Methodologies for Representing Mental Distress in Diverse Youth Populations

Background and Purpose: To date, suicide research has fallen short of addressing how diversity shapes mental health risk. This limitation is significant, given that adolescent girls of color have the highest rates of attempted suicide compared to their non-Hispanic White peers. The elevated prevalence of suicidal behaviors has significant—and sobering—implications for the future well-being of girls of color, as attempted suicide is a strong predictor of completed suicide. In social work research, visual research methodologies hold promise for deepening our understanding of suicide risk by engaging participants who are normally excluded from research due to cultural, linguistic, or developmental barriers. This presentation describes the application of body mapping, a qualitative methodological and analytical tool that permits a sensitive exploration of the cognitive, somatic, emotional, and social experiences of suicidal behaviors in girls of color.

Methods. We present qualitative data collected with a sample of 18 girls of color between the ages of 13 and 17 years who had attempted suicide two to four weeks prior to data collection. The average age of the girls was 15 years. Participants identified with several different racial ethnic categories, including Latina (n = 7), Black (n = 4), and biracial (n = 7). Participants completed a clinical ethnographic interview (CEI) to explore how suicidal behaviors were embedded in dynamic and meaningful sociocultural contexts. Using a combination of open-ended questions and body mapping techniques, the CEI elicited information that situated mental distress in emotional, embodied, and social contexts. The body map represents a visual referent to help the participant illustrate and describe how she feels. Using cultural consensus analysis, we analyzed body maps to identify cultural variations associated with attempting suicide.

Results. Body maps facilitated participants’ expression of their experiences of suicidal behaviors in visual, rather than verbal, terms. Participants often fell silent when verbally queried about their experiences, but when permitted an opportunity to draw their experiences, they created body maps using intense color, written word, and illustrative techniques. Rather than describing their experiences in cognitive terms (e.g., suicidal ideation), patients communicated their distress in emotional and somatic terms. When explaining the cause of their distress, all participants pointed to relational contexts and past experiences of adverse childhood experiences as triggers.

Conclusions and Implications. Our findings suggest that body mapping can facilitate an exploration of emotional distress in ways that open-ended questioning cannot. Specifically, results help to shed light on the distinct ways in which girls of color experience and express their distress. Importantly, most national organizations for the prevention of suicide emphasize cognitive risk factors. Our findings suggest that such warning signs might not resonate with diverse populations. To this end, we conclude our presentation with a discussion of potential policy and practice considerations when working with girls of color in the aftermath of a suicide attempt.