The Grady Nia Project's Contributions to Science
Our years of research combined with our clinical experience show the value of culturally informed assessments and interventions designed specifically for low-income, urban, African Americans with a history of suicidal behavior and interpersonal trauma. Below find a summary of significant findings from Nia. Click here for a complete list of references.
The Nia Project works!
- A culturally-informed empowerment group is more effective than standard treatment for abused and suicidal African American women at:
- Decreasing general psychological distress, depressive symptoms, and suicidal ideation
- Increasing women’s spiritual well-being, self-esteem, and adaptive coping skills
- Alleviating hopelessness and improving effectiveness of obtaining resources when working with patients who are motivated to change their abusive situation from the onset of treatment
- An empowerment-based group intervention has been found to be faster in reducing general distress and depression when compared to other treatments.
- Nia’s effectiveness in reducing depressive symptoms and suicidal ideation occurs through improvements in existential well-being. In other words, this empowerment-based group intervention enhances women’s sense of meaning in life. Through this enhanced meaning, depressive symptoms and thoughts of suicide decrease.
- Our patients are highly satisfied with the Nia program and realize that participating in the culturally-informed empowerment based group encourages them to talk about intimate violence and suicidal feelings, reduce their suicidality, and cope more effectively with intimate partner violence.
Compassion meditation works!
- Cognitively-based compassion meditation, a mindfulness-based practice of reacting to our own emotional pain with sympathy, alleviates depression in low-income African American men and women who have recently attempted suicide.
- For these individuals, compassion meditation training is more effective at reducing self-criticism and depression than participating in a traditional support group.
- Compassion meditation reduces depression among suicidal African Americans via its effect on self-criticism.
- Self-compassion is a factor for suicide resilience.
- Self-compassion plays a significant role in ameliorating the effect of shame on depressive symptoms.
- Compassion meditation is especially helpful for African American suicide attempters with high reactivity.
- Homeless individuals may need interventions tailored to maximize their effects.
Risk and protective factors associated with suicidality in low-income African American women
- African American women are more likely to engage in suicidal behavior if they:
- Have difficulties adjusting to marriage
- Experience more negative life events
- Have a history of child abuse or multiple experiences of trauma
- Have mental health difficulties such as distress, depression, PTSD, and substance use
- The greater the number of risk factors, the higher the risk of suicidal behavior.
- Women are less likely to engage in suicidal behavior when they:
- perceive positive social support and a sense of belonging
- feel close to their family of origin and feel accepted and valued in their family
- have children
- use healthy coping skills
- are hopeful and confident in their own abilities
- have a higher sense of meaning in their life
- have access to appropriate resources
- Women who are more involved in religious beliefs and practices have lower acceptance of suicide.
- The greater the number of protective factors, the lower the likelihood of suicidal behavior.
Psychodynamics of suicide in African Americans
- Higher levels of suicidal intent are associated with less emotional investment in relationships and less differentiated self and object representations. Among individuals who have attempted suicide, more severe depressive symptoms are linked with more self-targeted anger, shame, guilt, negative views of relationships, use of unhealthy defenses, and impaired reality testing.
- Object relations mediate the link between childhood maltreatment and suicidal behavior among low-income, African American women.
- Regardless of suicide attempt history, patients with borderline personality disorder wish to be loved and understood, experience rejection from others, and respond with depression and disappointment.
Suicide resilience among African American women
- Among low-income African American women, higher levels of childhood abuse (physical, sexual, emotional) and cumulative abuse are associated with lower levels of suicide resilience. These links are explained by increased acquired capability for suicide and perceived burdensomeness.
- Intrapersonal strengths explain the association between childhood abuse and suicide resilience; intrapersonal strengths are a positive and protective influence on suicide resilience in the face of childhood abuse among this population.
Intimate partner violence among African American women
- A brief screening device for intimate partner violence (Universal Violence Prevention Screening Protocol) can be used in emergency care settings to identify abused, low-income, black women. Screening for intimate partner violence in the ED does not increase the risk of adverse events.
- Women who experience intimate partner violence are
- More prone to symptoms of psychological distress, depression, PTSD, anxiety, parenting stress, and suicidality and more likely to use psychiatric outpatient services
- Less likely to have good social support, which partially accounts for their psychological distress.
- These links are partially explained by multiple ways of coping, spiritual well-being, social support, and ability to access resources.
- Social support partially explains the link between exposure to childhood maltreatment and exposure to intimate partner violence in adulthood.
- Women who indicate greater readiness to leave their abusive partner have worse mental health symptoms, perhaps because they feel more vulnerable and self-aware of their situation. Their readiness to change the abusive situation may contribute to and result from increased psychological distress.
- Perceived neighborhood disorder and community cohesion moderate the relation between exposure to childhood emotional abuse and adult physical intimate partner violence.
- Social support buffers against the dangerous effect of neighborhood disorder on depressive symptoms, hopelessness, and suicide intent in women exposed to intimate partner violence.
Family violence among older African American women
- Among older, inner-city, African American women, lack of employment and high levels of family violence exposure are linked with worse physical and mental health outcomes.
