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Adams R, Haroz EE, Rebman P, Suttle R, Grosvenor L, Bajaj M, Dayal RR, Maggio D, Kettering CL, Goklish N. Developing a suicide risk model for use in the Indian Health Service. NPJ MENTAL HEALTH RESEARCH 2024; 3:47. [PMID: 39414996 DOI: 10.1038/s44184-024-00088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 09/10/2024] [Indexed: 10/18/2024]
Abstract
We developed and evaluated an electronic health record (EHR)-based model for suicide risk specific to an American Indian patient population. Using EHR data for all patients over 18 with a visit between 1/1/2017 and 10/2/2021, we developed a model for the risk of a suicide attempt or death in the 90 days following a visit. Features included demographics, medications, diagnoses, and scores from relevant screening tools. We compared the predictive performance of logistic regression and random forest models against existing suicide screening, which was augmented to include the history of previous attempts or ideation. During the study, 16,835 patients had 331,588 visits, with 490 attempts and 37 deaths by suicide. The logistic regression and random forest models (area under the ROC (AUROC) 0.83 [0.80-0.86]; both models) performed better than enhanced screening (AUROC 0.64 [0.61-0.67]). These results suggest that an EHR-based suicide risk model can add value to existing practices at Indian Health Service clinics.
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Affiliation(s)
- Roy Adams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Emily E Haroz
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Paul Rebman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Rose Suttle
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21205, USA
| | - Luke Grosvenor
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, USA
| | - Mira Bajaj
- Mass General Brigham McLean, Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Rohan R Dayal
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21205, USA
| | - Dominick Maggio
- Whiteriver Indian Hospital, 200 W Hospital Dr, Whiteriver, Arizona, USA
| | | | - Novalene Goklish
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21205, USA
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Nevarez Flores AG, Martin A, Bartkowiak-Theron I, Makin J, Norris K, Castle D, Neil AL. The impact of suicide registers and other monitoring systems on suicide prevention: A scoping review. Int J Soc Psychiatry 2024:207640241261164. [PMID: 39076149 DOI: 10.1177/00207640241261164] [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: 07/31/2024]
Abstract
BACKGROUND Decreasing suicide mortality has become an overarching goal for societies worldwide. Suicide registers and other monitoring systems are a valuable source of information that can be used for addressing the suicide phenomenon and evaluating preventative interventions. AIMS This scoping review provides an overview of literature published in the last decade that has focussed on the operations (functioning) and characteristics of suicide registers and other suicide monitoring systems. METHODS Four electronic databases were searched in 2020 for identifying published material from January 2010 to October 2020. The searches were updated in October 2023 to include material from 2020 to date. Grey literature through Google searches and mental health commissions websites and the reference lists of selected documents were also searched. RESULTS Twenty-five articles were included in this review. Nearly half the articles were from the United States, followed by Australia. Nine countries were identified as having used suicide registers or suicide-specific monitoring systems to inform suicide prevention. Monitoring mechanisms varied across the countries examined. No article provided evidence that definitively linked suicide registers or other monitoring systems for suicide with the prevention of suicide or reduction in suicide rates. However, a variety of benefits of suicide monitoring for preventative and public health interventions were identified. CONCLUSIONS The number of nations with surveillance systems for suicide prevention is low. Further, there is a lack of consistency in the systematic collection, analysis and interpretation of suicide-related information across the countries examined. Efforts to establish high-quality suicide surveillance systems that can be accessed in a timely and easy manner are needed to inform tailored strategies for suicide prevention.
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Affiliation(s)
- Adriana G Nevarez Flores
- Tasmanian Centre for Mental Health Service Innovation, Tasmanian Health Service, Hobart, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Angela Martin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Isabelle Bartkowiak-Theron
- School of Social Sciences, University of Tasmania, Hobart, Australia
- Tasmanian Institute of Law Enforcement Studies, University of Tasmania, Hobart, Australia
| | - Jennifer Makin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kimberley Norris
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - David Castle
- Tasmanian Centre for Mental Health Service Innovation, Tasmanian Health Service, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Lui JHL, Chen BC, Benson LA, Lin YJR, Ruiz A, Lau AS. Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:720-732. [PMID: 37422107 DOI: 10.1016/j.jaac.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth. METHOD Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years. RESULTS In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes. CONCLUSION Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services. PLAIN LANGUAGE SUMMARY The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.
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Affiliation(s)
| | - Belinda C Chen
- University of California, Los Angeles, Los Angeles, California
| | - Lisa A Benson
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Yen-Jui R Lin
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Amanda Ruiz
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Anna S Lau
- University of California, Los Angeles, Los Angeles, California
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VanWormer JJ, Berg RL, VanWormer A, Weichelt BP. Race, Rurality, and Suicidality in Children and Adolescents. Am J Prev Med 2024; 66:883-887. [PMID: 38072296 DOI: 10.1016/j.amepre.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Suicide is among the leading causes of death in U.S. youth. Rural residency is a risk factor, but suicide variability by race/ethnicity is more nuanced. Early detection of suicidal ideation and intent are key components of prevention, but to the authors' knowledge, few prior studies have examined how rurality and race interact on youth suicidality. This study examined suicidality between White non-Hispanic versus non-White or Hispanic youth, as well as those who lived in rural versus non-rural areas. METHODS Cross-sectional analyses were conducted using data from youth age 5-17 years who had complete capture of their medical care in a Wisconsin healthcare system. Suicidality was extracted from medical records by screening for diagnoses indicative of suicidal attempt or ideation between 2017 and 2022. Race/ethnicity and rural residence were extracted from administrative records. Analyses were done in 2023. RESULTS The sample included 27,392 rural and 20,370 non-rural youth, with suicidality observed in 2% of participants. There was a significant interaction between rural residence and race/ethnicity (p=0.015). Non-White or Hispanic youth in rural areas had the highest risk of suicidality at 75 (CI: 57, 97) per 10,000. Non-White or Hispanic youth in non-rural areas had the lowest risk of suicidality at 38 (CI: 28, 52) per 10,000. CONCLUSIONS Racial/ethnic minority youth who lived in rural areas were more likely to experience suicidality as compared to their non-rural counterparts. Larger prospective studies are needed to identify causal elements of the rural environment that may hasten racial disparities in youth suicidality.
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Affiliation(s)
- Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin.
| | - Richard L Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Arin VanWormer
- Department of Nursing, University of Wisconsin - Eau Claire, Eau Claire, Wisconsin
| | - Bryan P Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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Ehlers CL, Gilder DA, Benedict J, Wills DN, Phillips E, Gonzales C, Karriker-Jaffe KJ, Bernert RA. Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents. Transcult Psychiatry 2024; 61:273-284. [PMID: 38311923 PMCID: PMC11376403 DOI: 10.1177/13634615241227679] [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: 02/06/2024]
Abstract
American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n = 360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in "social zeitgebers" that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.
