Global systematic review of the effects of suicide prevention interventions in Indigenous peoples

Examining community-level protection from Alaska Native suicide: An Indigenous knowledge-informed extension of the legacy of Michael Chandler and Christopher Lalonde

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.

Suicide and suicide attempts in the Pacific Islands: A Systematic Literature Review

Background

The Pacific Islands have some of the highest rates of suicide in the Western Pacific region. The purpose of this study was to systematically review the literature on suicidal behaviour in the Pacific Islands.

Methods

A comprehensive search of Web of Science, PubMed, PsycINFO, Cochrane, CINAHL and Embase databases was conducted for all articles published until 1^st February 2021. Inclusion criteria included papers that referred to a pre-specified list of Pacific Islands. Papers referring exclusively to other countries were excluded. Other exclusion criteria included not being about suicide or suicide attempts or not presenting original research. Narrative synthesis was applied without meta-analysis. The review followed PRISMA guidelines.

Findings

A total of 36 papers were included for review. Of the Pacific Islands, Kiribati has the highest age-standardised rate of suicide mortality. Key risk groups across the Islands included youth, people of Indian ethnicity in Fiji (a prominent ethnic group in Fiji), and Indigenous peoples across other Islands. Prominent methods were self-poisoning and hanging. A distinct lack of intervention studies was found.

Interpretation

Overall, the Pacific Islands appear to have relatively high rates of suicide and suicide attempts compared to other countries in the region. This was particularly striking among youth. This review provides important directions for future suicide prevention activities, including means restriction, sensitive media/community coverage, enhanced surveillance, and the development and evaluation of interventions tailored to the needs of young people and other cultural groups.

Funding

None.