Transcultural aspects of suicidal behaviour

Due to increasing immigration in Germany the German Mental Health Care System today has to deal in a growing number with the assessment of the level of psychic functioning and the capability of self control in patients of different ethnic origin. For clinicians this is a challenge, since suicidal behaviour in terms of its frequency, meaning, motives and manner is very much dependent on the cultural context in which it occurs. Moreover, the general attitude of an individual towards suicide is embedded in the culture of origin of the immigrant. Until now there has been only little systematic research on the influence of culture on suicidal behaviour. In this review the traditions of suicidal behaviour in different cultures in their religious and historical dimensions will be reflected. The historical and cultural roots of suicidal behaviour will be put in context to a categorization of the different variants of suicide, such as institutionalized suicide versus individualized suicide. Psychodynamic aspects of suicidal ideation will be highlighted in cross-cultural perspective with a distinction between a. the wish to die, b. the wish to kill and c. the wish to be killed. It will be shown that there can be differentiated between accepted and non-accepted suicide. With respect to epidemiology there will be discussed the impact of culture on the suicide rates across cultures. The influence of culture on the psychopathology of suicidal behaviour will be summed up systematically. These aspects are of high relevance for the understanding and assessment of suicidal crisis in immigrants, since the suicidal patient even today - although subconsciously - is influenced by the deep rooted traditions of suicidal behaviour in his culture of origin.