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Affiliation(s)
- Cindy L Ehlers
- Neurosciences Department, The Scripps Research Institute, USA
| | - David A Gilder
- Neurosciences Department, The Scripps Research Institute, USA
| | | | - Derek N Wills
- Neurosciences Department, The Scripps Research Institute, USA
| | - Evie Phillips
- Neurosciences Department, The Scripps Research Institute, USA
| | - Cathy Gonzales
- Neurosciences Department, The Scripps Research Institute, USA
- Pala Band of Mission Indians, Pala, CA, USA
| | | | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
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Rollman JE, Thomas M, Mercer Kollar LM, Ports KA, Clelland C, Satter DE, David-Ferdon C. American Indian and Alaska Native violence prevention efforts: a systematic review, 1980 to 2018. Inj Epidemiol 2024; 8:72. [PMID: 38504377 PMCID: PMC10949553 DOI: 10.1186/s40621-024-00488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Violence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations. METHODS A review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population. RESULTS A total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results. CONCLUSIONS This review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations.
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Affiliation(s)
- Jeffrey E Rollman
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - M Thomas
- Independent Researcher, Gulf Breeze, FL, 32563, USA
| | - Laura M Mercer Kollar
- Division of Violence Prevention, Centers for Disease Control and Prevention, National Center for Injury Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA.
| | - Katie A Ports
- American Institutes for Research, 10 South Riverside Plaza, 6th Floor, Chicago, IL, 60606, USA
| | - Carmen Clelland
- Indian Health Service, 5600 Fishers Lane, Rockville, MD, 20857, USA
- Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, 1825 Century Boulevard, Atlanta, GA, 30345, USA
| | - Delight E Satter
- Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, 1825 Century Boulevard, Atlanta, GA, 30345, USA
| | - Corinne David-Ferdon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Atlanta, GA, 30341, USA
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Ormiston CK, Lawrence WR, Sulley S, Shiels MS, Haozous EA, Pichardo CM, Stephens ES, Thomas AL, Adzrago D, Williams DR, Williams F. Trends in Adolescent Suicide by Method in the US, 1999-2020. JAMA Netw Open 2024; 7:e244427. [PMID: 38551558 PMCID: PMC10980967 DOI: 10.1001/jamanetworkopen.2024.4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/03/2024] [Indexed: 04/01/2024] Open
Abstract
Importance Adolescent suicide in the US is a major public health problem, yet temporal trends in suicide methods by demographics are understudied. Objective To examine national trends in suicide mortality by method (firearm, poisoning, hanging and asphyxiation, and all other means) from 1999 to 2020 by demographic characteristics. Design, Setting, and Participants This serial cross-sectional study used national death certificate data of adolescent (aged 10-19 years) suicide decedents compiled by the National Center for Health Statistics from January 1, 1999, to December 31, 2020. Data analysis was performed from April 1, 2023, to July 9, 2023. Exposures Age, sex, and race and ethnicity. Main Outcomes and Measures Trends in age-standardized mortality rates and average annual percent change (AAPC) in rates were estimated by age, sex, and race and ethnicity for each suicide method. Results This study assessed data from 47 217 adolescent suicide decedents. From 1999 to 2020, suicide by firearm (AAPC, 1.0; 95% CI, 0.1-1.9), poisoning (AAPC, 2.7; 95% CI, 1.0-4.4), hanging and asphyxiation (AAPC, 2.4; 95% CI, 0.2-4.6), and other means (AAPC, 2.9; 95% CI, 1.2-4.6) increased. Rapidly increasing rates were observed among female adolescents for poisoning (AAPC, 4.5; 95% CI, 2.3-6.7) and hanging and asphyxiation (AAPC, 5.9; 95% CI, 5.0-6.8) suicides. From 2007 to 2020, firearm suicides sharply increased among female (annual percent change [APC], 7.8; 95% CI, 6.0-9.5) and male (APC, 5.3; 95% CI, 4.3-6.3) adolescents. Firearm suicide rates increased among Black adolescents from 2012 to 2020 (APC, 14.5; 95% CI, 9.7-19.5), Asian and Pacific Islander adolescents from 2008 to 2020 (APC, 12.0; 95% CI, 9.7-14.5), American Indian and Alaska Native adolescents from 2014 to 2020 (APC, 10.6; 95% CI, 2.6-19.3), and Hispanic or Latino adolescents from 2011 to 2020 (APC, 10.2; 95% CI, 6.3-13.8). During the study period, Black adolescents had the highest average increase in hanging and asphyxiation suicides (AAPC, 4.2; 95% CI, 3.2-5.2). From 2011 to 2020, poisoning suicide deaths increased (APC, 12.6; 95% CI, 8.5-16.7) among female adolescents. Conclusions and Relevance Suicide rates increased across all methods from 1999 to 2020. Differences were noted by sex, age, and race and ethnicity. Increasing suicide rates among racial and ethnic minoritized youth are especially concerning, and effective prevention strategies are urgently needed.
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Affiliation(s)
- Cameron K. Ormiston
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wayne R. Lawrence
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | | | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Emily A. Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Catherine M. Pichardo
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Erica S. Stephens
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Aleah L. Thomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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Wexler L, White LA, O'Keefe VM, Rasmus S, Haroz EE, Cwik MF, Barlow A, Goklish N, Elliott E, Pearson CR, Allen J. Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities. Arch Suicide Res 2024:1-16. [PMID: 38240632 PMCID: PMC11258209 DOI: 10.1080/13811118.2023.2300321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.
