Demographic, Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Dillard, Denise A.; Avey, Jaedon P; Robinson, Renee; Smith, Julia; Beals, Janette; Manson, Spero M.; Comtois, Katherine Anne

doi:10.1111/sltb.12259

Cited by 17 publications

(28 citation statements)

References 13 publications

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“…This qualitative study used an interpretive phenomenological approach to examine the narratives of 15 AN/AI adolescents and adults with a history of suicidality to understand what put them at risk and what helped them to stay alive during of high risk. Our data on participants’ suicide risk did not yield new insights, but they are consonant with previous studies of AN/AI suicide risk and help to contextualize participants’ narratives of help-seeking [7,42,43]. Our findings about participants’ help-seeking behavior underscore the central importance of both positive social connections and access to health services for people with suicide risk.…”

Section: Discussionsupporting

confidence: 84%

“…Numerous studies have examined risk factors for suicide in AN/AI communities. These investigations primarily focused on individual risk factors for AN/AI suicide, such as depression, trauma (e.g., child abuse), and substance abuse [6,7,8,9,10,11]. In the last decade, studies have increasingly focused on social and structural sources of AN/AI suicide risk, including colonization and its sequalae (e.g., social disruption, intergenerational trauma) [12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

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Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

Shaw

Beans

Comtois

et al. 2019

IJERPH

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This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15–56) with self-reported histories of suicide ideation and/or attempt. Several factors were found to be central to acquiring resilience to suicide risk among AN/AI people across a wide age range: meaningful and consistent social connection, awareness about how one’s suicide would negatively effect loved ones, and knowledge and utilization of available health services. Findings highlight the mutable nature of suicide risk and resilience, as well as the importance of interpersonal factors in suicidality.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

Shaw

Beans

Comtois

et al. 2019

IJERPH

Self Cite

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“…Thus despite NHW being 3 to 5 times more likely to use antidepressants than these other racial/ethnic groups, they had 2 to 3 times the suicide rate. AIAN antidepressant use is likely to be under 2% [36], meaning that the two groups with the highest suicide rates -the AIAN and NHW population groups -had both the lowest and highest antidepressant usage, respectively.…”

Section: Health Disparities In Antidepressant Use Suicide and Dmentioning

confidence: 99%

“…Indeed, estimates suggest that 20% of US children have a diagnosable mental health condition, and "[m]ore than half of mental illness emerges before age 14" [81], yet 85% of those needing treatment do not receive it [60,81]. Suicide is the second leading cause of death for 10-34 year olds, fourth leading cause of death for [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] year olds, and 8th leading for ages 55-64 [82].…”

Section: Driving Forcesmentioning

confidence: 99%

Rising US Suicides: Achieving Health Equity

Perry¹,

Allison²,

Bastiampillai³

et al. 2019

Preprint

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Evidence suggests that increased availability of mental health treatment has not significantly reduced depression prevalence and suicide in the US, and that significant personal (i.e., stigma) or practical/logistical barriers to effective mental health care remain. Mental health treatment has increased in the US since the early 1990s with greater use of antidepressant medications, especially SSRIs, however suicide rates continue to climb, with significant gender, ethnic, geographic, socioeconomic, and other health disparities. Depression rates are at best stable, but are increasing in certain subpopulations such as youths ages 12-17. Combating these distressing trends to achieve health equity will require more attention to promising and evidence-based, sustainable, proactive, practical solutions that address the varied causes, demographics, and differential risk factors and mechanisms of suicide deaths. Herein we explore sociodemographic disparities that exist in suicide deaths, with emphasis on two of the largest modifiable targets for suicide prevention: untreated or undertreated depression, and access to the lethal means (firearms) that cause more suicide deaths than all other means combined, and thus pose the greatest threat to individual and public health. Furthermore, we newly define increased or unsafe (i.e. disparate) access to firearms as a suicide health disparity that promotes health inequities. To achieve the greatest results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs shown to reduce suicidal behaviors, and 2) enhanced focus on the two largest modifiable targets for suicide prevention: depression and firearms.

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“…Compounded by a federal system of severely underfunded mental health care [4], suicide risks among AI/ANs include but are not limited to: mental health problems, chronic pain [5–7], historical trauma [8–10], adverse childhood experiences [11]—including domestic violence or history of abuse, alcohol or drug misuse [10, 12, 13], and the suicide attempt or death of family or friends [7, 13]. Protection from suicide for AI/AN communities has been linked to cultural factors, including tribal spirituality, participation in cultural activities, social support from tribal leaders, and holistic connectedness to self/family/community/land [14–18].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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BackgroundThis 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.MethodsOur 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.DiscussionDue 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 registrationClinical Trials NCT03543865, June 1, 2018.

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Demographic, Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Cited by 17 publications

References 13 publications

Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

Rising US Suicides: Achieving Health Equity

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

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