Indigenous suicide in Australia, New Zealand, Canada and the United States

Abstract

This paper reviews literature on self‐harm and suicide among Indigenous populations in four nations with histories of British colonization, with a more detailed exploration of patterns and primary care considerations in Australian Aboriginal and Torres Strait Islander populations. Issues of definition, under‐reporting, lack of reporting, varying coronial practices and the influence of race on investigative procedures make comparisons of suicide rates among indigenous populations problematic. However, international interpretations highlight the impact of the breakdown of cultural structures and historical processes associated with colonization. Recent studies suggest that the predisposition to suicide by vulnerable young people is influenced not only by absolute living standards but also how they view their circumstances relative to those around them. The complexity of associations with mental disorder, alcohol use and ‘meaning’ in an indigenous context are considered. Responses in terms of prevention and treatment are presented, highlighting the importance of hospital‐based practitioners as the likely first point of contact. The article concludes by outlining considerations in the primary care management of indigenous self‐harm. See Commentary, page 8.

Understanding barriers to health care: a review of disparities in health care services among indigenous populations

“…In some cases, the rates of suicide are five times the rate of the general population (26). Similar results have been found when comparing rates of alcohol use, post-traumatic stress and depression (54)(55)(56).…”

“…The strongest associations were observed for mental health outcomes (psychological stress and depression) and health-related behaviours (substance abuse, alcohol abuse and smoking). Rates of substance and alcohol abuse are substantially higher among Indigenous groups, which have also been shown to be related to increased rates of suicide (26). A review of suicide rates among Indigenous populations in Canada, the U.S., New Zealand and Australia found that suicide rates among Indigenous young adult men was the highest out of all age groups and was 2 to 5 times higher than the general population (26).…”

Public Policy, Participation and the Third Position: The Implication of Engaging Communities on their Own Terms

“…The Aboriginal population plummeted to 50,000 by the 1890s through introduced diseases, dispossession of land, massacres and covert frontier wars (Flannery 1994). Current day Aboriginal health and mental health is considerably worse than for non-Aboriginal Australians and while the health of comparable populations in other first world countries have improved, Australian Aboriginal people still fare poorly comparatively (Hunter and Harvey 2002;Zubrick et al 2004). For example, while the life expectancy of Canadian, USA and New Zealand indigenous peoples is 5-7 years less than their non-Indigenous country people, Aboriginal Australians still die 20 years earlier than non-Aboriginal Australians (Hunter and Harvey).…”

Capability and adversity: reframing the “causes of the causes” for mental health

“…Premature mortality from substance misuse and suicide is also high in indigenous communities around the world, reflecting current and historical trauma, discrimination and disempowerment (Hunter and Harvey, 2002;Evans-Campbell, 2008;Wilk et al, 2017).…”