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Rossom RC, Simon GE. Screening for Suicide Risk Is Predicting the Future, Not Diagnosing the Present. Jt Comm J Qual Patient Saf 2023; 49:660-662. [PMID: 37852852 DOI: 10.1016/j.jcjq.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
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Ehlers CL, Gilder DA, Karriker-Jaffe KJ, Bernert R. Comorbidity of anxiety/affective, conduct/antisocial, attention deficit, and alcohol use disorders with suicidal behaviors in an American Indian community sample of adults and adolescents. J Psychiatr Res 2023; 167:63-70. [PMID: 37837862 PMCID: PMC10997741 DOI: 10.1016/j.jpsychires.2023.10.005] [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: 04/28/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
AIMS To study the associations of anxiety/affective disorders, conduct/antisocial disorders (ASPD/CD), attention deficit disorders (ADHD), and alcohol use disorders (AUD) with suicidal behaviors in an American Indian (AI) community sample of adolescents and adults. METHODS Participants were AI (360 adolescents, 925 adults) recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). RESULTS Among AI adults (mean age = 33 years), 17% percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts (including either a suicide attempt history or verified death by suicide; n = 19 deaths). Among AI adolescents (mean age = 15 years), 20% experienced suicidal thoughts and 9% experienced suicidal acts (including 3 deaths). In logistic regression analyses, suicidal thoughts were significantly associated with lifetime diagnoses of affective disorder, CD and ADHD in adolescents, and with anxiety disorder, affective disorder, and ASPD/CD in adults. Suicidal acts were associated with affective disorder, ADHD, and alcohol drinking in adolescents and with anxiety disorder, ASPD/CD and AUD in adults. The number of comorbid disorders greatly increased the risk of both suicidal thoughts and acts among both adolescents and adults. CONCLUSIONS In addition to affective disorders, both ADHD and CD in adolescents, and ASPD in adults, demonstrated an association with suicidal thoughts. Alcohol use by adolescents and AUD among adults also were associated with suicidal attempts in this AI sample. These findings suggest need for additional research and potential integration of alcohol in screening and intervention programs focused on the prevention of suicide among AI.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Barlow A, Haroz EE, O’Keefe VM, Brockie T, Manson SM, Allen J, Wexler L, Buchwald D, Rasmus S, Goklish N, Ivanich J, Stifter M, Cwik M. New Collaborative Research on Suicide Prevention, Practice, and Policy With American Indian and Alaska Native Communities Holds Promise for All Peoples. Health Promot Pract 2023; 24:841-851. [PMID: 36863761 PMCID: PMC10474247 DOI: 10.1177/15248399221116630] [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] [Indexed: 03/04/2023]
Abstract
Youth suicide is increasing in the United States, with deaths among younger people of color driving this upward trend. For more than four decades, American Indian and Alaska Native (AIAN) communities have suffered disproportionate rates of youth suicide and years of productive life lost compared to other U.S. Races. The National Institute of Mental Health (NIMH) recently funded three regional Collaborative Hubs to carry out suicide prevention research, practice, and policy development with AIAN communities in Alaska and rural and urban areas of the Southwestern United States. The Hub partnerships are supporting a diverse array of tribally-driven studies, approaches, and policies with immediate value for increasing empirically driven public health strategies to address youth suicide. We discuss unique features of the cross-Hub work, including: (a) long-standing Community-Based Participatory Research processes that led to the Hubs' innovative designs and novel approaches to suicide prevention and evaluation, (b) comprehensive ecological theoretical approaches that contextualize individual risk and protective factors in multilevel social contexts; (c) unique task-shifting and systems of care approaches to increase reach and impact on youth suicide in low-resource settings; and (d) prioritization of strengths-based approaches. The work of the Collaborative Hubs for AIAN youth suicide prevention is generating specific and substantive implications for practice, policy, and research presented in this article at a time when youth suicide prevention is a dire national priority. Approaches also have relevance for historically marginalized communities worldwide.
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Affiliation(s)
- A. Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E. E. Haroz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V. M. O’Keefe
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T. Brockie
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - S. M. Manson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J. Allen
- University of Minnesota Medical School, Duluth, MN, USA
| | - L. Wexler
- University of Michigan, Ann Arbor, MI, USA
| | - D. Buchwald
- Washington State University, Spokane, WA, USA
| | - S. Rasmus
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - N. Goklish
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- White Mountain Apache Tribe, Whiteriver, AZ, USA
| | - J. Ivanich
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M. Stifter
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. Cwik
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Haroz EE, Goklish N, Walsh CG, Cwik M, O’Keefe VM, Larzelere F, Garcia M, Minjarez T, Barlow A. Evaluation of the Risk Identification for Suicide and Enhanced Care Model in a Native American Community. JAMA Psychiatry 2023; 80:675-681. [PMID: 37195713 PMCID: PMC10193257 DOI: 10.1001/jamapsychiatry.2022.5068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/18/2022] [Indexed: 05/18/2023]
Abstract
Importance There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Novalene Goklish
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Colin G. Walsh
- Department of Biomedical Informatics, Department of Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Cwik
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Victoria M. O’Keefe
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Francene Larzelere
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell Garcia
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Tina Minjarez
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Allison Barlow
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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13
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Brockie T, Decker E, Barlow A, Cwik M, Ricker A, Aguilar T, Wetsit L, Wilson D, Haroz EE. Planning for implementation and sustainability of a community-based suicide surveillance system in a Native American community. Implement Sci Commun 2023; 4:1. [PMID: 36600290 DOI: 10.1186/s43058-022-00376-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Native American youth, primarily living on reservations, suffer the highest burden of suicide of any racial group in the USA. Implementation and sustainability of culturally grounded, evidence-based interventions are needed to address suicide in Native American populations. For nearly 40 years, Montana has ranked at or near the top nationwide for suicide. Fort Peck Tribal leadership declared a state of emergency in 2010 after six suicides and 20 attempts that occurred over a 5-month period. METHODS We used a community-based participatory research approach for adapting the Celebrating Life (CL) program with a specific focus on long-term sustainability, which has demonstrated efficacy in addressing suicide with the White Mountain Apache. The aims were to (1) adapt the CL program intake forms through roundtable discussions, (2) conduct asset and resource mapping to identify community and cultural resources to leverage for the CL program within the Fort Peck context, and (3) develop a sustainability plan for CL in Fort Peck through qualitative approaches informed by the Program Sustainability Assessment Tool. RESULTS Roundtable discussions resulted in adapted intake forms that capture variables relevant to the Fort Peck context. Asset mapping identified 13 community assets and 10 cultural resources to incorporate within the CL implementation process. Focus group discussions yielded four key themes that were incorporated into a plan for sustainability: (1) strategic partnerships, (2) long-term funding, (3) communication planning, and (4) workforce planning and engagement. CONCLUSIONS This paper outlines an avenue for using culturally adapted tools to design an implementation system driven by community and cultural assets within tribal communities and for integrating program planning for sustainability early in the implementation process.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Ellie Decker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Mary Cwik
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Adriann Ricker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Theresa Aguilar
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Lawrence Wetsit
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Deborah Wilson
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
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14
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Azizi H, Esmaeili ED, Khodamoradi F, Sarbazi E. Effective suicide prevention strategies in primary healthcare settings: a systematic review. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
There is a fundamental need for health systems, health managers, and policymakers to identify effective components of suicide prevention strategies (SPS) and programs in primary healthcare (PHC) settings. Accordingly, this systematic review aimed to identify and summarize effective and significant evidence on suicide prevention in PHC setting. We systematically searched the published literature in English from PubMed, Web of Science, Scopus, CINAHL, PsychoINFO, and Embase up to 31 July 2022. The study searched all records reporting effective and significant strategies and programs on suicide prevention in PHC settings. A content analysis approach was carried out to extract major components of suicide prevention strategies in PHC settings.
Results
A total of 10 records (8 original articles and 2 reports) with 1,199,986 samples were included. In all the included articles, SPS decreased suicide rates. The majority of studies were conducted among the general population. The content analysis approach emerged five major components to SPS in PHC setting: (1) training and educating healthcare providers, (2) screening and suicide risk assessment, (3) managing depression symptoms and mental disorders, (4) managing suicide attempters and at-risk cases, and (5) prevention strategies at the general population.
Conclusions
This review provided reliable evidence for health systems to develop SPS in PHC and practitioners who are eager to provide brief and effective contact interventions for suicide risk to well-serve their patients.
