Attempted suicide and associated health risk behaviors among Native American high school students

Intimate Partner Violence and Suicidality: Applicability of General Strain Theory to Women in Trinidad and Tobago

Suicide among women is a growing problem in Trinidad and Tobago. Despite efforts to reduce suicide, the etiology of suicidal behaviors in this region has rarely been examined. Using the National Women's Health Survey for Trinidad and Tobago in 2018 (n = 1,079), this study examined the causes of suicidality through concepts contained in Agnew's general strain theory, such as negative stimuli (i.e., intimate partner violence [IPV]) and negative emotion (i.e., depression). By estimating structural equation models, this study found that IPV was strongly related to depression and suicidality. Particularly, depression mediated the effect of IPV on suicidality.

Adolescents' Comfort in Disclosing to Caregivers Predicts Suicidal Thoughts and Behaviors Directly and Indirectly Through Difficulties in Emotion Regulation

Despite adolescents' suicidal thoughts and behaviors being major health problems, sparse literature exists on the roles of adolescents' disclosing their feelings to caregivers in their suicidal thoughts and behaviors. This study examined whether adolescents' comfort in disclosing their feelings and problems to caregivers predicts subsequent suicidal thoughts and behaviors and whether difficulties in emotion regulation mediate this association. High school students (N = 5,346 from 20 schools, 49% female-identified adolescents, and 35% 9th graders, 33% 10th graders, and 32% 11th graders) participated in the study for two years with four waves, each six months apart: fall semester in Year 1 (Wave 1), spring semester in Year 1 (Wave 2), fall semester in Year 2 (Wave 3), and spring semester in Year 2 (Wave 4). The degree to which adolescents felt comfortable disclosing their feelings and problems to caregivers at Wave 1 predicted lower suicidal thoughts and behaviors at Wave 4 directly and indirectly via higher emotional clarity at Wave 2 and feeling more able to handle negative emotions at Wave 3. Moreover, when female-identified adolescents reported feeling unable to handle negative emotions at Wave 3, they reported engaging in more suicidal thoughts and behaviors at Wave 4 than male-identified adolescents. Therefore, enhancing adolescents' comfort in disclosing their feelings and problems to caregivers and adolescent emotion regulation and taking a nuanced approach to support female-identified adolescents regarding their ability to handle negative emotions could prevent adolescents' suicidal thoughts and behaviors.

Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data

BACKGROUND

A previous study identified students taking Bangladeshi university entrance tests as a vulnerable group at a higher risk of suicidal behaviours before the COVID-19 pandemic. However, the impact of the pandemic on the magnitude of these behaviours among this population remains unexplored.

AIMS

This study aimed to investigate the prevalence of suicidal ideation and associated factors among Bangladeshi university entrance test takers following the pandemic. In addition, an approach based on Geographic Information System (GIS) data was used to visualise the distribution of suicidal ideation across the country.

METHODS

A cross-sectional approach was used to collect data among participants taking the entrance test at Jahangirnagar University in September 2022. Using SPSS, data were analysed with chi-squared tests and binary regression, and ArcGIS was used to map the results across the nation.

RESULTS

The study revealed a prevalence of 14.4% for past-year suicidal ideation, with 7.4% and 7.2% reporting suicide plans and attempts, respectively. Notably, repeat test-takers exhibited a higher prevalence of suicidal behaviours. Significant risk factors for suicidal ideation included urban residence, smoking, drug use, COVID-19 infection and deaths among close relations, depression, anxiety and burnout. The GIS-based distribution indicated significant variation in the prevalence of suicidal ideation across different districts, with higher rates observed in economically and infrastructurally deprived areas.

CONCLUSIONS

Urgent measures are needed to address the high prevalence of suicidal behaviours among students taking university entrance tests students in Bangladesh, particularly in light of the COVID-19 pandemic. Enhanced mental health support, targeted prevention efforts and improved resources in economically disadvantaged regions are crucial to safeguard the well-being of these students.

