Suicide and Spiritual Resistance Among Black People in the U.S.: From Death Consciousness to Divine Consciousness

Thesis advisor: Thanh V. TranSuicide is an escalating public health crisis for Black people in the United States, yet the majority of the suicide research in the United States is based on the European American population. The psychological impact of the centuries of persistent stress and pain Black Americans have endured in the U.S., fueled by racism since the tragic period of slavery, is well-documented. However, despite the unrelenting historical and contemporary manifestations of racism and other systems of oppression in U.S. society, Black Americans have chosen death by suicide at rates lower than White Americans. Previous research has established the complexity of suicide and revealed that there are multiple personal and societal stress factors that contribute to creating risk factors for Black suicide. Research has also established that Black Americans historically have cultivated a resistance to the desire to take their own lives, seemingly linked to religious/spiritual and cultural coping resources that have served as a protective factor against suicidal behavior. Yet, there is a lack of scholarship that explores the impact of these resources on suicide in this population. Suicidologists are calling for suicide to be examined within a multidimensional contextual framework and for there to be a shift from a deficit approach to a strengths-based approach. There is a need for greater research focus on the factors that influence suicidal behavior in Black Americans, as well as the factors that are associated with creating a shield of protection against this self-destructive behavior. Through a convergent mixed-method approach, and guided by a robust cluster of theories, with Critical Race Theory and the Afrocentric Worldview as the overarching theoretical and philosophical approaches, this dissertation aims to address the gaps in the literature by examining several research questions. The following questions are examined through quantitative research: (1) Do racial discrimination and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and racial discrimination and personal stress?; (2) Do post-incarceration status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and post-incarceration and personal stress?; (3) Do veteran status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and veteran status and personal stress? The data for this study were drawn from the cross-sectional National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) III which covers April 2012-June 2013. Logistic regression was employed to analyze the data. The quantitative research explores the impact of personal and societal stressors on the mental health of Black people and the role of religion/spirituality in cultivating a healthy emotional and mental environment that insulates them from suicide. The qualitative data include interviews with three adult Black men from the researcher’s family across three generations. Through three generations of Black men from one family, this dissertation further aims to examine whether religion/spirituality is a protective factor insulating Black people in the U.S. from developing suicidal behavior as they navigate societal stress factors including racial discrimination, post-incarceration status, and veteran status and whether religion/spirituality as a protective factor is passed down intergenerationally. If so, it aims to explore whether there are any intergenerational patterns and/or differences in the utilization of religion/spirituality as a source of protection against developing suicidal behavior. Assessed together, the findings from the quantitative and the qualitative research underscore the potential impact of stress and societal stress factors on suicidal behavior among Black people. Specifically, the quantitative research shows an association between personal stress and societal stress factors including racial discrimination, post-incarceration status, veteran status, and suicide attempts. The quantitative research also underscores the complexity of the role of religion/spirituality as a protective factor, as the findings from the quantitative research show that religion/spirituality was not a buffer against suicide attempts for the participants in that study. The findings from the qualitative research reveal that religion/spirituality can serve as a buffer and illustrates religion/spirituality functioning as an extension of Afrocentric culture and serving as a protective shield enabling some Black people to resist the full psychological impact of personal and societal stressors. This dissertation provides the foundation for the broader work highlighted through this study encapsulated in the Ubuntu Relational Framework for the Study of Black Suicide, an Afrocentric framework I developed that emerged as a guide for exploring the risks and protective factors of Black suicide. The constructs of death consciousness and Divine consciousness emerged during the analysis of the qualitative research as a way of conceptualizing the influence of societal stressors and protective factors on suicidal behavior, and they are an expression of Afrocentric culture. This framework highlights the need to equally prioritize the concern of what animates Black people’s desire to live, which was illuminated through the qualitative research, along with the question of what factors make them at risk for cultivating a desire to die. It further attends to the need for social workers to address the conditions of the racist U.S. environment these factors are assessed within. This dissertation also includes my autoethnography which serves as an analytic review and critical analysis of key concepts related to the study of Black suicide. It is a resource for further grounding in the historical and contemporary context of the Black experience and the Afrocentric worldview incorporated in this work. Autoethnography is an epistemological site for exploring Divine consciousness and the role of religion/spirituality and culture passed down intergenerationally as a protective factor against suicidal behavior. It further outlines a methodology for employing spiritual and cultural resources and operationalizing spiritual resistance. Finally, this dissertation goes beyond identifying risk and protective factors for suicidal behavior in Black people. It outlines a structure for training social work clinicians and researchers in this Afrocentric framework that would expand social workers’ knowledge of African-centered social work, and a method appropriate for responding to this multidimensional mental health problem that requires a creative, culturally rich approach. The training includes a methodology for employing religious/spiritual and cultural resources that operationalizes spiritual resistance that will equip social workers for supporting Black people in developing a healthy holistic mental and social environment within an oppressive racist environment.Thesis (PhD) — Boston College, 2021.Submitted to: Boston College. Graduate School of Social Work.Discipline: Social work

