factors.

References


Bryan, C. J., & Rudd, M. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology, 62(2), 185-200.

Joe, S., Baser, R. E., Breeden, G., Neighbors, H. W., & Jackson, J. S. (2006). Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States. JAMA, 296(17), 2112-2123.