Psychological Medicine

Original Articles

Pathways to suicidality across ethnic groups in Canadian adults: the possible role of social stress

D. E. Clarkea1a2a3a4 c1, A. Colantonioa3a4a5, A. E. Rhodesa2a3a6a7a8 and M. Escobara3

a1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

a2 Department of Psychiatry, University of Toronto, Toronto, Canada

a3 Graduate Department of Public Health Sciences, University of Toronto, Toronto, Canada

a4 Toronto Rehabilitation Institute, Toronto, Canada

a5 Department of Occupational Science and Occupational Therapy, University of Toronto, Canada

a6 Suicide Studies Unit, St Michael's Hospital, Toronto, Canada

a7 Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Canada

a8 Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Hospital, Canada


Background Ethnicity is an important determinant of mental health outcomes including suicidality (i.e. suicidal ideation and suicide attempt). Understanding ethnic differences in the pathways to suicidality is important for suicide prevention efforts in ethnically diverse populations. These pathways can be conceptualized within a social stress framework.

Method The study examines ethnic differences in the pathways to suicidality in Canada within a social stress framework. Using data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) and path analysis, we examined the hypotheses that variations in (1) socio-economic status (SES), (2) sense of community belonging (SCB), (3) SES and SCB combined, and (4) SES, SCB and clinical factors combined can explain ethnic differences in suicidality.

Results Francophone whites and Aboriginals were more likely to report suicidality compared to Anglophone whites whereas visible minorities and Foreign-born whites were least likely. Disadvantages in income, income and education, income and its combined effect with depression and alcohol dependence/abuse led to high rates even among the low-risk visible minority group. Indirect pathways for Asians differed from that of Blacks and South Asians, specifically through SCB. With the exception of SCB, Aboriginals were most disadvantaged, which exacerbated their risk for suicidality. However, their strong SCB buffered the risk for suicidality across pathways. Disadvantages in education, income and SCB were associated with the high risk for suicidality in Francophone whites.

Conclusions Francophone whites and Aboriginals had higher odds of suicidality compared to Anglophone whites; however, some pathways differed, indicating the need for targeted program planning and prevention efforts.

(Received November 16 2006)

(Revised September 21 2007)

(Accepted October 01 2007)

(Online publication November 02 2007)


c1 Address for correspondence: D. E. Clarke, Ph.D., Research Associate, Department of Mental Health, Johns Hopkins School of Public Health, Hampton House, Room 802, 624 N. Broadway, Box 495, Baltimore, MD 21205, USA. (Email: