The Grady Nia Project's Contributions to Science
The Grady Nia Project Works!
- The NIA project is more effective than standard treatment at decreasing general psychological distress, depressive symptoms, and suicidal ideation.
- Nia is also more effective than standard treatment at increasing women's spiritual well-being, self-esteem, and adaptive coping skills.
- A Nia informational 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 of existential well-being. In other words, the treatment done by Nia enhances women's sense of meaning in life. Through this enhanced meaning, depression symptoms and thoughts of suicide decrease.
- Nia is more effective than standard treatment in alleviating hopelessness and improving effectiveness of obtaining resources when working with clients who are motivated to change their abusive situation from the onset of treatment.
- Our clients are highly satisfied with the Nia program and recognize that Nia helps them to talk about intimate violence and suicidal feelings, to reduce their suicidality, and to cope more effectively with domestic violence.
Take home messages
- The Nia project is meeting the goals of improving mental health difficulties, reducing suicidal ideation, and empowering women to use healthy coping strategies in the face of domestic violence.
- Our clients are satisfied with Nia and indicate that Nia has helped them to cope with their psychological difficulties and abusive relationships.
- Nia interventions can be supplemental to other treatments when working with African American women and victims of domestic violence; with special consideration of women that are motivated to change their abusive relationship.
Compassion Meditation Works!
- 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 mediation training is more effective at reducing self-criticism and depression than participating on a traditional support group.
- Compassion meditation reduces depression among suicidal African Americans via its effect on self-criticism.
Take home message
- Compassion meditation is a promising intervention to reduce depression and self-criticism among disadvantaged suicidal African American individuals. In particular, our research suggests that compassion meditation lowers self-criticism, which in turn lowers depressive symptoms in this at risk population.
What Psychological Factors are Associated with Intimate Partner Violence and Suicidality in African American Women?
- Low-income African American women that experience intimate partner violence are at increased risk for psychological distress, such as being suicidal, depressed, and hopeless, and using drugs.
- They also are less likely to have good social support from family, friends, and community members.
- Abused and suicidal women who also abuse alcohol are particularly vulnerable to being depressed.
- Abused and suicidal women who are depressed are less likely to be employed and more likely to lose their jobs.
- Positive changes in employment status make these women less depressed.
Take Home Messages
- Women exposed to intimate violence are more likely than women without a history of abuse to have psychological, social and employment problems
- These problems are most prominent for women who struggle with depression or excessive alcohol use in addition to their abuse history
- Having social support and becoming gainfully employed needs to be a priority in treatment as they have proven to help these women feel better
What are some risk and protective factors associated with suicidality?
- Women that are more involved in religious beliefs and practices have lower acceptance of suicide. Similarly, women that experience a higher sense of meaning in life are less likely to attempt suicide.
- Women that have children, use healthy coping skills, are hopeful and confident in their own abilities, have access to appropriate resources, and perceive positive social support and a sense of belonging, are less likely to engage in suicidal behavior.
- Feeling close to the family of origin as well as feeling accepted and valued in the family also protect against suicide attempts.
- Difficulties adjusting to marriage, experiencing negative life events, having a history of child abuse or multiple experiences of trauma, as well as mental health difficulties such as distress, depression, PTSD, and substance use, increase the risk for suicidal behavior among African American women.
- The greater the number of risk factors a woman has, the higher the risk of suicidal behavior. Conversely, the greater the number of protective factors a woman has, the lower the likelihood of attempting suicide.
Take home messages
- Experiencing mental health issues, trauma, and other negative life experiences increase the risk for suicidal ideation.
- Conversely, having a supportive context and a sense of self-confidence protects against suicidality.
- Spirituality, or the degree to which a woman perceives meaning in her life and is connected to religious beliefs/practices, is an especially important protective factor against suicidality among low-income African American females. Thus, spirituality should be considered in treatment.
- There is a cumulative effect of risk and protective factors that can further increase or decrease vulnerability.
- When developing interventions for suicidality it is important to consider the psychosocial risk and protective factors associated with suicidality and direct efforts towards reducing women’s vulnerability by targeting the factors listed above.
How are some psychosocial variables related to suicidal ideation?
- Being a mother protects women from suicidal ideation by increasing a woman's reasons for living.
- Women with lower self-confidence are more vulnerable to suicidality due to the effects of low levels of perceived social support and poor effectiveness obtaining resources. Thus, lower self-perceived ability results in lower social support and poorer effectiveness obtaining results, and in turn these factors increase suicidal behavior.
- Poor social environmental factors, such as low social support and low family attachment, increases the likelihood of experiencing depression. Furthermore, due to the effect of depression, these social factors are associated with having more suicidal thoughts.
- Partner abuse is related with suicidal behavior by increasing psychological distress, hopelessness, and drug use. This relationship is weakened when women perceive greater access to social support.
- Lastly, PTSD is associated with suicidal intention due to the effect of exposure to trauma and psychotic-spectrum symptoms such as paranoid ideation and hallucinations.
Take home messages
- Some of the ways that partner abuse is associated with suicidal ideation is by increasing psychological difficulties and hopelessness among African American females. Social support can protect these women from the negative effects of partner abuse.
- Being in a non-supportive environment leads to greater risk for depressive symptoms, which in turn increase suicidal ideation.
