Suicide among Native Americans in the United States, both attempted and completed, is more prevalent than in any other racial or ethnic group in the United States.Olson, Lenora M.; Wahab, Stéphanie (2016-06-29). "American Indians and Suicide". Trauma, Violence, & Abuse. 7 (1): 19–33. .Cash, Scottye J.; Bridge, Jeffrey A. (October 2009). "Epidemiology of youth suicide and suicidal behavior". Current Opinion in Pediatrics. 21 (5): 613–619. . . Among American youths specifically, Native American youths also show higher rates of suicide than American youths of other ethnic groups. Despite making up only 0.9% of the total United States population, American Indians and Alaska Natives (AIANs) are a significantly heterogeneous group, with 560 federally recognized tribes, more than 200 non-federally recognized tribes, more than 300 languages spoken, and one half or more of them living in urban areas.Balsam, K. F., Huang, B., Fieland, K. C., Simoni, J. M., & Walters, K. L. (2004). Culture, trauma, and wellness: A comparison of heterosexual and lesbian, gay, bisexual, and two-spirit Native Americans. Cultural Diversity and Ethnic Minority Psychology, 10(3), 287–301. Gary, F., Baker, M., Grandbois, D. (March 28, 2005) "Perspectives on Suicide Prevention among American Indian and Alaska Native Children and Adolescents: A Call for Help" Vol. 10 No. 2 Suicide rates are likewise variable within AIAN communities.
In 2016, reported rates ranged from 0 to 150 per 100,000 members of the population for different groups. Native American men are more likely to commit suicide than Native American women, but Native American women show a higher prevalence of suicidal behaviors. Interpersonal relationships, community environment, spirituality, mental healthcare, and alcohol abuse interventions are among subjects of studies about the effectiveness of suicide prevention efforts. David Lester calls attention to the existence and importance of theories of suicide developed by indigenous peoples themselves, and notes that they "can challenge traditional Western theories of suicide."David Lester (2006) Suicide Among Indigenous Peoples: A Cross-Cultural Perspective, Archives of Suicide Research, 10:2, 117–124
2013 and 2016 studies by Olson and Wahab as well as Doll and Brady report that the Indian Health Service has lacked the resources needed to sufficiently address mental health problems in Native American communities. The most complete records of suicide among Native Americans in the United States are reported by the Indian Health Service.
The elevated suicide rates observed among Native American populations are substantially connected to the enduring consequences of European colonization and the intergenerational trauma inflicted by white settlement. Suicidal thoughts among Native Americans stem from a complicated history involving European colonization, land dispossession, cultural suppression, discrimination, intergenerational trauma, and genocide inflicted by white people. Native American theories of suicide Mohave
David Lester calls attention to the existence and importance of theories of suicide developed by indigenous peoples themselves. Lester reports that the Mohave attribute suicide to "excessive individualism,"Lester, David. "Note on a Mohave Theory of Suicide". Cross-Cultural Research. 31 (3): 268–272. . or more specifically, one's dependence on and commitment to the tribal community giving way to increasing dependence on a single romantic partner. Citing Devereux, Lester explains that "The modern Mohave seems to be more involved with lovers and spouses than was the case in the past, and there is an accompanying reduction in the affective commitment to and emotional dependence on the kin group and the tribe as a whole."
He goes on to explain that a Mohave individual facing alienation from romantic distress would be in danger of experiencing the same alienation as a past Mohave individual would if rejected by his or her whole tribe. Mohave tradition also holds the belief that one's chances of spending the afterlife with a loved one are stronger if the individual dies at a time soon after the death of that loved one.
Funeral goers take precautions to prevent widows or widowers from attempting suicide during the ceremony, since the perceived risk is very high. When a baby is born in a "transverse position," it is traditionally thought to be simultaneously attempting to kill its mother and to commit suicide so that the mother and child will live in the afterlife together.
