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Rasmus S, Wexler L, White L, Allen J. Examining community-level protection from Alaska Native suicide: An Indigenous knowledge-informed extension of the legacy of Michael Chandler and Christopher Lalonde. Transcult Psychiatry 2024:13634615241255713. [PMID: 39169864 DOI: 10.1177/13634615241255713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Chandler and Lalonde broadened the scope of inquiry in suicide research by providing theoretical grounding and empirical support for the role of community, culture, and history in understanding Indigenous youth suicide and reimagining its prevention. Their work pushed the field to consider the intersectional process of individual and collective meaning-making in prevention of Indigenous suicide, together with the central role culture plays in bringing coherence to this process over time. Their innovation shifted the research focus to include the shared histories, contexts, and structures of meaning that shape individual lives and behaviors. We describe here a new generation of research extending their pathbreaking line of inquiry. Recent work aims to identify complex associations between community-level structures and suicidal behavior by collaborating with Alaska Native people from rural communities to describe how community protective factors function as preventative resources in their daily lives. Community engagement and knowledge co-production created a measure of community protection from suicide. Structured interviews with rural Alaska Native community members allowed use of this measure to produce relevant, accessible, and actionable knowledge. Ongoing investigations next seek to describe their mechanisms in shaping young people's lives through a multilevel, mixed-methods community-based study linking community-level protection to protection and well-being of individual youth. These efforts to understand the multiple culture-specific and culturally mediated pathways by which communities build on their strengths, resources, and practices to support Indigenous young people's development and reduce suicide risk are inspired by and expand on Chandler and Lalonde's remarkable legacy.
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Affiliation(s)
- Stacy Rasmus
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | | | - James Allen
- University of Alaska Fairbanks, Fairbanks, AK, USA
- University of Minnesota Medical School, Duluth Campus, MN, USA
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McGovern R, Balogun-Katung A, Artis B, Bareham B, Spencer L, Alderson H, Brown E, Brown J, Lingam R, McArdle P, Newham JJ, Wojciechowska A, Rankin J, Redgate S, Thomason P, Kaner E. The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews. JOURNAL OF PREVENTION (2022) 2024; 45:651-684. [PMID: 38884876 PMCID: PMC11271346 DOI: 10.1007/s10935-024-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.
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Affiliation(s)
- R McGovern
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - A Balogun-Katung
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Artis
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Bareham
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - L Spencer
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - H Alderson
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - E Brown
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - J Brown
- Children's Social Care, Newcastle City Council, Newcastle upon Tyne, UK
| | - R Lingam
- Population Child Health Research Group, School of Women and Children's Health, University New South Wales, Sydney, Australia
| | - P McArdle
- Child and Adolescent Mental Health Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A Wojciechowska
- Disabilities Integrated Team at the Tees, Esk and Wear Valleys, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - S Redgate
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - P Thomason
- Children's Social Care, Gateshead Council, Tyne and Wear, UK
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Thompson C, Million T, Tchir D, Bowen A, Szafron M. Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review. Int J Equity Health 2024; 23:28. [PMID: 38347516 PMCID: PMC10863162 DOI: 10.1186/s12939-024-02118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Despite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0-6 years; and (2) explore how frontline workers are included in the program process. METHODS This scoping review was completed using the Arksey and O'Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990-2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis. RESULTS Forty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation. CONCLUSION Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.
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Affiliation(s)
- Charlene Thompson
- College of Nursing, University of Saskatchewan, Health Sciences Building - 1A10, 107 Wiggins Road, Box 6, Saskatoon, SK, S7N 5E5, Canada.