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A call to healing: Black Lives Matter movement as a framework for addressing the health and wellness of Black women

The Black Lives Matter (BLM) movement re-centered and illuminated the disparities facing the Black population as a result of systemic racism in the United States (U.S.). Notably, BLM also highlighted and uplifted issues facing Black women. Numerous studies have demonstrated that Black women are at-risk for cardiovascular disease, maternal and infant mortality, breast cancer, and mental health symptoms. This paper seeks to argue that the BLM movement is a critical site for radical transformation for raising critical consciousness. In focusing on the well-being of Black people, BLM puts forth a framework of healing justice that employs an anti-racist, intersectional, holistic, and culturally and politically appropriate informed therapeutic approach. This framework addresses the historical and contemporary trauma that Black people have and continue to experience in the U.S. This paper asserts that this framework can cultivate a space of vulnerability for Black women to heal and to continue to develop resilience for liberation and self-determination.

A call to healing: Black Lives Matter movement as a framework for addressing the health and wellness of Black women

The Black Lives Matter (BLM) movement re-centered and illuminated the disparities facing the Black population as a result of systemic racism in the United States (U.S.). Notably, BLM also highlighted and uplifted issues facing Black women. Numerous studies have demonstrated that Black women are at-risk for cardiovascular disease, maternal and infant mortality, breast cancer, and mental health symptoms. This paper seeks to argue that the BLM movement is a critical site for radical transformation for raising critical consciousness. In focusing on the well-being of Black people, BLM puts forth a framework of healing justice that employs an anti-racist, intersectional, holistic, and culturally and politically appropriate informed therapeutic approach. This framework addresses the historical and contemporary trauma that Black people have and continue to experience in the U.S. This paper asserts that this framework can cultivate a space of vulnerability for Black women to heal and to continue to develop resilience for liberation and self-determination. </p

Partial Loss of USP9X Function Leads to a Male Neurodevelopmental and Behavioral Disorder Converging on Transforming Growth Factor β Signaling

The X-chromosome gene USP9X encodes a deubiquitylating enzyme that has been associated with neurodevelopmental disorders primarily in female subjects. USP9X escapes X inactivation, and in female subjects de novo heterozygous copy number loss or truncating mutations cause haploinsufficiency culminating in a recognizable syndrome with intellectual disability and signature brain and congenital abnormalities. In contrast, the involvement of USP9X in male neurodevelopmental disorders remains tentative. We used clinically recommended guidelines to collect and interrogate the pathogenicity of 44 USP9X variants associated with neurodevelopmental disorders in males. Functional studies in patient-derived cell lines and mice were used to determine mechanisms of pathology. Twelve missense variants showed strong evidence of pathogenicity. We define a characteristic phenotype of the central nervous system (white matter disturbances, thin corpus callosum, and widened ventricles); global delay with significant alteration of speech, language, and behavior; hypotonia; joint hypermobility; visual system defects; and other common congenital and dysmorphic features. Comparison of in silico and phenotypical features align additional variants of unknown significance with likely pathogenicity. In support of partial loss-of-function mechanisms, using patient-derived cell lines, we show loss of only specific USP9X substrates that regulate neurodevelopmental signaling pathways and a united defect in transforming growth factor β signaling. In addition, we find correlates of the male phenotype in Usp9x brain-specific knockout mice, and further resolve loss of hippocampal-dependent learning and memory. Our data demonstrate the involvement of USP9X variants in a distinctive neurodevelopmental and behavioral syndrome in male subjects and identify plausible mechanisms of pathogenesis centered on disrupted transforming growth factor β signaling and hippocampal function