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15
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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16
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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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17
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Ehlers CL, Yehuda R, Gilder DA, Bernert R, Karriker-Jaffe KJ. Trauma, historical trauma, PTSD and suicide in an American Indian community sample. J Psychiatr Res 2022; 156:214-220. [PMID: 36265258 PMCID: PMC9842016 DOI: 10.1016/j.jpsychires.2022.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
AIMS To study the associations between perceived historical trauma, current traumatic events, diagnoses of post-traumatic stress disorder (PTSD), and suicidal behaviors in an American Indian community sample. METHODS Participants were American Indians recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), as well as the Historical Loss Scale, Historical Loss Associated Symptoms Scale, and Stressful Life Events Scale. RESULTS In data from 447 American Indian adults (mean age = 33 years), twenty percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts, (including either a suicide attempt history or verified death by suicide (n = 4)). Diagnosis of PTSD and experience of assaultive trauma were each significantly associated with suicidal thoughts and acts, although assaultive trauma did not remain significant in models adjusting for gender and PTSD. High endorsement of symptoms associated with historical trauma was significantly associated with suicidal acts, and this remained significant when adjusting for gender and PTSD. CONCLUSIONS PTSD and historical trauma have an association with suicide and suicidal attempts in this American Indian community. Although further research is needed to evaluate the causal nature of these relations, these findings suggest treatment and prevention programs for American Indian suicide may benefit from addressing issues related to feelings of historical losses, PTSD, and their associated symptomatology.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - Rachel Yehuda
- James J. Peters Bronx Medical Center and Psychiatry Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences Stanford University, Stanford, CA, USA
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Outpatient Mental Health Follow-up and Recurrent Self-harm and Suicide Among Patients Admitted to the ICU for Self-harm: A Population-based Cohort Study. Chest 2022; 163:815-825. [PMID: 36445799 DOI: 10.1016/j.chest.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk. RESEARCH QUESTION What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm? STUDY DESIGN AND METHODS Population-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with 'early follow-up' indicating 1 to 21 days after discharge, 'late follow-up' indicating 22 to 60 days after discharge, and 'no follow-up' indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge. RESULTS We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide. INTERPREATION Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.
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O’Keefe VM, Waugh E, Grubin F, Cwik M, Chambers R, Ivanich J, Weeks R, Barlow A. Development of "CULTURE FORWARD: A strengths and culture-based tool to protect our native youth from suicide". CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2022; 28:587-597. [PMID: 35771514 PMCID: PMC9588522 DOI: 10.1037/cdp0000546] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Indigenous knowledge and practices promote American Indian/Alaska Native (AI/AN; Native) communities' health and well-being. Historical losses and continued oppression have resulted in disproportionately higher AI/AN youth suicide rates. This article describes the development of a new national resource guide titled "CULTURE FORWARD" for tribal leaders and stakeholders to support youth suicide prevention efforts through cultural strengths. METHOD The CULTURE FORWARD guide was developed over 6 months through a community-engaged process. We conducted nine roundtables and eight interviews with a wide variety of community members, leaders, and providers representing 36 diverse tribal communities and geographic regions. Participants discussed AI/AN youth risk and protective factors, successful community efforts to prevent suicide, and content and dissemination ideas. A comprehensive literature review complemented qualitative findings. A diverse and representative National Advisory Editorial Board guided content and design throughout development. RESULTS Qualitative data were analyzed iteratively and thematically. Across all listening sessions, culture was identified as a key protective factor against AI/AN youth suicide. Five themes related to cultural strengths informed guide chapters. Each chapter includes an introduction; how that theme helps prevent Native youth suicide; a review of academic literature, community stories and programs; action steps; and additional resources. CONCLUSIONS CULTURE FORWARD honors and empowers communities by weaving strands of knowledge, stories, and practical resources highlighting Native communities' strengths to protect against Native youth suicide. The guide is free online and print copies are being distributed nationally. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Victoria M. O’Keefe
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
| | - Emma Waugh
- United South and Eastern Tribes, Inc., Nashville, Tennessee, United States
| | - Fiona Grubin
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
| | - Mary Cwik
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
| | - Rachel Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
| | - Jerreed Ivanich
- Department of Community and Behavioral Health, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Rose Weeks
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
| | - Allison Barlow
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health
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20
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Platt JM, Pamplin JR, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Martínez-Alés G, Shaman J, Keyes K. Racial Disparities in Spatial and Temporal Youth Suicide Clusters. J Am Acad Child Adolesc Psychiatry 2022; 61:1131-1140.e5. [PMID: 35031449 PMCID: PMC9271532 DOI: 10.1016/j.jaac.2021.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Deaths by suicide correlate both spatially and temporally, leading to suicide clusters. This study aimed to estimate racial patterns in suicide clusters since 2000. METHOD Data from the US National Vital Statistics System included all International Classification of Diseases, Tenth Revision (ICD-10)-coded suicide cases from 2000-2019 among American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (A/PI), Black, or White youth and young adults, aged 5-34 years. We estimated age, period, and cohort (APC) trends and identified spatiotemporal clusters using the SaTScan space-time statistic, which identified lower- and higher-than-expected suicide rates (cold and hot clusters) in a prespecified area (150 km) and time interval (15 months). We also calculated the average proportion of deaths by suicide contained in clusters, to quantify the relative importance of spatiotemporal patterning as a driver of overall suicide rates. RESULTS From 2010-2019, suicide rates increased from between 37% among AI/AN (95% CI = 1.22, 1.55) to 81% among A/PI (95% CI = 1.65, 2.01) groups. Suicide clusters accounted for 0.8%-10.3% of all suicide deaths, across racial groups. Since 2000, the likelihood of detecting cluster increased over time, with considerable differences in the number of clusters in each racial group (4 among AI/AN to 72 among White youth). Among Black youth and young adults, 27 total clusters were identified. Hot clusters were concentrated in southeastern and mid-Atlantic counties. CONCLUSION Suicide rates and clusters in youth and young adults have increased in the past 2 decades, requiring attention from policy makers, clinicians, and caretakers. Racially distinct patterns highlight opportunities to tailor individual- and population-level prevention efforts to prevent suicide deaths in emerging high-risk groups.
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Affiliation(s)
| | - John R Pamplin
- Center for Urban Science and Progress, New York University, New York; Grossman School of Medicine, New York University, New York
| | | | | | | | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York; Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | - Madelyn S Gould
- Mailman School of Public Health, Columbia University, New York; Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | | | - Jeffrey Shaman
- Mailman School of Public Health, Columbia University, New York
| | - Katherine Keyes
- Mailman School of Public Health, Columbia University, New York
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21
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Kegler SR, Simon TR, Zwald ML, Chen MS, Mercy JA, Jones CM, Mercado-Crespo MC, Blair JM, Stone DM, Ottley PG, Dills J. Vital Signs: Changes in Firearm Homicide and Suicide Rates - United States, 2019-2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:656-663. [PMID: 35550497 PMCID: PMC9098246 DOI: 10.15585/mmwr.mm7119e1] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020. METHODS National vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty. RESULTS From 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10-44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25-44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10-44 years, rates did increase. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE During the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.