- Similarly, women who experience PTSD symptoms suffer from more trauma exposure and thought disorders which ultimately increase suicidal ideation.
- It is important to understand the ways through which different psychosocial factors increase suicidal ideation in order for our treatments to be more effective by addressing these specific factors.
How is abuse related to negative psychological outcomes?
- Intimate violence results in greater depressive symptoms and stress in parenting through the effect of less adaptive ways of coping, lower spiritual well-being, and lower social support.
- Similarly, exposure to intimate violence results in more anxiety symptoms when women use less adaptive ways of coping, have a lower social support, and are forced to use more medical and psychosocial services (e.g., shelters, food banks, case managers, emergency rooms).
- Lastly, abused women are more likely to struggle with self-esteem as well as religious faith and practices, which in turn increases the risk of PTSD symptoms.
Take home messages
- Having less adaptive coping skills, a lower sense of spirituality, and perceiving poor social support increases the risk of suffering from negative psychological outcomes in African American women exposed to intimate partner abuse.
- African American women who are victims of domestic violence are more likely to use treatment services and due to this higher treatment utilization they are at higher risk of suffering from anxiety symptoms.
- African American women that are exposed to domestic violence, and as a result experience lower self-esteem and struggle with their religious beliefs, are more vulnerable to suffer from PTSD symptoms.
What are the psychosocial factors that distinguish suicide attempters from nonattempters?
- Disadvantaged African American women victims of interpersonal violence with a history of suicide attempts are at an increased risk of experiencing global psychological distress, PTSD symptoms, depression, hopelessness, and substance abuse when compared with African American woman that have similar demographics but have never attempted suicide.
- When compared to individuals who do not attempt suicide, women that attempt suicide also report less efficiency in finding resources, fewer adaptive coping strategies, lower spiritual well-being and lower self-confidence in their abilities.
- They also have perceive less supportive strengths in their families, lower satisfaction in their intimate partnership, low levels of social support, and poor interpersonal conflict skills.
- Individuals who don't attempt suicide are less acceptant of suicide, engage in more religious practices, and plan more strategies to prevent harm and to leave the abusive relationships than those who attempt suicide.
- Women with more than one suicide attempt are at higher risk to commit suicide, have experienced more childhood trauma, have greater mental health problems, and are more hopeless about the future than women who attempt suicide for the first time.
Take home messages
- There are psychosocial factors that differentiate those who attempt suicide from those who do not nonattempters. These factors need to be considered in treatment.
- Women that attempt suicide experience more mental health difficulties, have more problems in their relationships, and perceive less support from their environment than women that have similar social backgrounds but that have not attempted suicide.
- Women that have attempted suicide in more than one occasion are even more vulnerable to suicidality and require closer monitoring and attention.
What do we know about history of childhood maltreatment as it relates to adult psychosocial difficulties and suicidality?
- African American women who have been abused and have 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 made a suicide attempt.
- As the number of experiences of childhood abuse increase, so does the likelihood of suicide attempts in this women.
- 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 of trust, closeness, and hopelessness associated with 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 hopelessness. Along the same lines, childhood maltreatment is related with higher PTSD symptoms due to the effect of lower meaning in life and experiences of intimate partner violence.
Take home messages:
- Women that are maltreated in their childhood are more likely to experience psychological and social difficulties as well as suicidality.
- Women that were repetitively abused in their childhood are especially vulnerable to suicide attempts.
- Having a sense of meaning is an important factor that protects African American women with a history of childhood maltreatment from hopelessness and PTSD symptoms.
- Having a history of childhood maltreatment and being exposed to domestic violence increases the risk of experiencing PTSD symptoms.
What are some other aspects to consider in treatment when working with abused African American females?
- Compared to national averages, low-income African American women are less likely to seek medical and mental health treatment. Medical care and routine psychiatric care are among the services that are more frequently used in this population.
- African American women who report higher intimate violence exposure are more likely to use psychiatric outpatient services.
- African American women who were recruited in an emergency department of a public hospital and were exposed to intimate partner violence are more likely to be uninterested about changing their abusive situation or ambivalent about the need to change.
- African American women that indicate a desire to change the abusive situation also suffer from more symptoms of depression, PTSD, and suicidal ideation.
- African American women that are insecure and anxious about their close relationships and experience more difficulties in social interactions attend therapy less frequently.
Take home messages
- African American women are less likely to seek treatment and might only do so when in need of immediate medical services or in emergency situations. Thus, emergency rooms and primary care settings are especially important to engage this population in treatment.
- In this population, women are more motivated to change when the negative psychological outcomes associated with the abusive situation increases. Similarly, the use of psychiatric services is greater in females that report higher levels of abuse and might indicate higher levels of vulnerability.
- Women´s levels of motivation to change should be evaluated and address at the onset of treatment or in emergency settings. Targeting motivation to change in emergency departments when women are just in the beginning stages of change is especially important to increase treatment utilization.
- Women that experience more difficulties in their social relationships are more likely to dropout of treatment. Thus, interpersonal styles of women seeking for services need to be addressed to increase treatment retention.
Other important findings:
- We developed a brief mental health survey for use in emergency departments to identify women victims of intimate partner violence
- We found that African American individuals who experience racism identify more with African American culture and are less affiliated to other ethnic and racial groups
- We confirmed the usefulness of using a comprehensive biopsychosocial approach to analyze the experiences of abuse among incarcerated women: