Reducing the Burden of Suicide among American Indian and Alaska Native Youth

Presenter

Catherine Roca, M.D.
Office for Research on Disparities and Global Mental Health

Goal

The overall goal of this initiative is to stimulate research focused on preventing suicide and promoting resilience in American Indian and Alaska Native (AI/AN) youth.

Rationale

Native youth suffer disproportionately from suicide. From 2009-2012, the age-adjusted suicide rate for American Indian and Alaska Native youth ages 10-24 was 14.66/100,000, which is significantly higher than the overall suicide rate for that U.S. age group of 8.25/100,000.¹ Male Alaska Native youth (10-24) in particular suffer from the highest rate of suicide of all demographic groups, 109/100,000 (2009-2012).² However, not all American Indian and Alaska Native communities experience the same challenges with suicide. Rates can vary considerably among communities, even within the same region.^3,4,5 While the causes for this variation are poorly understood, suggested explanations for resilience in certain individuals and communities include increased adherence to cultural spirituality,⁶ and meaningful community participation and participation in traditional practices.⁷ Culturally sensitive, public health approaches to suicide prevention have yielded some successes;⁸ however, a systematic review of the literature concluded there is insufficient evidence to know which strategies are most effective in preventing suicide among indigenous populations.⁹ Creating strong partnerships between the communities, local governments and researchers to rigorously evaluate current programs, developing community-based strategies that keep in mind the preferences of Native communities, and developing interventions that can be delivered in low resource settings will enhance current efforts to develop the HHS Tribal Behavioral Health Agenda, as well as efforts of the Arctic Council to reduce suicide in the circumpolar North.

Areas of interest include:

• Development of models for sustainable use of task-shifting for culturally congruent delivery of treatment engagement strategies, as well as training and supervision of a variety of health workers for delivery of mental health interventions;
• Where such models exist, implementation research for scale up of evidence-based models of task shifting in mental health care;
• Implementation research to identify appropriate application of technology to extend mental health human resources in remote and rural settings;
• Research to identify effective, feasible approaches to reducing access to lethal means for suicidal individuals through community partnership agreements;
• Research to determine mechanisms of risk and resilience in youth for suicidal behavior outcomes; and,
• Research to determine how to improve the adoption, fidelity of implementation, and sustainability of effective youth suicide prevention programs, with attention to efficient ways of training various types of providers.

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References

¹http://www.cdc.gov/injury/wisqars/index.html . Retrieved May 1, 2015.

² Suicide Statistics for Alaska (2010). Alaska Department of Health and Social Services, Statewide Suicide Prevention Council. http://dhss.alaska.gov/SuicidePrevention/Pages/statistics.aspx 

³ Regional Differences in Indian Health: 2002-2003 Edition http://www.ihs.gov/dps/publications/regionaldifferences03/#p4 

⁴ Young, T., Revish, B., Soininen, L. (2015) Suicide in circumpolar regions: An introduction and overview. International Journal of Circumpolar Health, 74:27349.

⁵ Mullany, B., Barlow, A., Goklish, N., Larzelere-Hinton, N., Cwik, F., Craig, M., & Walkup, JT. (2009) Toward understanding suicide among youth: Results from the White Mountain Apache tribally mandated suicide surveillance system, 2001-2006. American Journal of Public Health, 99(10), 1840-1848.

⁶ Garroutte, E., Goldberg, J., Beals, J., Herrell, R., Manson, S., and the AI –SUPERPFP Team. (2003) Spirituality and attempted suicide among American Indians. Social Science and Medicine, 56(7), 1571-1579.

⁷ DeCou, CR., Skewes, M.C., and Lopez E.D. (2013) Traditional living and cultural ways as protective factors against suicide: perception of Alaska Native university students. International Journal of Circumpolar Health, 72:20968.

⁸ May, P.A., Serna, P., Hurt, L. and DeBruyn. (2005) Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. American Journal of Public Health. 95(7), 1238-1244.

⁹ Clifford A.C., Doran C.M. and Tsey K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC Public Health.13: 463.