Meta-analysis of the effect of racial discrimination on suicidality

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there have been reports that minorities and marginalized groups exposed to RD are at a higher risk of suicide. Given that RD negatively impacts mental health and that suicide is a major public health concern, we meta-analytically reviewed the literature to investigate whether RD is associated with suicidal ideation (SI) and suicide attempt (SA). We identified 43 eligible articles investigating the association between RD and suicidality through PubMed, Embase, PsycINFO and Scopus, from which we pooled 39 effect sizes for SI (58,629 individuals) and 15 for SA (30,088 individuals). Results demonstrated that RD has a small but significant effect both on SI (r = 0.16, 95% CI: 0.12 to 0.19; p < 0.0001) and on SA (r = 0.13, 95% CI: 0.02 to 0.23; p = 0.018). We found no indication of publication bias, and fail-safe tests confirmed the robustness of the results. Furthermore, we tested the moderating effects of several study characteristics (e.g., age, race, RD and SI time frame assessment, and categorization of RD measures). The only study characteristic to moderate the effect of RD on SI was SI time frame assessment (r = 0.07; 95% CI: 0.015 to 0.12; p = 0.01). Our findings suggest that SI and SA are phenomena that may be influenced by exposure to RD. Thus, individuals that are discriminated based on race may develop more suicidal thoughts and an increased likelihood of attempting suicide. These findings underscore the need for more prevention and intervention efforts to attenuate the effect of RD on suicidality.

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We conducted a meta-analysis of 62,349 individuals.

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We pooled effect sizes from 43 studies from seven countries.

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Racial discrimination has a statistically significant effect on suicidal ideation (r = 0.16, p < 0.0001).

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Racial discrimination has a statistically significant effect on suicide attempt (r = 0.13, p = 0.018).

Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact

INTRODUCTION

Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability.

METHODS

Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design.

RESULTS

Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation.

CONCLUSION

Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.

Suicide Across Buddhism, American Indian-Alaskan Native, and African Traditional Religions, Atheism and Agnosticism: An Updated Systematic Review

Religion can exert a powerful influence on human behavior, including suicide. Research has demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior, but may also, at times, serve as a risk factor. In clinical practice with individuals managing suicidality, a clear understanding of the influence of religion on suicidality is required to effectively assess for risk of suicide. In the 10 years since the article, 'Religion and suicide: Buddhism, American Indian/Alaskan Native (AIAN) and African religions, Atheism, and Agnosticism' (Lizardi and Gearing, J Relig Health 49:377-384, 2010), there has been a significant increase in research advancing our understanding of the nature of this relationship across faiths and beliefs. Consequently, this article provides an expanded and updated review of the research in the 10 years since our original publication examining the relationship between suicide and religion across Buddhism, AIAN, African religions, as well as atheism, agnosticism. The databases PsycINFO, MEDLINE, SocINDEX, and CINAHL databases were searched for published articles on religion and suicide over the last decade, between 2009 and 2019. Epidemiological data on suicidality across these world religions, and attitudes and beliefs toward suicide are presented. Updated recommended practice guidelines for effectively incorporating religiosity into suicide risk assessment and treatment are provided, and areas of future research are identified.

Reservation-Urban Comparison of Suicidal Ideation/Planning and Attempts in American Indian Youth

BACKGROUND

Our aim was to identify sex- and location-specific risk factors for suicide ideation/planning and attempts among American Indian youth.

METHODS

Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled years 2003 to 2011. Logistic regression was used to identify sex- and school location-specific risk behaviors and psychosocial factors for past 12-month ideation/planning and past 12-month attempts.

RESULTS

Contrary to our hypothesis, the prevalence of ideation/planning and attempts did not significantly differ between reservation/urban location; however, risk factors associated with suicidality did. Sadness/hopelessness was associated with both outcomes for all groups. However, violent victimization was associated with both outcomes only among girls. Lack of school safety was associated with attempts but not ideation/planning among all students. There were distinct differences in risk factors associated with both outcomes among boys.

CONCLUSIONS

The results indicate differences and similarities in risk behaviors and psychosocial factors associated with suicidality by sex and reservation/urban setting. Implications include screening potentially at-risk students for depression, violent victimization, substance use, and school safety and use of the findings by tribal and school programs in designing prevention and intervention programs.

Trends of Suicidal Behaviors Among High School Students in the United States: 1991-2017

OBJECTIVES

To determine if racial and ethnic subgroups of adolescents are at high risk for engagement in suicidal behaviors.

METHODS

Using the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, we conducted logistic regression analyses to examine trends by different racial and ethnic groups, with each suicide indicator serving as a dichotomous outcome. Participants included 198 540 high school students.

RESULTS

Across all sex and race and ethnic groups, there were significant linear decreases in self-reported suicidal ideation and suicide plans from 1991 to 2017. Female adolescents (odds ratio [OR], 0.98; P < .001) had significant decreases in attempts over time. Black adolescents had positive linear trends for suicide attempts among both boys (OR, 1.04; P < .001) and girls (OR, 1.02; P = .003). Black adolescent boys (OR, 1.04; P = .048) had a significant linear increase in injury by attempt.

CONCLUSIONS

The results suggest that, over time, black youth have experienced an increase in suicide attempts, which is troubling because attempts are the most prominent risk factor associated with suicide death. For black boys, a significant increase in injury by attempt occurred, which suggests that black boys may be engaging in increasingly lethal means when attempting suicide. Examining trends of suicidal thoughts and behaviors over time by sex and race and ethnicity allow us to determine where to focus prevention and intervention efforts. Future research should examine the underlying reasons for these changes observed in US high school students.

Indigenous Adolescents' Suicidal Behaviors and Risk Factors: Evidence from the National Youth Risk Behavior Survey

The study sought to examine indigenous adolescents' suicidal behaviors and risk factors in a nationally representative sample and explore potential causes of disparities. The study analyzed the 1991-2013 Youth Risk Behavior Survey National Combined Datasets. Suicidal behavior outcomes included suicide consideration, planning, and attempts during the past 12 months. Logit regressions were used to estimate the effects of potential suicide risk factors on these suicidal behaviors. The results showed that a high percentage of indigenous adolescents exhibited suicidal behaviors (consideration: 24.6 %; planning: 20.7 %; attempts: 16.2 %). After adjusting for risk factors, indigenous adolescents were no more likely than other adolescents to consider or plan for suicide (consideration: OR 1.18, CI 0.96-1.45, p = 0.125; planning: OR 1.16, CI 0.95-1.42, p = 0.156); however, they remained significantly more likely to have made suicide attempts (OR 1.73, CI 1.32-2.26, p < 0.001). Disparities in adolescent suicidal behaviors could be explained by the heterogeneous prevalence of suicidal risk factors across different races/ethnicities.

Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe

BACKGROUND

Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations.

OBJECTIVES

We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths.

METHODS

We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time.

RESULTS

DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses.

CONCLUSION

COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.

Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Health-Related Factors and Suicidal Ideation in High School Students in Rural China

The study aimed to understand the reporting rate of suicidal ideation and its health-related factors in 1,378 high school students in rural China. These students were recruited from two high schools in Lijin County, Shandong Province, China by using a stratified random cluster sampling method. Overall, 13.5% of the sample reported having suicidal ideation in the past year, and there was no significant difference between boys and girls in reporting rate of suicidal ideation. Nightmares, physical activity, and sleep duration as well as family environment, paternal education, and mental heath status were significantly associated with suicidal ideation. More efforts for these factors should be considered in suicide prevention for high school students in rural China.

"Rebuilding our community": hearing silenced voices on Aboriginal youth suicide

This paper brings forth the voices of adult Aboriginal First Nations community members who gathered in focus groups to discuss the problem of youth suicide on their reserves. Our approach emphasizes multilevel (e.g., individual, family, and broader ecological systems) factors viewed by participants as relevant to youth suicide. Wheaton's conceptualization of stressors and Evans-Campbell's multilevel classification of the impacts of historical trauma are used as theoretical and analytic guides. Thematic analysis of qualitative data transcripts revealed a highly complex intersection of stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Our multilevel coding approach revealed that suicidal behaviors were described by community members largely as a problem with deep historical and contemporary structural roots, as opposed to being viewed as individualized pathology.

Substance use and sexual risk behaviors among american Indian and alaska native high school students

BACKGROUND

We describe the prevalence of behaviors that put American Indian and Alaska Native (AI/AN) high school students at risk for teen pregnancy and sexually transmitted infections (STIs) and the relationships among race/ethnicity and these behaviors.