| | - Tara Million
- Department of Indigenous Studies, University of Lethbridge, A410 University Hall, Lethbridge, AB, T1K 3M4, Canada
| | - Devan Tchir
- Alberta Health Services, Edmonton, AB, Canada
| | - Angela Bowen
- College of Nursing, University of Saskatchewan, Health Sciences Building - 1A10, 107 Wiggins Road, Box 6, Saskatoon, SK, S7N 5E5, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
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Au-Yeung A, Marfatia D, Beers K, General DA, McQueen KCD, Martin-Hill D, Wekerle C, Green TJ. Exploring the feasibility of a mental health application (JoyPop TM) for Indigenous youth. Front Psychiatry 2023; 14:1269347. [PMID: 37867769 PMCID: PMC10588183 DOI: 10.3389/fpsyt.2023.1269347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Objective The purpose of the current study was to explore the acceptability and feasibility of a resilience-focused mobile application, JoyPop™, for use with Indigenous youth. Methods A Haudenosaunee community-based research advisory committee co-developed the research project, in accordance with OCAP™ principles. Adopting a mixed-method approach, five youths from an immersion school used the JoyPop™ app for four consecutive weeks, as well as completed pre-test questions and weekly usage surveys. Most participants also completed post-test questions and a semi-structured interview. Based on a semi-structured interview protocol, youth responded to questions, and the most common themes were categorized to capture the experience of using the app. Results All youth reported a positive impression, used the app daily, found it easy to navigate, and indicated that they would recommend it to a friend. All features were uniformly positively endorsed. There were features that youth used most often (Deep Breathing, "SquareMoves" game, and Art features) and moderately (Rate My Mood, Journaling, and SleepEase). The social connection feature, Circle of Trust, was least utilized, with youth reporting a preference for in-person problem-solving. The drop-down menu of crisis helplines was not used. Youth recommended more gaming options. In terms of cultural resonance, appreciation for the app's use of water sounds in the SleepEase feature was expressed, as was cultural consistency with the "Good Mind" perspective. Recommendations included additional nature sounds, Indigenous design elements, the inclusion of Native language words, and traditional stories. Discussion The JoyPop™ app was positively received by Six Nations youth, and ways to ensure its cultural appropriateness were identified. Moving forward, it is recommended that Indigenous designers create a new version with community design co-creation. Additional research with various groups of Indigenous youth is warranted as a pan-Indigenous approach is not recommended.
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Affiliation(s)
- Allison Au-Yeung
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daksha Marfatia
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kamryn Beers
- Department of Health, Aging and Society, Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada
| | | | | | - Dawn Martin-Hill
- Department of Anthropology, Indigenous Studies Program, McMaster University, Hamilton, ON, Canada
| | - Christine Wekerle
- Department of Pediatrics, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Optentia Research Unit, North-West University, Potchefstroom, South Africa
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Nguyen T, Ullah S, Looi JCL, Allison S, Mulder R, Bastiampillai T. Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019. Aust N Z J Psychiatry 2023; 57:1324-1330. [PMID: 37092737 PMCID: PMC10517587 DOI: 10.1177/00048674231167327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. METHODS Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006-2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. RESULTS Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15-44 years have the highest suicide rates across all countries. CONCLUSION Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15-44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth.
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Affiliation(s)
- Teresa Nguyen
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey CL Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University, Canberra Hospital, Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Roger Mulder
- Department of Psychological Medicine (Christchurch), University of Otago, Dunedin, New Zealand
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Aker A, Serghides L, Cotnam J, Jackson R, Robinson M, Gauvin H, Mushquash C, Gesink D, Amirault M, Benoit AC. The impact of a stress management intervention including cultural components on stress biomarker levels and mental health indicators among indigenous women. J Behav Med 2023; 46:594-608. [PMID: 36652086 PMCID: PMC10344996 DOI: 10.1007/s10865-023-00391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
We examined the effectiveness of a 26-week culture-inclusive intervention on reducing salivary stress biomarker levels, and perceived stress, depressive, and post-traumatic stress disorder (PTSD) symptoms measured using scales in 53 Indigenous women in Ontario, Canada. Statistical analyses compared the average biomarker levels, and the area under the curve (AUC) of biomarkers. Differences in biomarkers and mental health scale scores pre- and post-intervention were compared using mixed models with a random intercept. Interaction terms were included between the intervention and age, education, disability, and HIV status, individually, to test for sub-group differences. Cortisol AUC post-intervention was decreased compared to pre-intervention (β -1.29 µg/dL; 95%CI -2.35, -0.23). There was a slight decrease in perceived stress levels (aOR: -2.80; 95%CI -5.09, -0.50). The associations were stronger among women of younger age, higher education, and no disabilities. These interventions can be effective, but future interventions should target Indigenous population sub-groups to address individual needs.
