Suicide and prostitution among street youth: a qualitative analysis

Adolescence, Summer, 2002 by Sean A. Kidd, Michael J. Kral

In recent years, increasing attention has been paid to the problem of street youth suicide in the research literature. Most studies report a suicide attempt rate for that population between 20% and 40% (Adlaf& Zdanowicz, 1999; Greene & Ringwalt, 1996; Molnar, Shade, Kral, Booth, & Watters, 1998; Rotheram-Borus, 1993; Stiffman, 1989; Yoder, 1999). Hwang (1999), in a study conducted in Toronto (Ontario death records 1995-1997), found that homeless males aged 18-24 had a completed suicide rate of 77/100,000. This rate is 10.3 times higher than the national rate for males of that age group. Of the possible explanations for these high rates of suicidal behavior, childhood physical and sexual abuse have received considerable attention. It has been found that street youth who have attempted suicide are more likely to have been physically and/or sexually abused than street youth who have not attempted suicide (Molnar et al., 1998; Yoder, 1999). Other factors that have been linked with suicidal behavior among street youth are being female, having a history of attempting suicide, being a "throwaway," poor self-esteem, depression, having a friend who attempted suicide, lack of food and shelter, fighting with peers, HIV/AIDS, a family history of substance abuse, and substance abuse (Greene & Ringwalt, 1996; Hagan & McCarthy, 1997; Ringwalt, Greene, & Robertson, 1998; Rotheram-Borus, 1993; Rotheram-Borus, Koopman, & Ehrhardt, 1991; Yoder, 1999).

A major stressor in the lives of street youth is finding a source of income. Research has indicated that 16-46% of street youth become involved in prostitution (Kipke, Unger, O'Connor, Palmer, & LaFrance, 1997; McCarthy & Hagan, 1992; Schissel, 1997; Yates, Mackenzie, Pennbridge, & Swofford, 1991), and the majority of those working as prostitutes are street youth (Farley & Barkan, 1998). When compared to other street youth, individuals who engage in prostitution more frequently report histories of childhood abuse, particularly sexual abuse (Adlaf & Zdanowicz, 1999; Schissel, 1997; Yates et al., 1991). Additionally, individuals who enter into prostitution as children/juveniles, especially those with histories of abuse, are more likely to have been forced into the sex trade (over 50%) (Larsen, 2000). The day-today experiences of persons who are prostituting themselves are equally bleak. Sexual and physical violence are common, they are an extremely high risk group for AIDS, and are frequently found to be suffe ring from posttraumatic stress disorder and depression (Earls & David, 1989; Farley & Barkan, 1998). Finally, street youth involved in prostitution have also been found to be more likely to be abusers of crack cocaine, and are more entrenched (heavily identify) with the street lifestyle (Adlaf & Zdanowicz, 1999).

Suicide among street youth working as prostitutes has received relatively little attention. Yates et al. (1991) found that these youth more often abuse drugs and are more likely to have made a suicide attempt. Seng (1989) found that children who engaged in prostitution were more "potentially suicidal" than children who had been sexually abused but had not been prostitutes. Adlaf and Zdanowicz (1999) did not find a significant difference in the suicide attempt rate for street youth invalved in prostitution. This was likely due to the very small number of such youth they used in their cluster analysis (n = 4), given that 3 of those 4 youth reported having made a suicide attempt. Such findings, in combination with high rates of recognized risk factors for suicide among this group, highlight the importance of further investigation.

A potential limitation of the research conducted thus far is that very little has been done to access the meanings street youth involved in prostitution give to their experiences. Investigating these meanings is important for determining the variables that might be involved and how these are situated culturally and contextually (Kazdin, 1998). Studying suicide by using narrowly operationalized variables may miss constructs important to the participants. This is especially likely given the differences in the experiences between street youth working as prostitutes and the mainstream populations from which many measures and much of current theory have been developed.

An influential interpretation of the phenomenon of suicide has been put forth by Shneidman (1996), who views suicide as an action taken when a person's threshold for psychological pain has been reached and becomes unbearable. This psychological pain arises from the individual's understanding of his or her past experiences, present circumstances, and potential future. Within this framework, an experience such as a history of sexual abuse is not a binary entry into a linear decision process of whether or not to end one's life. The emotional state of persons as they remember the abuse they suffered, and indeed the memory itself (Schacter, 1996), are strongly influenced by their personal understanding and perception of that experience and the context in which the act of remembering occurs. Further, this understanding changes as a function of context and cultural influence (Shore, 1996). It is from this theoretical stance that the present study was undertaken. The goal was to gain an understanding of what "suicid e" means to street youth who have been involved in prostitution-their understanding of the kinds of experiences and feelings that lead up to suicide, what a suicidal act is, and what happens after suicide. Also sought were the participants' perceptions of their strengths and the kinds of experiences that dissuade them from attempting to end their lives (an area too seldom addressed in suicide research). This inductive approach is contrasted with traditional deductive hypothesis testing in which the researcher's understandings of what comprises suicidal distress and risk are applied. It was hoped that the present study would reveal variables and constructs central to sex-trade-involved street youths' understandings of suicide.