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22
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Troya M, Spittal MJ, Pendrous R, Crowley G, Gorton HC, Russell K, Byrne S, Musgrove R, Hannah-Swain S, Kapur N, Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101399. [PMID: 35518122 PMCID: PMC9065636 DOI: 10.1016/j.eclinm.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. METHODS Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. FINDINGS A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. INTERPRETATION The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations. FUNDING No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- M.Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, 4.07 Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Grace Crowley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kirsten Russell
- School of Psychological Sciences and Health, Graham Hills Building, 40 George Street, Glasgow, UK
| | - Sadhbh Byrne
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Musgrove
- Centre for Mental Health and Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Navneet Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Corresponding author.
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23
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Simon GE, Shortreed SM, Rossom RC, Beck A, Clarke GN, Whiteside U, Richards JE, Penfold RB, Boggs JM, Smith J. Effect of Offering Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care on Self-harm Among Adult Outpatients With Suicidal Ideation: A Randomized Clinical Trial. JAMA 2022; 327:630-638. [PMID: 35166800 PMCID: PMC8848197 DOI: 10.1001/jama.2022.0423] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
Importance People at risk of self-harm or suicidal behavior can be accurately identified, but effective prevention will require effective scalable interventions. Objective To compare 2 low-intensity outreach programs with usual care for prevention of suicidal behavior among outpatients who report recent frequent suicidal thoughts. Design, Setting, and Participants Pragmatic randomized clinical trial including outpatients reporting frequent suicidal thoughts identified using routine Patient Health Questionnaire depression screening at 4 US integrated health systems. A total of 18 882 patients were randomized between March 2015 and September 2018, and ascertainment of outcomes continued through March 2020. Interventions Patients were randomized to a care management intervention (n = 6230) that included systematic outreach and care, a skills training intervention (n = 6227) that introduced 4 dialectical behavior therapy skills (mindfulness, mindfulness of current emotion, opposite action, and paced breathing), or usual care (n = 6187). Interventions, lasting up to 12 months, were delivered primarily through electronic health record online messaging and were intended to supplement ongoing mental health care. Main Outcomes and Measures The primary outcome was time to first nonfatal or fatal self-harm. Nonfatal self-harm was ascertained from health system records, and fatal self-harm was ascertained from state mortality data. Secondary outcomes included more severe self-harm (leading to death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm). Results A total of 18 644 patients (9009 [48%] aged 45 years or older; 12 543 [67%] female; 9222 [50%] from mental health specialty clinics and the remainder from primary care) contributed at least 1 day of follow-up data and were included in analyses. Thirty-one percent of participants offered care management and 39% offered skills training actively engaged in intervention programs. A total of 540 participants had a self-harm event (including 45 deaths attributed to self-harm and 495 nonfatal self-harm events) over 18 months following randomization: 172 (3.27%) in care management, 206 (3.92%) in skills training, and 162 (3.27%) in usual care. Risk of fatal or nonfatal self-harm over 18 months did not differ significantly between the care management and usual care groups (hazard ratio [HR], 1.07; 97.5% CI, 0.84-1.37) but was significantly higher in the skills training group than in usual care (HR, 1.29; 97.5% CI, 1.02-1.64). For severe self-harm, care management vs usual care had an HR of 1.03 (97.5% CI, 0.71-1.51); skills training vs usual care had an HR of 1.34 (97.5% CI, 0.94-1.91). For the broader self-harm definition, care management vs usual care had an HR of 1.10 (97.5% CI, 0.92-1.33); skills training vs usual care had an HR of 1.17 (97.5% CI, 0.97-1.41). Conclusions and Relevance Among adult outpatients with frequent suicidal ideation, offering care management did not significantly reduce risk of self-harm, and offering brief dialectical behavior therapy skills training significantly increased risk of self-harm, compared with usual care. These findings do not support implementation of the programs tested in this study. Trial Registration ClinicalTrials.gov Identifier: NCT02326883.
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Affiliation(s)
| | | | | | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Gregory N. Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | | | | | - Julia Smith
- Kaiser Permanente Washington Health Research Institute, Seattle
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24
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Allen J, Wexler L, Rasmus S. Protective Factors as a Unifying Framework for Strength-Based Intervention and Culturally Responsive American Indian and Alaska Native Suicide Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:59-72. [PMID: 34169406 DOI: 10.1007/s11121-021-01265-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.
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Affiliation(s)
- James Allen
- Department of Family Medicine and Biobehavioral Health and Memory Keepers Medical Discovery Team-American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, Duluth, MN, 55812, USA.
| | - Lisa Wexler
- Department of Social Work and Research Center for Group Dynamics, Institute for Social Research, Univeristy of Michigan, Ann Arbor, MI, 48104, USA
| | - Stacy Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, 99775, USA
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25
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Cwik M, Doty SB, Hinton A, Goklish N, Ivanich J, Hill K, Lee A, Tingey L, Craig M. Community Perspectives on Social Influences on Suicide Within a Native American Reservation. QUALITATIVE HEALTH RESEARCH 2022; 32:16-30. [PMID: 34825619 PMCID: PMC10040248 DOI: 10.1177/10497323211045646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Relative to the general population, Native Americans (NA) bear a disproportionate burden of suicide-related mortality rates. NA males and females aged 15 to 24 years experience suicide rates nearly 3 times than the U.S. all races rates in this age group. Although efforts have been made to understand and reduce suicide in tribal communities, a large portion has focused on individual characteristics with less attention given to social factors that may also inform suicide. This article aims to build on a local conceptual model of NA youth suicide by examining additional potential social factors through qualitative interviews. Findings from the thematic analysis resulted in the identification of seven perceived social influences: contagion, violence and abuse, discrimination and bullying, negative expectations, spirituality, social support, and cultural strengths. Public health approaches to reduce suicide should consider local social factors that resonate with tribal communities to build resilience.
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Affiliation(s)
- Mary Cwik
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Kyle Hill
- Johns Hopkins University, Baltimore, MD, USA
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26
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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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27
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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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28
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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29
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Ivanich JD, Weckstein J, Nestadt PS, Cwik MF, Walls M, Haroz EE, O’Keefe VM, Goklish N, Barlow A. Suicide and the opioid overdose crisis among American Indian and Alaska Natives: a storm on two fronts demanding swift action. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:527-534. [PMID: 34374620 PMCID: PMC9091944 DOI: 10.1080/00952990.2021.1955895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The opioid crisis in the United States has received national attention and critical resources in the past decade. However, what has been overlooked is the effect the opioid crisis may be having on a three-decade suicide crisis among American Indian and Alaska Native (AIAN) communities that already have too few resources to address behavioral and mental health issues. This paper describes recent epidemiological trends associated with both opioid overdose and suicide at a national level for AIANs and the rest of the United States. We used data reported by the Centers for Disease Control and Prevention to report historical trends of opioid overdose and suicide for AIAN and non-AIAN populations. We found alarming and potentially correlated trends of opioid use and suicidality among AIAN populations. We highlight both current and future research that will be essential to understanding and addressing the unique intersection between opioid and suicide risk and protective factors to inform dual prevention and intervention efforts among AIAN populations with potential relevance to public health response among other at-risk populations.
