Understanding suicide among Chinese-Canadian women
In China – unlike most of the world – more women than men have historically died by suicide each year.
And this pattern may persist after immigration to North America, as women of Chinese origin in the U.S. have higher rates of suicidal thoughts and behaviour compared to other racial or ethnic groups.
In the first study of its kind, CAMH Clinician Scientist Dr. Juveria Zaheer sought to explore the experiences and beliefs of Chinese-Canadian women with a past suicide attempt. This was one arm of a study that also involved interviews with 30 women in China.
“The voices and the narratives of these women provide insights into their particular risk for suicide, and can lead to strategies for suicide prevention and intervention,” says Dr. Zaheer, of CAMH’s Institute for Mental Health Policy Research. In North America, more than 90 per cent of those who die by suicide have a mental illness, but in China, the rates are much lower, and suicide is considered an act of powerlessness. Her study, which sheds light on risk factors among Chinese-Canadian women, was published in July 2016 in Social Science & Medicine.
Through in-depth interviews with 10 Chinese-Canadian women, Dr. Zaheer and colleagues identified a pattern of stoic endurance, lack of support and physical symptoms related to the women’s lives, which ultimately led to a breaking point and thoughts of suicide.
“These women experienced ongoing stress and pressure, leading to intense distress,” says Dr. Zaheer, who is also an emergency department psychiatrist at CAMH. The stress was often immigration-related – financial problems, unfulfilled expectations, lack of recognition of their educational credentials – combined with the efforts of working, and caring for elderly parents and children.
Yet the women described feeling “invalidated” when they tried to describe their emotions or challenges with family members. They lacked control to make decisions about their own lives, and were expected to sacrifice for the family. “They felt obligated to push through without complaint, reflecting the cultural concept of ‘ren’ or endurance,” says Dr. Zaheer. “This is how they described coping.”
A breaking point
The distress manifested as symptoms of insomnia, mood changes, exhaustion or body pain. If a doctor’s help was sought, sleeping pills were often prescribed. Among these women, the underlying pressures persisted and the distress worsened, to the point at which all described being overwhelmed and reaching a “breaking point” where suicide was considered an option.
“Suicide was seen as an escape from their suffering and pain. It was also a way of communicating their distress,” says Dr. Zaheer. “Some of the women described it as a solution to a ‘meaningless,’ ‘boring’ or ‘pointless’ life.”
“Through knowledge of these patterns and coping strategies, we can catch this problem early,” says Dr. Zaheer.
Primary care clinicians should recognize that distress among Chinese-Canadian immigrant women may not be evident or dramatic, and instead symptoms of insomnia, body pain or fatigue should be red flags. “If these symptoms worsen, it signals the need for screening for depression, anxiety and suicidal ideation,” she says.
In a future article, Dr. Zaheer will explore how these women conceptualized their recovery. Elements of recovery included their doctor’s acknowledgement of their suffering, and the availability of a social worker or case manager to work with them, their family and medical team, she says.
“It was also important for them to recognize that they can and should take time for self-care, which includes activities that they enjoy, and striving to balance the demands on their lives.”
This study was a partnership between the University of Toronto’s Department of Psychiatry and the Factor-Inwentash Faculty of Social Work, along with Dr. Paul S. Links, principal investigator from the Department of Psychiatry at the Schulich School of Medicine & Dentistry at Western University.
The research was funded by the Canadian Institutes of Health Research and the Natural Science Foundation in China.