(PS2-B40) Suicidality Without Depression: Differences Between Broad Cultural Groups

Background: Globally, suicide is one of the leading causes of death, and depression is one of the primary causes of disability (World Health Organization, 2019). Depression is the largest single contributor to suicide attempts and deaths by suicide. However, there are significant cultural differences in the meaning, method, and rates of suicide between cultures (Colucci, 2013). The current study examines the relationship between suicidality and depression among six broad cultural groups.

Method: A total of 17,015 participants were recruited to a multilingual (English, Spanish, Chinese, Arabic, and Russian) depression and suicide screening study via Google Ads (Gross et al., 2014; Leykin et al., 2012). Participants were divided into six broad cultural groups (Goodmann et al., 2021) by jointly considering language and the country of residence: Latin America (n=7203), South Asia (n=1352), Russian (n=3508), Western English speakers (n=2028), Chinese (n=582), and Arab (n=2339). Participants were screened for current (past 2 weeks) major depressive episode (MDE) via a MDE screener (Muñoz, 1998) keyed to the DSM, which included a question about a suicide attempt in the past two weeks. Binary logistic regression analyses were used to examine whether cultural group moderates the relationship between depression and suicide attempts.

Results: As expected, those screening positive for a current MDE had 66% higher odds of reporting a suicide attempt in the past two weeks (Wald chi-square (1) = 5.112, p = 0.02, OR = 1.66, 95%CI: 1.07-2.59). However, when differences between the cultural groups were examined, a more complex picture emerged. The Chinese group had the highest proportion of people reporting a suicide attempt in the past two weeks without screening positive for depression (30.0%), followed by the Russian group (15.7%), whereas other groups were less likely to report an attempt without screening positive for depression (6.0-8.5%). The relationship between depression and suicide attempts was significantly moderated by cultural group (Wald chi-square (5) = 34.01, p < 0.001), and the moderation remained significant after controlling variables known to be associated with suicidality, such as living alone, marital status, employment, education, age, and gender (Wald chi-square (5) = 13.00, p = 0.02).

Conclusions: Although current depressive symptoms are robust predictors of a suicide attempt, for some cultures (e.g., the Chinese group), suicide attempts are far more likely to occur without screening positive for depression according to Western diagnostic systems. Depression may be experienced differently by Chinese-speaking populations, for instance, and not adequately captured by standard Western screeners.  Cultures may also vary in non-mental health factors that lead to suicide attempts. Clinicians should carefully assess for suicide risk even if patients are not currently depressed.