Wednesday, February 13, 2008

Suicide, Native American and Alaskan Native Indigenous Peoples, and Successful Prevention Programs for Youth at Risk

Native American and Alaskan Native indigenous peoples face a variety of present-day challenges, ranging from tribal sovereignty to religious freedom, from language preservation and survival to mental and physical health issues. This is especially true for Native American and Alaskan Native youths, who are often at the center of personal, social, and cultural conflicts. It is with little shock then that Native American and Alaskan Native youths have one of the highest suicide rates in the United States.

Suicide is the third leading cause of death among adolescents in the United States, accounting for a greater number of deaths than the next seven leading causes of death combined for 15 to 24 year olds (Centers for Disease Control and Prevention [CDC], 2006). Almost 1 in 12 adolescents in high school made a suicide attempt in 2005, with 17% of all adolescents seriously considering making a suicide attempt (CDC, 2006). Despite the staggering facts behind these numbers, Native American and Alaskan Native indigenous youth have even higher rates.

Suicide accounts for nearly one in five deaths among Native American and Alaskan Native youths (15-19 year olds), a considerably higher proportion of deaths than for any other ethnic groups within the United States (CDC, 2006). In fact, differences in suicide rates between Native American and Alaskan Native youths and other ethnic youths have been noted for over three decades (May and Dizmang 1974), yet it has been difficult to develop culturally appropriate prevention programs.

Suicide prevention programs that are culturally appropriate and incorporate culturally specific knowledge and traditions have been shown to be the most successful and well received by Native American and Alaskan Native indigenous communities. In one review, Middlebrook, LeMaster, Beals, Novins, and Manson(2001) identified nine prevention programs that met Institute of Medicine criteria for evaluating preventive interventions (Mrazek & Haggerty 1994). Of these, five specifically targeted Native American and Alaskan Native suicide among youths: the Zuni Life-Skills Development Curriculum (LaFromboise and Howard-Pitney 1994), the Wind River Behavioral Program (Tower 1989), the Tohono O’odham Psychology Service (Kahn, et al. 1988), the Western Athabaskan Natural Helpers Program (May, et al. 2005), and the Indian Suicide Prevention Center (Shore, et al. 1972). Other successful Native American and Alaskan Native programs have included suicide prevention as a component of more general youth based health initiatives, such as the Hui Malama o ke Kai project (Akeo, et al. 2008). These prevention programs are largely successful because they incorporate positive messages regarding cultural heritage that increase the self-esteem and sense of mastery among Native American and Alaskan Native youths, and focus on protective factors in a culturally appropriate context (LaFromboise 1996). They also teach culturally relevant coping methods such as traditional ways of seeking social support.

The results of prevention efforts are promising for Native American and Alaskan Native indigenous youth. For example, the most recent follow-up report from the Western Athabaskan Natural Helpers Program indicated a decrease of 61% in suicide attempts during the 12 years the program has been implemented (May, et al. 2005). May and colleagues attributed the success of this program to a comprehensive prevention strategy that addressed multiple levels of behavioral health problems, strong community investment in the program, and ongoing evaluation to maintain program focus.

The indigenous peoples of North America continue to face a variety of challenges in the twenty-first century. Among the myriad health problems they face, suicide continues to be a major issue. However, there is much hope as health practitioners, policy makers, and others have continued to work with indigenous peoples to create culturally appropriate prevention programs. Although the suicide rate among Native American and Alaskan Native youths is still the highest of any ethnic group in the United States, current programs are having a positive impact and are being used by others as culturally appropriate models. It is through collaboration and long-term cooperation that suicide rates among Native American and Alaskan Native youths will drop – hopefully one day to below the national average.

Akeo, Nani P., et al.
2008 Hui Malama o Kai Mobilizing to Prevent Youth Violence and Substance Use with Passion, Common Goals, and Culture. American Journal of Preventive Medicine 34(3):S67-S71.

Centers for Disease Control and Prevention
2006 Welcome to WISQARS (Web-based Injury Statistics Query and Reporting System).

Kahn, M., et al.
1988 An Indigenous Community Mental Health Service on the Tohono O'odham (Papago) Indian Reservation: Seventeen Years Later. American Journal of Community Psychology 16:369-379.

LaFromboise, T.
1996 American Indian Life Skills Development Curriculum. Madison: WI: University of Wisconsin Press.

LaFromboise, T., and B. Howard-Pitney
1994 The Zuni Life Skills Development Curriculum: A Collaborative Approach to Curriculum Development. American Indian and Alaska Native Mental Health Research 4:98-121.

May, P., and L. Dizmang
1974 Suicide and the American Indian. Psychiatric Annals 4:22-28.

May, P., et al.
2005 Outcome Evaluation of a Public Health Approach to Suicide Prevention in an American Indian Tribal Nation: 1988-2002. American Journal of Public Health 95:1238-1244.

Middlebrook, D., et al.
2001 Suicide Prevention in American Indian and Alaska Native Communities: A Critical Review of Programs. Suicide and Life Threatening Behavior 31:132-149.

Mrazek, P., and R. Haggerty
1994 Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Washington, DC: National Academic Press.

Shore, J., et al.
1972 A Suicide Prevention Center on an Indian Reservation. American Journal of Psychiatry 120:1086-1091.

Tower, M.
1989 A Suicide Epidemic in an American Indian Community. American Indian and Alaska Native Mental Health Research 3:34-44.

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