Suicidality Among Adolescent Alberta Indians

A high rate of suicide attempts and suicide ideation characterized a sample of 229 grade 7 to 9 adolescents resident on seven reserves in central Alberta. The prevalence of suicidality for these adolescent Indians was very similar to rates reported for Navajo youth and for 8th- and 10th-grade American non-Indian students. Comparison of Indian and non-Indian suicidality risk factors showed somewhat elevated levels of family disruption and psychological problems among Indian adolescents. Compared to Canadian nonadolescents, substance abuse levels were high, and conditions necessary to modeling were virtually omnipresent. Suicide ideation was significantly elevated for Indian adolescents with low psychological well-being, no father in the home, and a prior suicide in the household. Controlling for age, risk factors for suicide attempts were heavy alcohol use, no father in the home, sleeping problems, and low psychological well-being. The high rates of adolescent Native suicide imply that a much higher proportion of their suicide attempts succeed. Targeted, community-based counselling and educational programs are needed to address these problems.     

Disentangling the Person and the Place as Explanations for Regional Differences in Suicide

Identifying whether suicides in a region are due to characteristics of the residents living there or to some enduring feature of the region is difficult when using cross‐sectional studies. To distinguish these factors, we compared the suicides of a region's residents with people who were temporarily visiting the region. Using U.S. death records from 1973–2004, we focused on states with the highest and lowest suicide rates over this period. The high suicide region consisted of Arizona, Colorado, Montana, New Mexico, Nevada, Oregon, and Wyoming; the low suicide region consisted of Connecticut, Illinois, Massachusetts, New Jersey, and New York. For each region, we considered three groups of decedents: residents who died inside the region, residents who died outside the region, and visitors to the region. Proportionate mortality ratios were calculated for all suicides and separately for firearm suicides. In the high suicide region, visitors to and residents away from the region both had elevated suicide levels, to about the same extent as residents dying inside the region. Therefore, short‐term exposure to the region and being a resident of the region each predicted suicide. In the low suicide region, the suicides of residents at home were reduced, but their suicides rose dramatically once they left the area. There was no decrease in suicides among visitors to the region. Firearm use was related to the suicide levels of each region. Overall, the results suggest that both the available means to commit suicide and the contextual features of the regions contributed to their extreme suicides. We discuss how an examination of visitors can help researchers generate novel inferences about the causes of suicide.     

Living in Harmony with Navajo Indian Traditional Religious Beliefs: Honesty,Acceptance, and Understanding

ABSTRACT

This paper reports on the religious beliefs and traditions of Navajo American Indian elders. It reinforces the importance of religion in their everyday lives, and the commitment they have to fulfilling important roles within their culture as American Indian elders. The paper also discusses developing an appreciation of Navajo religious beliefs and particularly honesty, acceptance and understanding. Information for this paper was gleaned from poetry group sessions with older Navajo Indians who were residents of an extended care facility.     

Violent death in the West: suicide and homicide in New Mexico, 1958-1987

We examined New Mexico vital statistics data for suicides and homicides among the state's Hispanics, Native Americans, and non-Hispanic whites collected from 1958 to 1987. We found high age-adjusted rates for both suicides and homicides among Hispanic and Native American males, in comparison with rates for non-Hispanic white males. Suicide rates among Native American women were comparatively low, contrasting with their high homicide rates. Homicide rates for males in all three ethnic groups increased substantially over the 30-year study period. We conclude that death from violent causes, both suicide and homicide, is a major public health problem in New Mexico, and disproportionately affects minority males.     

Health Problems and Male Firearm Suicide

Drawing on constructs of masculinity as it relates to both gun ownership and men's health, we use a rich data set, the New Jersey Violent Death Reporting System as well as hospital discharge data, to analyze 3,413 completed male suicides between the years of 2003 and 2009. We test the hypotheses that the use of firearms is more common when physical health problems are cited as suicide circumstances, and that suicide decedents who use firearms have poorer physical health than those who used other methods. Results show that firearms are disproportionately used in male suicides when physical health is listed as a circumstance. Additionally, among suicide decedents with a hospitalization during the 3 years prior to death, those who used firearms were in poorer health than those who used other methods. These findings have implications for prevention efforts, because restricting access to lethal means is an important aspect of suicide prevention.     