- Among these women, higher spirituality is linked with better physical health.
- The Nia team collaborated in the development of a new measure of family violence in older women (Family Violence in Older African American Women Scale) with two distinct factors: Abuse and Caregiving Failure.
- African American women cite spiritual sources over physicians as being able to help survivors of family violence. Barriers to receiving help include: negative encounters with
- doctors, distrust of the system, and not enough age-appropriate resources.
Intimate partner violence and suicidality among African American women
- Low-income African American women who experience intimate partner violence are at higher risk for psychological distress, such as suicidality, depression, PTSD, hopelessness, and drug use than their nonabused counterparts.
- These women are less likely to have social support from family, friends, and community members.
- Positive changes in employment status make these women less depressed.
- Risk factors for suicidal behavior among abused women include increased number and severity of negative life events, a history of child maltreatment, psychological distress and depression, hopelessness, and substance abuse. Protective factors against suicidal behavior include hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining resources.
Racial/ethnic identity and community in abused, suicidal African American women
- Among low-income African Americans with a history of suicidal behavior and intimate partner violence, experiencing more racist events is linked with increased identification with an individual’s own ethnicity and less identification with those of other ethnicities.
- An individual’s community environment is linked with their mental health. Community disorder increases the risk of psychological distress, which is explained by social support. Social support plays an important role as a point for intervention to improve the mental health of low-income African Americans.
- In conducting culturally sensitive research, it is important to consider race of the interviewer. African American women report higher levels of stress (life, time pressure, and social acceptability), social victimization, and intimate partner violence to African American interviewers than to European-American interviewers.
Impact of childhood maltreatment on adult psychosocial outcomes and mediators of these associations
- African American women who have been abused and attempted suicide report higher levels of different types of childhood maltreatment (childhood sexual abuse, physical abuse, emotional abuse, emotional neglect, and/or physical neglect) than women who never attempted suicide.
- As the number of experiences of childhood abuse increases, so does the likelihood of suicide attempts.
- Sexual coercion by an intimate partner partially explains the link between childhood abuse and suicidal ideation.
- Women with histories of childhood maltreatment also experience more hopelessness, feelings of isolation and detachment, insecure attachment in relationships, problems in taking perspective and thinking about others, and lower social skills. These difficulties with trust, closeness, and hopelessness due to childhood maltreatment increase the vulnerability for suicidal behavior.
- It is through the effects of a lower sense of meaning in life and lower self-esteem that childhood maltreatment is associated with less hopefulness. Along the same lines, childhood maltreatment is related to higher PTSD symptoms due to the effect of lower meaning in life and experiences of intimate partner violence.
- Daily life stressors explain the link between childhood maltreatment and adult intimate partner violence. Additionally, attachment styles (negative views of self and others) explain the link between childhood maltreatment and daily life stressors.
PTSD among African Americans
- African American women who are exposed to intimate partner violence, and consequently experience lower self-esteem and struggles with religious beliefs, are more vulnerable to suffer from PTSD symptoms.
- Women who experience PTSD symptoms suffer from more trauma exposure and thought disorders, which ultimately increase suicidal ideation.
- Childhood maltreatment is related to higher PTSD symptoms due to the effect of lower sense of meaning in life, experiences of intimate partner violence, negative religious coping, and low self-esteem.
- The link between PTSD symptoms and suicidal ideation is explained by depressive symptoms.
- The link between PTSD symptoms and alcohol abuse is explained by life stress.
- Existential well-being explains the links between 1) PTSD symptoms and hopelessness and 2) PTSD and suicidal ideation.
Substance abuse among African Americans
- Low-income African American women who experience intimate partner violence are more likely to become depressed if they abuse alcohol.
- Those with depression are less likely to be employed and more likely to lose their jobs.
- African American women with more secure attachment in relationships, fewer fearful or dismissive attachments, and greater social support from friends and family are less likely to have problems with substance use.
- Intimate partner violence increases the risk of alcohol abuse, and this link is explained by social support.
- Drug abuse is a risk factor for parenting stress.
Parenting stress among African American women
- Parenting stress explains the link between intimate partner violence and child emotional and behavioral problems.
- Existential and religious well-being serves as a protective factor against parenting stress, including parental distress, difficult child, and parent-child dysfunctional interaction.
- Women with higher perceptions of neighborhood disorder have higher parenting stress.
Abused African American women and their children
- Intimate partner violence is related to children’s internalizing and externalizing problems. This link is explained partially by children’s perceived levels of social support.
- Experiencing or witnessing intimate partner violence negatively impacts maternal mental health, family cohesion, and relatedness, which are subsequently linked with poorer child adjustment, especially for internalizing problems.
- Child emotional abuse is linked with poorer peer and family functioning in children.
- Maltreated children are significantly more likely to use psychiatric and medical services.
- Receipt of food stamps, mother’s distress, and child maltreatment increase children’s risk for internalizing and externalizing problems. However, family adaptability and cohesion and participation in after-school programs reduce the risk of these problems.
- The link between child abuse and social functioning is explained by peer and family support.