METHODS

We analyzed merged 2007 and 2009 data from the national Youth Risk Behavior Survey, a biennial, self-administered, school-based survey of US students in grades 9-12 (N = 27,912). Prevalence estimates and logistic regression, controlling for sex and grade, were used to examine the associations between race/ethnicity, and substance use, and sexual risk behaviors.

RESULTS

Of the 26 variables studied, the adjusted odds ratios (AOR) were higher among AI/AN than White students for 18 variables (ranging from 1.4 to 2.3), higher among AI/AN than Black students for 13 variables (ranging from 1.4 to 4.2), and higher among AI/AN than Hispanic students for 5 variables (ranging from 1.4 to 1.5). Odds were lower among AI/AN than Black students for many of the sexual risk-related behaviors.

CONCLUSIONS

The data suggest it is necessary to develop targeted, adolescent-specific interventions aimed at reducing behaviors that put AI/AN high school students at risk for teen pregnancy, STI/HIV, and other health conditions.

Acute alcohol intoxication and suicide among United States ethnic/racial groups: findings from the national violent death reporting system

BACKGROUND

To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities.

METHODS

Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08 g/dl. Overall, 76% of decedents were tested for the presence of alcohol.

RESULTS

The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30 years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis.

CONCLUSIONS

Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30 years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.

Associations between suicidal high school students' help-seeking and their attitudes and perceptions of social environment

Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9 % female, 46.9 % male; racial distribution 79.5 % Caucasian, 11.9 % Hispanic/Latino, and 3.6 % Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14 %) students reporting SI, only 23 % told an adult, 29 % sought adult help, and 15 % did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.

A Typology of Violence against Self and Others and Its Associations with Drinking and Other Drug Use among High School Students in a U.S. General Population Survey

This study examined associations between binge drinking and other substance use and perpetration of violence against self and others. Data were pooled from the 2003, 2005, and was constructed to reflect four categories of behaviors: other-directed violence only, self-directed violence only, combined other- and self-directed violence, and no violence. Results from multinomial logistic regressions show that the frequency of binge drinking and other substance use were significant risk factors for each of the violence categories relative to no-violence. However, the strengths of these associations varied across the violence categories.

Medical home access among American Indian and Alaska Native children in 7 states: National Survey of Children's Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children's Health data. Analyses included 1-17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child's age, household education and income, and state) and health-related [child's insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4-50.8) than NHW children (58.3, 95 % CI = 56.2-60.4). Child's age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3-5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1-0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.

Three scales assessing high school students' attitudes and perceived norms about seeking adult help for distress and suicide concerns

Validated measures that can be administered to school populations are needed to advance knowledge of help-seeking processes and to evaluate suicide prevention programs that target help-seeking. With 6,370 students from 22 high schools, we assessed the psychometric properties of three brief measures: Help-Seeking Acceptability at School, Adult Help for Suicidal Youth, and Reject Codes of Silence. Internal consistency coefficients ranged from .64 to .84. In support of construct validity, lower scores on each scale were associated with more maladaptive coping norms; for each one unit increase on each scale, students were one third to one half as likely to report suicidal ideation, suicide attempts, and elevated depression.

Stakeholders' perspective: injury behaviour and attitude of young Asians in New Zealand

Purpose

Of the unintentional injuries sustained by 20‐25 year old Asians, one‐third have been attributed to road traffic crashes. This study seeks to examine stakeholders' perceptions of Asian youth injury prevention behaviours in Auckland, New Zealand.

Design/methodology/approach

Information was collected through face‐to‐face individual interviews, with key stakeholders who were aware of youth injury prevention and road traffic safety issues. Analysis used the statements of the discussants as the basis of describing the findings.

Findings

Risk‐taking behaviours, environment, and individual variations in attitudes influence the occurrence of injuries among Asian migrant students. Domestic injuries of students from affluent backgrounds were linked to their inexperience in domestic or kitchen work. Injuries also resulted from unprovoked race‐related street assaults by locals. Road traffic injuries may be attributed to the driving quality of some Asian youths and are influenced by traffic orientations of their country of origin. Migrant youths are often reluctant to seek medical help for their injuries due to precarious employment situations. Asian youths are reactive to minor injuries and expect robust medical procedures. Mental health and suicidal status is hard to assess due to stigma. Family pressure and limited involvement with alcohol and drugs have a protective effect against injuries.