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Affiliation(s)
- Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, University of Colorado – Anschutz Medical Campus, Aurora, CO, USA
| | - Julia Weckstein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary F. Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Walls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E. Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria M. O’Keefe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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30
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Haroz EE, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021; 7:e24377. [PMID: 34473065 PMCID: PMC8446841 DOI: 10.2196/24377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.
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Affiliation(s)
- Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Pioche
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma Waugh
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Usher
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew C Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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31
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Pollock NJ, Liu L, Wilson MM, Reccord C, Power ND, Mulay S, Karaivanov Y, Tonmyr L. Suicide in Newfoundland and Labrador, Canada: a time trend analysis from 1981 to 2018. BMC Public Health 2021; 21:1291. [PMID: 34215242 PMCID: PMC8252247 DOI: 10.1186/s12889-021-11293-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. METHODS We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. RESULTS From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide. CONCLUSIONS The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide.
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Affiliation(s)
- Nathaniel J Pollock
- School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada. .,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada. .,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Li Liu
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margo M Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Charlene Reccord
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole D Power
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine, Discipline of Family Medicine, Faculty of Medicine, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Lil Tonmyr
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
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32
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Quinlan K, Nickerson K, Ebin J, Humphries-Wadsworth T, Stout E, Frankini E. Supporting a public health approach to suicide prevention: Recommendations for state infrastructure. Suicide Life Threat Behav 2021; 51:352-357. [PMID: 33876497 DOI: 10.1111/sltb.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The U.S. National Strategy for Suicide Prevention calls for states to identify supportive structures that encourage efficient, effective, and sustainable suicide prevention programming at the state, territorial, tribal, and local levels (HHS & Action Alliance, 2012). To meet this objective, the Suicide Prevention Resource Center (SPRC) completed a literature review and environmental scan, convened an advisory panel of suicide prevention experts, and conducted interviews with suicide prevention and policy experts to identify six essential state-level infrastructure elements: Authorize-Designate a lead organization for suicide prevention in the state and give it the resources to put a state plan into practice. Lead-Maintain a dedicated leadership and core staff positions in order to enact the plan. Create collaboration within state government. Partner-Ensure a state-level public-private partnership with a shared vision for suicide prevention. Examine-Encourage the collection and analysis of high-quality suicide data. Build-Support a multifaceted lifespan approach to suicide prevention across the state. Guide-Build state and local capacity for prevention. In this commentary, we recommend a framework for organizing an emerging evidence base on the infrastructure and systems that are needed to support an effective, sustainable, public health approach to suicide prevention.
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Affiliation(s)
| | | | - Julie Ebin
- Education Development Center, Waltham, MA, USA
| | | | | | - Elisabeth Frankini
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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33
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Mohatt NV, Kreisel CJ, Hoffberg AS, Mph LW, Beehler SJ. A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States. J Rural Health 2020; 37:565-575. [PMID: 33210399 DOI: 10.1111/jrh.12532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Suicide rates continue to be significantly higher in rural compared to urban communities in the United States, with the suicide rate disparity continuing to grow since 1999. This systematic review synthesizes rural-specific factors related to increased suicide risk. METHODS OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar were searched for articles published after 2003 investigating rural adult suicide in the United States. Selection criteria were: (1) study participants > 18 years old; (2) included rural participants or communities; (3) included suicidal self-directed violence outcomes; (4) within the United States; (5) published after 2003; (6) presented peer-reviewed original data; (7) identified rural-specific risk or protective factors for suicide or barriers to treatment. FINDINGS Of the 1,058 records screened, 34 studies were included. The strength of evidence was relatively stronger for individual level factors including lethal means, alcohol and substance use. CONCLUSIONS Access to firearms is strongly related to elevated rural US suicide rates, with substance use, economic stress, and behavioral health care utilization as additional individual level factors that may contribute to the disparity. At the community level, economic distress and access to care were commonly identified factors. Future research should better quantify how risk factors contribute to rural suicide and examine interdependence across social-ecological levels. Suicide prevention efforts for the rural United States must address access to lethal means, in particular the use of firearms, and navigate limited access to quality behavioral health care.
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Affiliation(s)
- Nathaniel V Mohatt
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Carlee J Kreisel
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam S Hoffberg
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Leah Wendleton Mph
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Sarah J Beehler
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
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Zortea TC, Brenna CTA, Joyce M, McClelland H, Tippett M, Tran MM, Arensman E, Corcoran P, Hatcher S, Heisel MJ, Links P, O'Connor RC, Edgar NE, Cha Y, Guaiana G, Williamson E, Sinyor M, Platt S. The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts. CRISIS 2020; 42:474-487. [PMID: 33063542 PMCID: PMC8689932 DOI: 10.1027/0227-5910/a000753] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract. Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13–16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.
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Affiliation(s)
- Tiago C. Zortea
- Suicidal Behaviour Research Laboratory, University of Glasgow, UK
| | | | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
| | | | - Marisa Tippett
- Western Libraries, University of Western Ontario, London, ON, Canada
| | | | - Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
| | - Simon Hatcher
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marnin J. Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Paul Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Rory C. O'Connor
- Suicidal Behaviour Research Laboratory, University of Glasgow, UK
| | | | - Yevin Cha
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Giuseppe Guaiana
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Mark Sinyor
- Department of Psychiatry, University of Toronto, ON, Canada
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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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HAROZ EMILYE, WALSH COLING, GOKLISH NOVALENE, CWIK MARYF, O’KEEFE VICTORIA, BARLOW ALLISON. Reaching Those at Highest Risk for Suicide: Development of a Model Using Machine Learning Methods for use With Native American Communities. Suicide Life Threat Behav 2020; 50:422-436. [PMID: 31692064 PMCID: PMC7148171 DOI: 10.1111/sltb.12598] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Suicide prevention is a major priority in Native American communities. We used machine learning with community-based suicide surveillance data to better identify those most at risk. METHOD This study leverages data from the Celebrating Life program operated by the White Mountain Apache Tribe in Arizona and in partnership with Johns Hopkins University. We examined N = 2,390 individuals with a validated suicide-related event between 2006 and 2017. Predictors included 73 variables (e.g., demographics, educational history, past mental health, and substance use). The outcome was suicide attempt 6, 12, and 24 months after an initial event. We tested four algorithmic approaches using cross-validation. RESULTS Area under the curves ranged from AUC = 0.81 (95% CI ± 0.08) for the decision tree classifiers to AUC = 0.87 (95% CI ± 0.04) for the ridge regression, results that were considerably higher than a past suicide attempt (AUC = 0.57; 95% CI ± 0.08). Selecting a cutoff value based on risk concentration plots yielded 0.88 sensitivity, 0.72 specificity, and a positive predictive value of 0.12 for detecting an attempt 24 months postindex event. CONCLUSION These models substantially improved our ability to determine who was most at risk in this community. Further work is needed including developing clinical guidance and external validation.