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Affiliation(s)
- Amira Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
- Department of Immunology, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Jasmine Cotnam
- Women's College Hospital, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Randy Jackson
- McMaster Indigenous Research Institute, McMaster University, Hamilton, ON, Canada
| | - Margaret Robinson
- Department of Sociology and Social Anthropology, Dalhousie University, Nova Scotia, Canada
| | | | - Christopher Mushquash
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
- Department of Psychology, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Thunder Bay, ON, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Anita C Benoit
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.
- Women's College Hospital, Women's College Research Institute, University of Toronto, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Sjoblom E, Ghidei W, Leslie M, James A, Bartel R, Campbell S, Montesanti S. Centering Indigenous knowledge in suicide prevention: a critical scoping review. BMC Public Health 2022; 22:2377. [PMID: 36536345 PMCID: PMC9761945 DOI: 10.1186/s12889-022-14580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention-typically involving individual-level efforts for behavioural change via mental health professional intervention-by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. METHODS A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. RESULTS Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. CONCLUSIONS Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.
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Affiliation(s)
- Erynne Sjoblom
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Winta Ghidei
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Marya Leslie
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Ashton James
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Reagan Bartel
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Sandra Campbell
- Librarian, Health Sciences, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Stephanie Montesanti
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada.
- School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of prevention strategies, logics, and rationales. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Sehgal A, Barnabe C, Crowshoe L(L. Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review. PLoS One 2022; 17:e0273841. [PMID: 36044532 PMCID: PMC9432764 DOI: 10.1371/journal.pone.0273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
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Affiliation(s)
- Anika Sehgal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden (Lindsay) Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Grande AJ, Elia C, Peixoto C, Jardim PDTC, Dazzan P, Veras AB, Cruickshank JK, da Rosa MI, Harding S. Mental health interventions for suicide prevention among indigenous adolescents: a systematic review. SAO PAULO MED J 2022; 140:486-498. [PMID: 35508004 PMCID: PMC9671239 DOI: 10.1590/1516-3180.2021.0292.r1.22102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/12/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.
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Affiliation(s)
- Antonio Jose Grande
- PhD. Physical Educator and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Christelle Elia
- MSc. Dietitian and Research Assistant, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Clayton Peixoto
- PhD. Psychologist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paulo de Tarso Coelho Jardim
- PhD. Dentist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paola Dazzan
- PhD. Physician and Professor, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill Campus, London, United Kingdom.
| | - Andre Barciela Veras
- PhD. Physician and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - John Kennedy Cruickshank
- MBChB, MD. Physician and Professor of Cardiovascular Medicine & Diabetes, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Maria Inês da Rosa
- PhD. Physician and Professor, Translational Psychiatry Laboratory, Postgraduate Program in Health Sciences, Universidade do Extremo Sul Catarinense (UNESC), Criciúma (SC), Brazil.
| | - Seeromanie Harding
- PhD. Professor of Social Epidemiology, Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
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Saving Lives: A Systematic Review on the Efficacy of Theory-Informed Suicide Prevention Programs. Community Ment Health J 2022; 58:454-473. [PMID: 34114121 DOI: 10.1007/s10597-021-00841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Suicide is a global epidemic. This review assessed the scope and effectiveness of suicide prevention programs. Systematic literature searches were conducted using PsycINFO, ERIC and MEDLINE to retrieve articles published between January 2007 and March 2017 and fulfilled inclusion criteria (studies evaluating the efficacy of theory/model-informed suicide prevention programs in increasing participant knowledge or skills when presented with a peer at risk of suicide). The review is informed by PRISMA guidelines. Of 1398 studies identified, 25 were reviewed and most: targeted professionals; were 1-4-day workshops; were underpinned by 21 different theories; taught less detail to the community than professionals; and improved target outcomes. Current programs, although effective, are limited by their inaccessibility, narrow content for the community and substantial variability in theory base. Future suicide prevention programs will benefit from being informed by a more specific theory, delivered through technology, targeting more of the community and improving methodological rigour.