Research limitations/implications

While some Asian family values are protective against youth injury risk behaviours, negative parental attitudes may have the opposite effect. This has implications for community‐based prevention programmes. Under‐reporting of injuries and unprovoked racial attacks on Asian youths are of great concern. Further research on mental health and suicidal behaviour of Asian students and culturally appropriate injury prevention programmes are advocated.

Originality/value

The paper explores risk behaviours and attitudes towards prevention of injuries among young Asian students, including levels of knowledge and awareness, and their risk modifying intentions, from the viewpoint of professional stakeholders.

Getting into trouble: perspectives on stress and suicide prevention among Pacific Northwest Indian youth

Suicide rates among Indian youth in the United States are two to three times the national average. Although researchers have identified related risk and protective factors, they have limited understanding of the perspectives of youth at risk. In this descriptive, ethnographic study in a Pacific Northwest tribe, the goal was to gain an understanding of the life experiences of the youth. Focus groups and observations were conducted with 30 Indian youth aged between 14 and 19 years in a Pacific Northwest tribe. Youth were asked to talk about their stressors, sense of family/community support, and hopes for the future. Youth reported major stress and noted that friends and family were both a support and also a source of stress. They hoped for strengthening of cultural values, economic development, and opportunities to give their talents to the tribe. These findings provide further insight about suicide risk among Indian youth and advance the understanding of suicide prevention in a transcultural setting.

Current drinking and health-risk behaviors among male high school students in central Thailand

Background

Alcohol drinking is frequently related to behavioral problems, which lead to a number of negative consequences. This study was to evaluate the characteristics of male high school students who drink, the drinking patterns among them, and the associations between current drinking and other health risk behaviors which focused on personal safety, violence-related behaviors, suicide and sexual behaviors.

Method

A cross-sectional study was conducted to explore current alcohol drinking and health-risk behaviors among male high school students in central Thailand. Five thousand one hundred and eighty four male students were classified into 2 groups according to drinking in the previous 30 days (yes = 631, no = 4,553). Data were collected by self-administered, anonymous questionnaire which consisted of 3 parts: socio-demographic factors, health-risk behaviors and alcohol drinking behavior during the past year from December 2007 to February 2008.

Results

The results showed that the percent of current drinking was 12.17. Most of them were 15-17 years (50.21%). Socio-demographic factors such as age, educational level, residence, cohabitants, grade point average (GPA), having a part time job and having family members with alcohol/drug problems were significantly associated with alcohol drinking (p < 0.05). Multiple logistic regression analysis, after adjusting for socio-demographic factors, revealed that health-risk behavioral factors were associated with current alcohol consumption: often drove after drinking alcohol (OR = 3.10, 95% CI = 1.88-5.12), often carried a weapon (OR = 3.51, 95% CI = 2.27-5.42), often got into a physical fight without injury (OR = 3.06, 95% CI = 1.99-4.70), dating violence (OR = 2.58, 95% CI = 1.79-3.71), seriously thought about suicide (OR = 2.07, 95% CI = 1.38-3.11), made a suicide plan (OR = 2.10, 95% CI = 1.43-3.08), ever had sexual intercourse (OR = 5.62, 95% CI = 4.33-7.29), alcohol or drug use before last sexual intercourse (OR = 2.55, 95% CI = 1.44-4.53), and got someone pregnant (OR = 3.99, 95% CI = 1.73-9.25).

Conclusions

An increased risk of health-risk behaviors, including driving vehicles after drinking, violence-related behaviors, sad feelings and attempted suicide, and sexual behaviors was higher among drinking students that led to significant health problems. Effective intervention strategies (such as a campaign mentioning the adverse health effects and social consequences to the risk groups, and encouraging parental and community efforts to prevent drinking) among adolescents should be implemented to prevent underage drinking and adverse consequences.

Culture and context: buffering the relationship between stressful life events and risky behaviors in American Indian youth

The Sacred Mountain Youth Project was conducted to investigate risk and protective factors related to alcohol and drug use among American Indian youth. Findings indicated that stressful life events were positively associated with depressed mood, substance use, and risky behavior; cultural identity had no direct effects, but a secondary model showed that social support and protective family and peer influences were related to cultural identity. These findings suggest that the relationships between stressors and their negative sequelae are complex. Emphasis on protective processes that are culturally specific to American Indian youth may lead to effective alcohol and drug use prevention programs.