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Affiliation(s)
- EMILY E. HAROZ
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - COLIN G. WALSH
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - NOVALENE GOKLISH
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and White Mountain Apache Tribe, Whiteriver, AZ, USA
| | - MARY F. CWIK
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - VICTORIA O’KEEFE
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - ALLISON BARLOW
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tingey L, Larzelere F, Goklish N, Rosenstock S, Jennings Mayo-Wilson L, Pablo E, Goklish W, Grass R, Sprengeler F, Parker S, Ingalls A, Craig M, Barlow A. Entrepreneurial, Economic, and Social Well-Being Outcomes from an RCT of a Youth Entrepreneurship Education Intervention among Native American Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2383. [PMID: 32244495 PMCID: PMC7177681 DOI: 10.3390/ijerph17072383] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 12/02/2022]
Abstract
Background: Entrepreneurship education has demonstrated positive impacts in low-resource contexts. However, there is limited evidence of such programs evaluated among Native American (NA) youth in a rural reservation. Methods: A 2:1 randomized controlled trial evaluated the impact of the Arrowhead Business Group (ABG) entrepreneurship education program on entrepreneurship knowledge, economic empowerment, and social well-being among 394 NA youth. An intent to treat analysis using mixed effects regression models examined within and between study group differences from baseline to 24 months. An interaction term measured change in the intervention relative to change in the control. ABG participants were purposively sampled to conduct focus groups and in-depth interviews. Results: Significant intervention vs. control group improvements were sustained at 12 months for entrepreneurship knowledge and economic confidence/security. Significant within-group improvements were sustained for ABG participants at 24 months for connectedness to parents, school, and awareness of connectedness. Qualitative data endorses positive impacts on social well-being among ABG participants. Conclusion: Observed effects on entrepreneurship knowledge, economic empowerment, and connectedness, supplemented by the experiences and changes as described by the youth themselves, demonstrates how a strength-based youth entrepreneurship intervention focused on developing assets and resources may be an innovative approach to dually address health and economic disparities endured in Native American communities.
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Affiliation(s)
- Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Novalene Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Larissa Jennings Mayo-Wilson
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
- Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University School of Public Health, 1025 E. 7th St., Bloomington, IN 47405, USA;
| | - Elliott Pablo
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Warren Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Ryan Grass
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Feather Sprengeler
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Sean Parker
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Allison Ingalls
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Mariddie Craig
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Allison Barlow
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
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Brent DA. Commentary: Reducing adolescent suicide: a global imperative - a reflection on Glenn et al. (2020). J Child Psychol Psychiatry 2020; 61:309-311. [PMID: 31820433 DOI: 10.1111/jcpp.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
Glenn and colleagues have examined rates of adolescent suicide across 45 countries and explored the role of sex, age, rurality and availability of guns and railways on suicide rates. Higher rates of adolescent suicide in New Zealand may be explained by the very high rate of adolescent suicide in young Maoris. Future work could be enhanced by reporting on national trends in suicide, reporting on rates broken down by race and ethnicity, and through the development of international psychological autopsy studies that could shed light on cross-country differences. While this article found that income inequality was correlated with the male-to-female ratio of adolescent suicide across countries, the opposite trend has been reported in the United States. However, as noted by this article, the effects of poverty matter. The Move To Opportunity study found that when youth under the age of 13 were moved from a high poverty to a low poverty neighbourhood, there were enduring effects, including lower levels of depression and anxiety. While adolescent suicide is a global concern, reduction in the suicide rate may have local solutions, including those that address the pernicious effects of poverty and poor neighbourhoods on youth.
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Affiliation(s)
- David A Brent
- UPMC Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Haroz EE, Decker E, Lee C, Bolton P, Spiegel P, Ventevogel P. Evidence for suicide prevention strategies with populations in displacement: a systematic review. INTERVENTION (AMSTELVEEN, NETHERLANDS) 2020; 18:37-44. [PMID: 32665770 PMCID: PMC7359961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Little is known about effective strategies to reduce rates of suicide among refugees and other displaced populations. This review aims to synthesise and assess the evidence base for suicide prevention and response programmes in refugee settings. We conducted a systematic review from peer-reviewed literature databases (five databases) and grey literature sources of literature published prior to November 27, 2017. We identified eight records (six peer-reviewed articles and two grey literature reports) that met our inclusion criteria. None of the eight records provided conclusive evidence of effectiveness. Five records had an unclear level of evidence and three records were potentially promising or promising. Most of the studies reviewed utilised multiple synergistic strategies. The most rigorous study showed the effectiveness of Brief Intervention and Contact and Safety planning. There is limited evidence of the effectiveness of other suicide prevention strategies for these groups. Future studies should attempt to better understand the impact of suicide prevention strategies, and explicitly unpack the individual and synergistic effects of multiple-strategies on suicide-related outcomes. Evidence from this review supports the use of Brief Intervention and Contact type interventions, but more research is needed to replicate findings particularly among populations in displacement.
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Affiliation(s)
- Emily E. Haroz
- PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Catherine Lee
- PhD, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Paul Bolton
- MBBS, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Paul Spiegel
- MD, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Peter Ventevogel
- MD, Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees
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O'Keefe VM, Haroz EE, Goklish N, Ivanich J, Cwik MF, Barlow A. Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide. BMC Public Health 2019; 19:1675. [PMID: 31830933 PMCID: PMC6909588 DOI: 10.1186/s12889-019-7996-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION Clinical Trials NCT03543865, June 1, 2018.
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Affiliation(s)
- Victoria M O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA.
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Jerreed Ivanich
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | | | - Mary F Cwik
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
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Affiliation(s)
- James Allen
- James Allen is with the Department of Family Medicine and Biobehavioral Health and the Memory Keepers Medical Discovery Team-American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth
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Pollock NJ. Place, the Built Environment, and Means Restriction in Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224389. [PMID: 31717635 PMCID: PMC6888187 DOI: 10.3390/ijerph16224389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 01/19/2023]
Abstract
Restricting access to lethal means is a key public health intervention for preventing suicide. Means restriction research has often focused on suicide methods that are modifiable through legislation or policy interventions. However, some of the most common methods such as hanging may not be sensitive to regulation. The aims of this paper are to examine built environment and place-based approaches to means restriction in suicide prevention, and further consider the connections between place, the environment, and suicide methods. To increase knowledge about specific methods and mechanisms of injury in suicide deaths, higher resolution data for surveillance and epidemiology is required. Data that can be used to better discern patterns about specific locations and materials used in suicide and self-harm will support efforts to uncover new directions for prevention.
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Affiliation(s)
- Nathaniel J. Pollock
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1C 5S7, Canada
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Rasmus SM, Charles B, John S, Allen J. With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:34-45. [PMID: 31343758 PMCID: PMC6750997 DOI: 10.1002/ajcp.12356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.