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Azizi H, Fakhari A, Farahbakhsh M, Esmaeili E. Effective programs on suicide prevention: Combination of review of systematic reviews with expert opinions. Int J Prev Med 2022; 13:39. [PMID: 35529514 PMCID: PMC9069150 DOI: 10.4103/ijpvm.ijpvm_454_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of outcomes. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Haroz E, Wexler L, Manson S, Cwik M, O’Keefe V, Allen J, Rasmus S, Buchwald D, Barlow A. Sustaining suicide prevention programs in American Indian and Alaska Native communities and Tribal health centers. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 35821881 PMCID: PMC9273109 DOI: 10.1177/26334895211057042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Research on sustaining community-based interventions is limited. This is particularly true for suicide prevention programs and in American Indian and Alaska Native (AIAN) settings. Aiming to inform research in this area, this paper sought to identify factors and strategies that are key to sustain suicide prevention efforts in AIAN communities. Methods: We used a modified Nominal Group Technique with a purposeful sample of N = 35 suicide prevention research experts, program implementors and AIAN community leaders to develop a list of prioritized factors and sustainability strategies. We then compared this list with the Public Health Program Capacity for Sustainability Framework (PHPCSF) to examine the extent the factors identified aligned with the existing literature. Results: Major factors identified included cultural fit of intervention approaches, buy in from local communities, importance of leadership and policy making, and demonstrated program success. Strategies to promote these factors included partnership building, continuous growth of leadership, policy development, and ongoing strategic planning and advocacy. All domains of the PHPCF were representative, but additional factors and strategies were identified that emerged as important in AIAN settings. Conclusions: Sustaining effective and culturally informed suicide prevention efforts is of paramount importance to prevent suicide and save lives. Future research will focus on generating empirical evidence of these strategies and their effectiveness at promoting program sustainability in AIAN communities.
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Affiliation(s)
- E.E. Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - L. Wexler
- University of Michigan, School of Social Work and the Research Center for Group Dynamics, Institute for Social Research, Ann Arbor, MI
| | - S.M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - M. Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - V.M. O’Keefe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J. Allen
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN
| | - S.M. Rasmus
- Center for Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska, Fairbanks, AK
| | - D. Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
| | - A. Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Lloyd-Johnsen C, Eades S, McNamara B, D'Aprano A, Goldfeld S. A global perspective of Indigenous child health research: a systematic review of longitudinal studies. Int J Epidemiol 2021; 50:1554-1568. [PMID: 33864092 DOI: 10.1093/ije/dyab074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children. METHODS A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0-18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised; PROSPERO registration CRD42018089950. RESULTS From 5545 citations, 380 eligible papers were included for analysis, representing 210 individual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%); 55% of studies were graded as 'good' quality; and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research. CONCLUSIONS We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally.
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Affiliation(s)
- Catherine Lloyd-Johnsen
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anita D'Aprano
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Allen J, Rasmus SM, Fok CCT, Charles B, Trimble J, Lee K. Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup'ik Alaska Native Youth Suicide. Assessment 2021; 28:709-723. [PMID: 31538813 PMCID: PMC8359856 DOI: 10.1177/1073191119875789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide is the second leading cause of death among American Indian and Alaska Native youth, and within the Alaska Native youth subpopulation, the leading cause of death. In response to this public health crisis, American Indian and Alaska Native communities have created strategies to protect their young people by building resilience using localized Indigenous well-being frameworks and cultural strengths. These approaches to suicide prevention emphasize promotion of protective factors over risk reduction. A measure of culturally based protective factors from suicide risk has potential to assess outcomes from these strengths-based, culturally grounded suicide prevention efforts, and can potentially address several substantive concerns regarding direct assessment of suicide risk. We report on the Reasons for Life (RFL) scale, a measure of protective factors from suicide, testing psychometric properties including internal structure with 302 rural Alaska Native Yup'ik youth. Confirmatory factor analyses revealed the RFL is best described through three distinct first-order factors organized under one higher second-order factor. Item response theory analyses identified 11 satisfactorily functioning items. The RFL correlates with other measures of more general protective factors. Implications of these findings are described, including generalizability to other American Indian and Alaska Native, other Indigenous, and other culturally distinct suicide disparities groups.