Religion and suicide: Buddhism, Native American and African religions, Atheism, and Agnosticism

Research has repeatedly demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior. A clear understanding of the influence of religion on suicidality is required to more fully assess for the risk of suicide. The databases PsycINFO and MEDLINE were used to search peer-reviewed journals prior to 2008 focusing on religion and suicide. Articles focusing on suicidality across Buddhism, Native American and African religions, as well as on the relationship among Atheism, Agnosticism, and suicide were utilized for this review. Practice recommendations are offered for conducting accurate assessment of religiosity as it relates to suicidality in these populations. Given the influence of religious beliefs on suicide, it is important to examine each major religious group for its unique conceptualization and position on suicide to accurately identify a client's suicide risk.

Toward understanding suicide among youths: results from the White Mountain Apache tribally mandated suicide surveillance system, 2001-2006

OBJECTIVES

We examined suicide and suicide attempt rates, patterns, and risk factors among White Mountain Apache youths (aged < 25 years) from 2001 to 2006 as the first phase of a community-based participatory research process to design and evaluate suicide prevention interventions.

METHODS

Apache paraprofessionals gathered data as part of a tribally mandated suicide surveillance system. We compared findings to other North American populations.

RESULTS

Between 2001 and 2006, 61% of Apache suicides occurred among youths younger than 25 years. Annual rates among those aged 15 to 24 years were highest: 128.5 per 100 000, 13 times the US all-races rate and 7 times the American Indian and Alaska Native rate. The annual suicide attempt incidence rate in this age group was 3.5%. The male-to-female ratio was 5:1 for suicide and approximately 1:1 for suicide attempts. Hanging was the most common suicide method, and third most common attempt method. The most frequently cited attempt precipitants were family or intimate partner conflict.

CONCLUSIONS

An innovative tribal surveillance system identified high suicide and attempt rates and unique patterns and risk factors of suicidal behavior among Apache youths. Findings are guiding targeted suicide prevention programs.

Adolescent alcohol involvement and suicide attempts: toward the development of a conceptual framework

The present article provides a conceptual framework of the relation between alcohol involvement (A) and suicide attempts (S). This framework can be broadly construed to reflect two dimensions: directionality (direction of causality; A-->S, S-->A, or a spurious relation) and temporality (distinguishing between proximal and distal effects of both behaviors). We review and evaluate the evidence on the association between A and S among adolescents using this conceptual framework as a guide. The extant data suggest that this relation is complex and not fully understood. Further, it seems unlikely that a single approach will be found to determine direction of causality, and the specification and validation of hypothesized mechanisms will involve a variety of different types of evidence. Suggestions for additional research using informative designs are discussed.

Reviewing suicide in Native American communities: situating risk and protective factors within a transactional-ecological framework

The alarming prevalence of suicidal behaviors in Native American communities remains a major concern in the 21st-century United States. Recent reviews have demonstrated that prevention programs and intervention efforts using transactional-ecological models have effectively reduced suicidal behaviors in the American Indian and Alaska Native populations sampled. As a result, this article adopts a transactional-ecological framework for conceptualizing suicidality and identifying points of intervention. Drawing on the most current empirical reports, the epidemiology of Native American suicidal behaviors is reviewed, while situating risk and protective factors within a biopsychosocial framework. Opportunities for intervention are discussed with a focus on the interactions between individuals and their environments, and the antecedent conditions leading to zones of heightened suicide risk.

American Indians and suicide: a neglected area of research

Suicide is a major public health problem for American Indians in the United States. Published studies indicate that American Indians experience the highest rate of suicide of all ethnic groups in the United States. This article synthesizes the epidemiology and risk factors associated with suicide among American Indians, barriers to research, prevention, mental-health services, and recommendations for research and practice. The authors' recommendations arise from the current literature as well as interviews with practitioners and academics in the field of suicide prevention. The authors present significant substantive and methodological issues that inform research on suicide in American Indian communities, as well as existing contemporary interventions. Overall, socioeconomic characteristics, substance abuse, barriers to mental health services and acculturation play a role in the occurrence of suicide in American Indian communities. These findings suggest suicide is an important public health problem that needs to be addressed for American Indians.