There is increasing interest in culturally responsive suicide prevention approaches for migrant and ethnoracially minoritized communities (Wexler and Gone, 2012; Na et al., 2016; Bowden et al., 2020; Allen et al., 2022; Meza and Bath, 2022). Culturally responsive suicide prevention can be broadly defined as prevention activities centered on the unique cultural, linguistic, and belief systems of different groups to enhance the effectiveness of suicide prevention efforts (Wexler and Gone, 2012). Recommended culturally responsive approaches by Meza and Bath (2022), which follow the Public Health Model of Suicide (World Health Organization, 2021a), include the following key components: (1) gathering large surveillance data that accurately reflects prevalence rates among diverse communities, in this case, international college students (Xiong and Pillay, 2022); (2) contextualizing risk and protective factors to include systems-level and culturally pertinent elements, such as experiences of discrimination or culturally significant values [e.g., community centered approaches (Allen et al., 2022)]; (3) incorporating culturally relevant risk and protective factors into the development of new treatment strategies [e.g., family discrepancy in academic performance expectations (Jun et al., 2022)]; and (4) engaging ethnoracially diverse minority communities in developing and testing the feasibility, acceptability, and ultimately the effectiveness of prevention and intervention methods (Allen et al., 2022). A growing body of evidence shows that culturally sensitive and responsive approaches are a promising direction for preventing suicide among migrant and non-western cultural groups (Villarreal-Otálora et al., 2019; Sjoblom et al., 2022).
A recent test of the Cultural Theory and Model of Suicide demonstrated that cultural risk and protective factors (e.g., acculturative stress, cultural sanctions, etc.) significantly influence suicide attempts beyond classically tested factors like hopelessness, depression, and reason for living in minoritized groups (Chu et al., 2019). Similarly, reviews on the experiences of depression and the varying language and idioms used to express distress across different cultures reveal distinct patterns in the understanding and expression of such disorders in non-Western contexts (Kaiser et al., 2015; Haroz et al., 2017). Such views are often associated with stigma toward both suicide and formal help-seeking (Bowden et al., 2020), leading to a preference for self-reliance and informal support systems like family networks, which could also provide valuable alternative avenues of support (Na et al., 2016). However, these supports may also be problematic when such networks are not readily available to international students living in another country, or if people within the network react negatively to the person’s help seeking.
Culturally responsive approaches address these unique aspects by avoiding the pitfalls of Western-centric assumptions that can make prevention efforts ineffective or harmful (Wexler and Gone, 2012). By prioritizing cultural congruence (i.e., matching interventions to the target population’s cultural needs), these approaches seek to create prevention activities aligned with relevant cultural norms and perspectives (Wexler and Gone, 2012). While many of these approaches already acknowledge the importance of protective factors, there is a growing emphasis on more explicitly integrating cultural strengths (i.e., racial/ethnic identity pride) into prevention efforts (Allen et al., 2022; Bath and Meza, 2023). This evolution represents a shift from historically deficit-focused approaches to those that more intentionally leverage cultural strengths, marking an important advancement in the research, prevention, and intervention strategies for minoritized groups and international students (Yakunina et al., 2013; Anandavalli, 2021; Allen et al., 2022).
Building on this evolving approach to cultural strengths, much of the research on culturally responsive strengths-based approaches stems from suicide prevention efforts with American Indian and Alaskan Native (AI/AN) populations. A notable recent advancement in this work relevant to international students is the culturally responsive Protective Factors Framework (Allen et al., 2022). This framework refines our understanding of emphasizing the importance of distinguishing between protective factors and protective mechanisms to understand how they interact to confer resilience against suicide risk factors (Allen et al., 2022). In this framework, protective factors are characteristics in an individual or the environment that reduce the risk of suicide. In contrast, protective mechanisms are the interrelated sequelae that mitigate risk and promote health outcomes. For instance, social support is a protective factor that may operate through multiple mechanisms. For instance, one mechanism could be reducing emotional distress, while another could be fostering a sense of belonging to promote resilience against suicidality. Separating these protective factors (e.g., social support) and mechanisms (e.g., sense of belonging) facilitates more nuanced perspectives on how prevention activities can confer resilience by mitigating risk factors.
Importantly, the framework also emphasizes the need to consider how each person’s sense of continuity in the past, present, and future is intrinsically intertwined with the analogous features of their broader community and culture. This approach places culture as central to prevention and implementation, encouraging community engagement and ownership of such efforts. Each of these elements makes the Protective Factors Framework ideally suited to supporting the development of a more culturally responsive suicide prevention approach for international students.