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Affiliation(s)
- James Allen
- University of Minnesota Medical School, Duluth, MN, USA
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Xavier SM, Jarvis GE, Ouellet-Plamondon C, Gagné G, Abdel-Baki A, Iyer SN. Comment les services d’intervention précoce pour la psychose peuvent-ils mieux servir les migrants, les minorités ethniques et les populations autochtones ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088188ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Leske S, Paul E, Gibson M, Little B, Wenitong M, Kolves K. Global systematic review of the effects of suicide prevention interventions in Indigenous peoples. J Epidemiol Community Health 2020; 74:1050-1055. [PMID: 32788303 DOI: 10.1136/jech-2019-212368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/30/2019] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide. METHODS We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies. FINDINGS We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before-after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before-after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias. CONCLUSION For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.
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Affiliation(s)
- Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia .,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Elise Paul
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Mandy Gibson
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Brock Little
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
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Grande AJ, Elia C, Peixoto C, Jardim PDTC, Dazzan P, Veras AB, Cruickshank JK, Harding S. Mental health interventions for suicide prevention among indigenous adolescents: a systematic review protocol. BMJ Open 2020; 10:e034055. [PMID: 32423928 PMCID: PMC7239512 DOI: 10.1136/bmjopen-2019-034055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/10/2020] [Accepted: 04/16/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION There are more than 370 million indigenous people from 5000 cultures living in 90 countries worldwide. Although they make up 5% of the global population, they account for 15% of the extreme poor. Youth suicide is the second leading cause of mortality among 15-29 years old and disproportionately affects indigenous youth. This research protocol pertains to a systematic review of studies that use a comparator/control group to evaluate the effectiveness of suicide interventions targeting indigenous adolescents (aged 10-19 years). METHODS AND ANALYSIS We will conduct a systematic search on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO from inception to September 2019 to identify articles that compare mental health interventions for suicide prevention among indigenous adolescents. Two reviewers will independently determine the eligibility of each study. Studies will be assessed for methodological quality using the risk of bias tool to assess non-randomised studies of interventions. We will conduct a meta-analysis if possible and use established statistical methods to identify and control for heterogeneity where appropriate. ETHICS AND DISSEMINATION This systematic review will use published data and does not require ethics approval. However, this review is in preparation of a feasibility study that will examine how best to support the physical and mental health of indigenous adolescents in Brazil. Ethics approval for the feasibility study was obtained from National Research Ethics Commission. Findings will be disseminated through a peer-reviewed publication and will be made available to key decision-makers with authority for indigenous health and other relevant stakeholders. PROSPERO REGISTRATION NUMBER CRD42019141754.
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Affiliation(s)
- Antonio José Grande
- State University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Christelle Elia
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Clayton Peixoto
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paola Dazzan
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Andre Barciela Veras
- State University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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20
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Gone JP, Kirmayer LJ. Advancing Indigenous Mental Health Research: Ethical, conceptual and methodological challenges. Transcult Psychiatry 2020; 57:235-249. [PMID: 32380932 DOI: 10.1177/1363461520923151] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The articles in this issue of Transcultural Psychiatry point the way toward meaningful advances in mental health research pertaining to Indigenous peoples, illuminating the distinctive problems and predicaments that confront these communities as well as unrecognized or neglected sources of well-being and resilience. As we observe in this introductory essay, future research will benefit from ethical awareness, conceptual clarity, and methodological refinement. Such efforts will enable additional insight into that which is common to Indigenous mental health across settler societies, and that which is specific to local histories, cultures and contexts. Research of this kind can contribute to nuanced understandings of developmental pathways, intergenerational effects, and community resilience, and inform policy and practice to better meet the needs of Indigenous individuals, communities and populations.