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Affiliation(s)
- Stacy M. Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Simeon John
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN 55805
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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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Kuiper N, Goldston D, Godoy Garraza L, Walrath C, Gould M, McKeon R. Examining the Unanticipated Adverse Consequences of Youth Suicide Prevention Strategies: A Literature Review with Recommendations for Prevention Programs. Suicide Life Threat Behav 2019; 49:952-965. [PMID: 29999179 DOI: 10.1111/sltb.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Youth suicide is a public health problem in the United States. Suicide prevention programs have been shown to be beneficial; however, knowledge of unanticipated adverse consequences of programs is limited. The objective of this review is to present what is known about these consequences so informed decisions and appropriate planning can be made prior to implementation of suicide prevention interventions. METHOD A narrative but systematic review was conducted assessing what is known about adverse consequences utilizing a comprehensive keyword search of EBSCO and PubMed databases. Study populations beyond youth were included. RESULTS Unanticipated adverse consequences of suicide prevention interventions were included in 22 publications. Consequences occur at three levels: at the level of the youth, those who identify or intervene with at-risk youth, and at the system level. While rare, unanticipated adverse consequences include an increase in maladaptive coping and a decrease in help-seeking among program targets, overburden or increased suicide ideation among program implementers, and inadequate systemic preparedness. CONCLUSIONS Overall, the benefits of youth suicide prevention outweigh the unanticipated adverse consequences. Nevertheless, these results may be utilized for informed decision-making regarding suicide prevention programming, and to ensure appropriate infrastructure is in place prior to prevention efforts.
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Affiliation(s)
| | - David Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Madelyn Gould
- Department of Epidemiology and Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Richard McKeon
- Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Abstract
This article summarizes current knowledge and consensus about depression and suicide among the indigenous young people of the United States. American Indians represent more than 500 tribes and also vary among settings-reservations, urban, suburban, and rural-but as a group, remain at high risk for suicide and possibly for depressive syndromes. Particular risk factors and correlates, as well as approaches to treatment, are discussed.
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Fuentes MM, Moore M, Qiu Q, Quistberg A, Frank M, Vavilala MS. Differences in Injury Characteristics and Outcomes for American Indian/Alaska Native People Hospitalized with Traumatic Injuries: an Analysis of the National Trauma Data Bank. J Racial Ethn Health Disparities 2019; 6:335-344. [PMID: 30276637 PMCID: PMC6424619 DOI: 10.1007/s40615-018-0529-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study compares characteristics of American Indian/Alaska Natives (AI/AN) and non-Hispanic Whites (NHW) hospitalized for traumatic injury and examines the effect of race on hospital disposition. METHODS Using 2007-2014 National Trauma Data Bank data, we described differences in demographic and injury characteristics between AI/AN (n = 39,656) and NHWs (n = 3,309,484) hospitalized with traumatic injuries. Multivariable regressions, adjusted for demographic and injury characteristics, compared in-hospital mortality and the risk of discharge to different dispositions (inpatient rehabilitation/long-term care facility, skilled nursing facility, home with home health services) rather than home between AI/AN and NHW patients. RESULTS Compared to NHWs, a higher proportion of AI/ANs were age 19-44 (49% versus 27%) years and hospitalized with assault-related injuries (25% versus 5%). AI/ANs had lower odds of dying than NHWs during hospitalization (adjusted odds ratio (aOR) 0.72, 95% CI 0.63-0.84). However, AI/ANs also had lower odds than NHWs to discharge to locations with additional health services even after controlling for injury severity (inpatient rehabilitation/long-term care facilities aOR 0.79, 95% CI 0.67-0.93; skilled nursing facility aOR 0.70, 95% CI 0.49-0.98; home with home health services aOR 0.62, 95% CI 0.49-0.79). CONCLUSIONS Injury patterns and acute hospitalization outcomes were significantly different for AI/ANs compared to NHWs. Injury prevention strategies targeting AI/ANs should reflect these differential injury patterns. Outcomes such as disability and access to rehabilitation services should be included when considering the burden of injury among AI/AN communities.
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Affiliation(s)
- Molly M Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Megan Moore
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Qian Qiu
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Alex Quistberg
- Department of Environmental & Occupational Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Matthew Frank
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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48
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Pollock NJ, Healey GK, Jong M, Valcour JE, Mulay S. Tracking progress in suicide prevention in Indigenous communities: a challenge for public health surveillance in Canada. BMC Public Health 2018; 18:1320. [PMID: 30482175 PMCID: PMC6260704 DOI: 10.1186/s12889-018-6224-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023] Open
Abstract
Indigenous peoples in Canada experience disproportionate rates of suicide compared to non-Indigenous populations. Indigenous communities and organizations have designed local and regional approaches to prevention, and the federal government has developed a national suicide prevention framework. However, public health systems continue to face challenges in monitoring the population burden of suicide and suicidal behaviour. National health data systems lack Indigenous identifiers, do not capture data from some regions, and do not routinely engage Indigenous communities in data governance. These challenges hamper efforts to detect changes in population-level outcomes and assess the impact of suicide prevention activities. Consequently, this limits the ability to achieve public health prevention goals and reduce suicide rates and rate inequities. This paper provides a critical analysis of the challenges related to suicide surveillance in Canada and assesses the strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities. To better understand these challenges, we discuss the policy context for suicide surveillance and examine the survey and administrative data sources that are commonly used in public health surveillance. We then review recent data on the epidemiology of suicide and suicidal behaviour among Indigenous populations, and identify challenges related to national surveillance. To enhance capacity for suicide surveillance, we propose strategies to better track progress in Indigenous suicide prevention. Specifically, we recommend establishing an independent community and scientific governing council, integrating Indigenous identifiers into population health datasets, increasing geographic coverage, improving suicide data quality, comprehensiveness, and timeliness, and developing a platform for making suicide data accessible to all stakeholders. Overall, the strategies we propose can build on the strengths of the existing national suicide surveillance system by adopting a collaborative and inclusive governance model that recognizes the stake Indigenous communities have in 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.
| | - Gwen K Healey
- Qaujigiartiit Health Research Centre, PO Box 11372, 764 Fred Coman Dr., Iqaluit, NT, X0A 0H0, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michael Jong
- Labrador-Grenfell Regional Health Authority, Labrador Health Centre, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine Program (NorFam), Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - James E Valcour
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, 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
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Robinson J, Bailey E, Witt K, Stefanac N, Milner A, Currier D, Pirkis J, Condron P, Hetrick S. What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis. EClinicalMedicine 2018; 4-5:52-91. [PMID: 31193651 PMCID: PMC6537558 DOI: 10.1016/j.eclinm.2018.10.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence. METHODS We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people. FINDINGS Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited. INTERPRETATION Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.
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Affiliation(s)
- Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Eleanor Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, VIC 3121, Australia
| | - Nina Stefanac
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Vic 3010, Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Support Building Auckland Hospital, 2 Park Rd, Auckland 1142, New Zealand
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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: 63] [Impact Index Per Article: 10.5] [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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