Understanding Suicide in Socially Vulnerable Contexts: Psychological Autopsy in a Small Town in Mexico

In Mexico, suicides are increasing in certain latitudes where local rates have grown to levels of alert; suicide is also the second most common cause of death for the group aged 15 to 19. The psychological autopsy method was utilized to uncover and analyze common factors in all of the registered suicides within 2011 and 2012 in a small town of the state of Guanajuato, located in the center of Mexico. A total of nine decedents were analyzed, and 22 interviews were conducted. The most salient factors were as follows: poverty, financial stress, substance abuse, low levels of education, conflictive relationships, and a poor handling of emotions. The concepts of social exclusion and vulnerability were employed to analyze suicides as symptoms of a much deeper problem of this country, suggesting that anomie and social malady are nowadays important suicidal factors, mostly for children and young people.     

Alcohol involvement in hospital-admitted nonfatal suicide acts

We analyzed alcohol involvement in 84,005 medically identified live discharges for self-inflicted intentional injuries (typically suicide acts) from hospitals in 20 U.S. states in 1997. Alcohol was involved in 27% of the discharges. Evidence of alcohol was significantly more prevalent in men than women, but generally men drink more than women. Blacks had the highest alcohol involvement in their suicide acts relative to their drinking patterns. Overall, alcohol involvement rose and subsequently fell with age, with involvement above 30% for ages 30-55. Lowering the minimum legal drinking age to 18 from 21 could potentially raise alcohol-involved suicide hospitalizations among youth by an estimated 27%.     

Suicidal Behavior in Relatives or Associates Moderates the Strength of Common Risk Factors for Suicide

The prevalence and odds ratios of different suicide risk factors were compared in three pairs of decedents: 80 suicides and 25 injury decedents with blood relatives with suicidal behavior history (biologically exposed); 259 suicides and 126 injury decedents with unrelated acquaintances with suicidal behavior history (socially exposed); and 471 suicides and 523 injury decedents with neither relatives nor acquaintances with suicidal behavior history (unexposed). Negative life events and high psychological stress were more common in socially exposed suicides than in other suicides. The adjusted odds ratios of most established suicide risk factors were higher in unexposed decedents than in biologically or socially exposed decedents, suggesting that the predictive value of established risk factors wanes in individuals who have been exposed to suicidal behavior in family or friends.     

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents

Suicide is currently the second leading cause of death for ages 15–24 years; reports indicate that 6–8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.     

A theory of reservation-dwelling American Indian alcohol use risk

The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group. It considers the distinction between factors that influence mean levels of American Indian problem drinking and factors that influence individual differences in American Indian drinking. It proposes important contextual differences between reservation-dwelling American Indians and Caucasians that may help explain the higher mean levels of American Indian problem drinking. The theory further holds that, within the high mean level of problem drinking characteristic of many American Indian reservations, individual differences in problem drinking can be explained by very similar personality and learning factors as those that influence problem-drinking levels for other ethnic groups.     

Outpatient health care utilization of suicide decedents in their last year of life

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care.     

Suicidal behavior in urban American Indian adolescents: a comparison with reservation youth in a southwestern state

The majority of American Indians live off of reservations, yet research on suicidal behavior in this population overwhelmingly focuses on reservation Indians. This exploratory study interviewed a stratified random sample of 144 urban and 170 reservation American Indian adolescents to compare rates and correlates of suicidal behavior. One fifth of urban youth and one third of reservation youth reported lifetime suicidal ideation, although similar numbers (14%-18%) reported an attempt. Urban youth had fewer psychosocial problems, and in separate multivariate analyses, the groups shared no common correlate of attempted suicide. Different approaches to prevention and treatment may be warranted for urban Indian youth.     

Validity and reliability of the audit and CAGE-AID in Northern Plains American Indians

According to the Indian Health Service, substance abuse and Type 2 diabetes are serious problems among Native Americans. To assess substance use in a medical setting, valid screening tests are needed so the Alcohol Use Disorders Identification Test (AUDIT), a simple brief screen for excessive drinking, and the CAGE-adapted to Include Drugs (CAGE-AID) for identifying primary care patients with alcohol and drug disorders were given 50 Northern Plains American Indians with diabetes. Both are short, easy to administer, have good sensitivity and specificity, and can be easily incorporated into a medical history protocol or intake procedure. Reliability coefficients were above .90 and appeared to have sufficient concurrent and divergent validity indicated by moderate correlations with the General Well-being Schedule (rs=-.39 and -.36), the Family-Adaptation, Partnership, Growth, Affection, & Resolve (r =-.47 and -.36), and the Beck Depression Inventory-IT (r = .36 and .29).     

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.     

American Indian methamphetamine and other drug use in the Southwestern United States

To investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region, we developed collaborations with Southwestern tribal entities and treatment programs in and around New Mexico. We held nine focus groups, mostly with Southwestern AI participants (N = 81) from three diverse New Mexico communities to understand community members, treatment providers, and clients/relatives views on methamphetamine. We conducted a telephone survey of staff (N = 100) from agencies across New Mexico to assess perceptions of methamphetamine use among people working with AI populations. We collected and analyzed self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (ASI) in the context of treatment at three diverse addiction treatment programs. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treat methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.     