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Affiliation(s)
- Joseph P Gone
- Department of Anthropology, Harvard University, Cambridge, MA, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
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21
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Cwik M, Goklish N, Masten K, Lee A, Suttle R, Alchesay M, O'Keefe V, Barlow A. "Let our Apache Heritage and Culture Live on Forever and Teach the Young Ones": Development of The Elders' Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:137-145. [PMID: 31313327 DOI: 10.1002/ajcp.12351] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The White Mountain Apache Tribe have developed an innovative curriculum that connects youth through Elders to their heritage, traditions, and culture, which has been proven to be a protective factor for native Americans. The development process took 4½ years and included community stakeholder buy-in, Elders' Council group formation, extensive formative work to identify content, iterative feedback between curriculum writers and Elders, and Elder training prior to implementation. Members of the Elders' Council have been visiting the local schools to teach youth about the Apache culture, language, and way of life since February 2014 reaching over 1000 youth. This approach demonstrates a promising upstream suicide prevention strategy. We discuss the process of development, implementation, and lessons learned, as this curriculum has potential for adaptation by other Indigenous communities.
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Affiliation(s)
- Mary Cwik
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Novalene Goklish
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Masten
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angelita Lee
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rosemarie Suttle
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melanie Alchesay
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Victoria O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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22
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Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples: a systematic review. BMC Med 2018; 16:145. [PMID: 30122155 PMCID: PMC6100719 DOI: 10.1186/s12916-018-1115-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/02/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations. METHODS We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations. RESULTS The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples. CONCLUSIONS This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.
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Affiliation(s)
- Nathaniel J Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada. .,Labrador Institute of Memorial University, P.O. Box 490, Stn. B, 219 Hamilton River Road, Happy Valley-Goose Bay, ,Newfoundland and Labrador, A0P 1E0, Canada.
| | - Kiyuri Naicker
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Alex Loro
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
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Singer JB, Erbacher TA, Rosen P. School-Based Suicide Prevention: A Framework for Evidence-Based Practice. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9245-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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24
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Bailey E, Spittal MJ, Pirkis J, Gould M, Robinson J. Universal Suicide Prevention in Young People. CRISIS 2017; 38:300-308. [DOI: 10.1027/0227-5910/a000465] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. Background: Universal education and awareness programs in schools are a promising suicide prevention intervention but to date no research has evaluated the iatrogenic effects of such programs. Aims: To evaluate the efficacy and acceptability of the safeTALK program for secondary school students and determine whether it is associated with any iatrogenic effects. Method: Participants were 129 students from the three main high schools in Alice Springs who attended the safeTALK training and consented to participate in the evaluation. Participants were assessed immediately before and immediately after the training using a purpose-designed survey. Follow-up questionnaires were administered online 4 weeks after completion of the training. Results: Participants demonstrated increases in knowledge about suicide, confidence in talking about issues related to suicide, willingness to talk about suicide, and likelihood of seeking help for suicidal thoughts. There was no evidence that the training induced suicidal thoughts or caused distress; in fact both appeared to decrease following the training. Most participants did not find the training upsetting; they reported the training to be worthwhile and most said that they would recommend it to a friend. Limitations: The lack of control group, use of non-validated measures, and relatively short follow-up period are limitations of this study. Conclusion: Universal suicide prevention workshops in schools can be beneficial and do not appear to be associated with iatrogenic effects.
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Affiliation(s)
- Eleanor Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Madelyn Gould
- Psychiatry and Public Health, Columbia University, New York, USA
| | - Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
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Kinchin I, Mccalman J, Bainbridge R, Tsey K, Lui FW. Does Indigenous health research have impact? A systematic review of reviews. Int J Equity Health 2017; 16:52. [PMID: 28327137 PMCID: PMC5361858 DOI: 10.1186/s12939-017-0548-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry. Methods Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples’ health would be explicated. Results Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated. Conclusions The findings of our study serve two main purposes. First, we have identified knowledge and methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0548-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia. .,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia.
| | - Janya Mccalman
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Felecia Watkin Lui
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
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Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. J Adolesc Health 2016; 59:S49-S60. [PMID: 27664596 PMCID: PMC5026677 DOI: 10.1016/j.jadohealth.2016.06.020] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/28/2016] [Accepted: 07/01/2016] [Indexed: 01/08/2023]
Abstract
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.