Comparison of suicides among Anglos and Hispanics in five southwestern states

Little is known about deaths resulting from self-inflicted violent behavior for Hispanic Americans. To learn more about suicide for Hispanics of Mexican origin (Mexican Americans) we focused on the five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) in which more than 60% of all Hispanics in the United States reside (86% of whom are Mexican American). We obtained data on the number of suicide deaths in the white population, with Hispanics and Anglos (white, non-Hispanic) identified separately. Suicides of Anglos were used as a comparison group. Results show that the suicide rate for whites in the five southwestern states (15.6) was almost one-fourth higher than the rate for whites nationally (12.7). Suicide rates for the two ethnic groups, however, showed the rate for Hispanics (9.0) to be less than the national rates for whites (12.7) and one-half that of Anglos residing in the same area (17.3). The lower suicide rate for Hispanics relative to Anglos is seen for both males and females. The ratio of male and female suicides for Hispanics was almost twice that for Anglos (4.0 to 1 for Hispanics and 2.3 to 1 for Anglos). More than 1 in 3 Hispanic men who committed suicide and more than 1 in 4 Hispanic women who committed suicide are under the age of 25.     

Preventing substance abuse in American Indian and Alaska native youth: promising strategies for healthier communities

Substance abuse has had profoundly devastating effects on the health and well-being of American Indians and Alaska Natives. A wide variety of intervention methods has been used to prevent or stem the development of alcohol and drug problems in Indian youth, but there is little empirical research evaluating these efforts. This article is an overview of the published literature on substance use prevention among Indian adolescents, providing background epidemiological information, a review of programs developed specifically for Indian adolescents, and recommendations for the most promising prevention strategies currently in practice.     

Anthropology and anthropologists in the Indian New Deal

The use of anthropological techniques to analyze problems in American society was a product of the late 1920s and the New Deal era. A major stimulus to the development of this “applied anthropology” was a series of projects initiated by John Collier in the Bureau of Indian Affairs beginning in 1935. Four of these experiments, the Applied Anthropology Unit, the Soil Conservation Service experiment on the Navajo reservation, the Technical Cooperation-Bureau of Indian Affairs soil conservation work on other Indian reservations, and the Indian Education, Personality, and Administration Research Project, are the subject of this article.     

The Expectancy Challenge Alcohol Literacy Curriculum (ECALC): A single session group intervention to reduce alcohol use

The Expectancy Challenge Alcohol Literacy Curriculum (ECALC) is a single session group-delivered program designed to modify alcohol expectancy processes and reduce alcohol use among children and young adults. The objective of this study was to demonstrate the effectiveness of the ECALC in reducing risky alcohol use among heavy drinking college men. Four fraternities at a large state university were randomly assigned to receive either the single session ECALC or a control presentation (2 fraternity houses per condition, n = 250). Alcohol expectancies were assessed before and immediately after program presentation. Results demonstrated significant changes on 5 of the 7 subscales of the Comprehensive Effects of Alcohol Scale (CEOA) among students who received the ECALC when compared with control participants. Alcohol use data were collected for 4 weeks before and 4 weeks after program presentation. Compared with those in the control condition, students who received the ECALC demonstrated significant reductions in all facets of alcohol use measured, including decreased mean and peak blood alcohol content (BAC), decreased mean number of days drinking per week, decreased mean drinks per sitting, and decreased number of binge-drinking episodes per month. This study represents 2 important advances. First is the significant reduction in risky alcohol use produced by a single session group-delivered program. The second important advance is the success in changing expectancy processes without using impractical elements common in previous expectancy challenge methods (e.g., a "barlab" environment and actual alcohol administration). (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Tobacco and alcohol tax relationships with suicide in Switzerland

Previous research has shown an empirical link between tobacco and alcohol use and suicide. If tobacco and alcohol use contribute to suicidal behaviors, then policies designed to reduce the tobacco and alcohol consumption may succeed in reducing suicides as well. To test this hypothesis, correlations for suicide rates with alcohol consumption, taxes on alcohol and tobacco in Switzerland were examined using sets of time-series data from Switzerland in 1965-1994. The tax on tobacco correlated significantly negatively with male standardized suicide rate. The tax on alcohol also correlated significantly with male standardized suicide rate in an autoregressive model. On the other hand, significant relationships with female suicide rate were not found. Policies designed to reduce tobacco consumption are consistent with a benefit of reducing suicides, particularly for men in this sample.