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Affiliation(s)
- Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Marium Naveed Khan
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Public Health Foundation of India, New Delhi, India; Sangath, Goa, India
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
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Cox GR, Bailey E, Jorm AF, Reavley NJ, Templer K, Parker A, Rickwood D, Bhar S, Robinson J. Development of suicide postvention guidelines for secondary schools: a Delphi study. BMC Public Health 2016; 16:180. [PMID: 26912256 PMCID: PMC4765027 DOI: 10.1186/s12889-016-2822-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide of school-aged adolescents is a significant problem, with serious implications for students and staff alike. To date, there is a lack of evidence regarding the most effective way for a secondary school to respond to the suicide of a student, termed postvention [(Crisis 33:208-214, 2012), (Crisis 34:164-182, 2013)]. The aim of this study was to employ the expert consensus (Delphi) methodology to the development of a set of guidelines, to assist English-speaking secondary schools to develop a plan to respond to a student suicide, or to respond to a suicide in the absence of a predetermined plan. METHODS The Delphi methodology was employed, which involved a two-stage process. Firstly, medical and research databases, existing postvention guidelines developed for schools, and lay literature were searched in order to identify potential actions that school staff could carry out following the suicide of a student. Based on this search, an online questionnaire was produced. Secondly, 40 experts in the area of suicide postvention from English-speaking countries were recruited and asked to rate each action contained within this questionnaire, in terms of how important they felt it was to be included in the postvention guidelines. A set of guidelines was developed based on these responses. In total, panel members considered 965 actions across three consensus rounds. RESULTS Five hundred fourty-eight actions were endorsed for inclusion into the postvention guidelines based on an 80% consensus agreement threshold. These actions were groups according to common themes, which are presented in the following sections: 1. Developing an Emergency Response Plan; 2. Forming an Emergency Response Team; 3. Activating the Emergency Response Team; 4. Managing a suspected suicide that occurs on school grounds; 5. Liaising with the deceased student's family; 6. Informing staff of the suicide; 7. Informing students of the suicide; 8. Informing parents of the suicide; 9. Informing the wider community of the suicide; 10. Identifying and supporting high-risk students; 11. Ongoing support of students; 12. Ongoing support of staff; 13. Dealing with the media; 14. Internet and social media; 15. The deceased student's belongings; 16. Funeral and memorial; 17. Continued monitoring of students and staff; 18. Documentation; 19. Critical Incident Review and annual review of the ER Plan; 20. Future prevention. Panel members frequently commented on every suicide being 'unique', and the need for flexibility in the guidelines, in order to accommodate the resources available, and the culture of the school community. CONCLUSION In order to respond effectively and safely to the suicide of a student, schools need to undertake a variety of postvention actions. These are the first set of postvention guidelines produced worldwide for secondary schools that are based on expert opinion using the Delphi method.
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Affiliation(s)
- Georgina R Cox
- Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Victoria, 3052, Australia.
- Faculty of Health, Arts and Design, School of Health Sciences, Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia.
| | - Eleanor Bailey
- Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Victoria, 3052, Australia.
| | - Anthony F Jorm
- Centre for Mental Health, The Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Victoria, 3010, Australia.
| | - Nicola J Reavley
- Centre for Mental Health, The Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Victoria, 3010, Australia.
| | - Kate Templer
- University of Tasmania, Faculty of Health, Hobart, Tasmania, 7001, Australia.
| | - Alex Parker
- Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Victoria, 3052, Australia.
- headspace National Youth Mental Health Foundation, 485 La Trobe St, Victoria, 3000, Australia.
| | - Debra Rickwood
- headspace National Youth Mental Health Foundation, 485 La Trobe St, Victoria, 3000, Australia.
- Faculty of Health, University of Canberra, Kirinari St, Bruce, Australian Capital Territory, 2601, Australia.
| | - Sunil Bhar
- Faculty of Health, Arts and Design, School of Health Sciences, Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia.
| | - Jo Robinson
- Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Victoria, 3052, Australia.
- headspace National Youth Mental Health Foundation, 485 La Trobe St, Victoria, 3000, Australia.
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Suicide and Substance Use Disorder Prevention for Rural American Indian and Alaska Native Youth. ADVANCING RESPONSIBLE ADOLESCENT DEVELOPMENT 2016. [DOI: 10.1007/978-3-319-20976-0_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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