Demographic variation
Regional According to 2000–2003 data from the Center for Disease Control and the Indian Health Service (IHS), the highest suicide death rates among AIAN populations occur in the IHS service areas of Tucson, Arizona; Aberdeen, South Dakota; and Alaska, and are 5 to 7 times higher than the national rate. The lowest suicide rates among IHS service areas were in California, Nashville, Tennessee, and Oklahoma.
Alcántara provides examples of this heterogeneity by contrasting links to suicidal ideation found in three different tribes: one in the Southwestern, one in the Northern Plains, and one in the Pueblo region. In the Southwestern tribe, links included single-parent households and more reported life events in the last 6 months since the study. In the Northern Plains tribe, links included low self-esteem and depressive symptoms. In the Pueblo tribe, links included the suicide of a friend in the past 6 months, lower perceived social support, and depressive symptoms.
Age Suicide is the eighth leading cause of death for AIANs and for the youth population (10 to 24) it is the second leading cause of death. Doll and Brady report that according to the Suicide Prevention Resource Center in 2011, 16% percent of young Native Americans reported attempting suicide at least once.Joy Doll & Katelyn Brady (2013) Project HOPE: Implementing Sensory Experiences for Suicide Prevention in a Native American Community, Occupational Therapy in Mental Health, 29:2, 149–158, Olson and Wahab's synthesis of literature and interviews explains that risk factors that more apparent in Native American youths (as opposed to youths of the general population) include previous attempts, family disruption, loss of ethnic identity, and lack of spiritual or religious orientation. Acculturation pressure is especially correlated to suicide in Native American adolescents and young adults.
Depression, anxiety, and overall poor health are also highly correlated, and these illnesses tend to be more serious among Native American youth compared to youth of the general population. Alcántara and Gone cite a study showing that incidence of Native American youth suicide attempts is associated with unintentional injury, violence, risky sexual activity, and tobacco, alcohol, and drug use. They cite another study showing that both male and female adolescents are at a higher risk of suicide if a close friend or peer who attempted or succeeded in committing suicide.
Risk factors specific to adolescent males include gang participation and history of psychiatric treatment, while risk factors specific to adolescent females include access to a firearm and attendance in special education classes. In a sample of Northern Plains reservation residents, people older than 25 were more likely to warn someone of their suicidal intentions, most likely a family member. People ages 15–24 were less likely to warn anyone, but when they did, it was most likely a friend.
Male and female AIANs previously resembled other racial and ethnic groups in that suicide rates tend to be higher in men than in women.Nock, Matthew K.; Borges, Guilherme; Bromet, Evelyn J.; Cha, Christine B.; Kessler, Ronald C.; Lee, Sing (2008-11-01). "Suicide and Suicidal Behavior". Epidemiologic Reviews. 30 (1): 133–154. . . Nock et al.'s epidemiological review of government reports and studies showed that in 2005, the suicide rate for males increased from 9.1 at ages 10–14 to 51.9 at ages 20–24. The relative rise in suicide rates for males compared to females upon adolescence is the highest of other racial and ethnic groups in the United States. However, according to CDC report in 2018, women suicide rate has increased by 139% and men increased 71% among these communities since 1999.
Bohn conducted a study of the relationships between abuse, substance abuse, depression, and suicide attempts with a sample of 30 Native American women ranging from ages 14 to 37 who had visited an urban midwestern clinic during their 3rd trimester of pregnancy.Diane K. Bohn (2003) Lifetime Physical and Sexual Abuse, Substance Abuse, Depression, and Suicide Attempts Among Native American Women, Issues in Mental Health Nursing, 24:3, 333–352, Nine of the 30 women had attempted suicide at least once, and two of them had attempted six times. Eight of the nine had attempted for the first time or the only time as adolescents. Seven of the nine were physically or sexually abused before their suicide attempt, and five of these seven had been abused as children. Half of all 30 women reported a history of depression, and half reported a history of alcohol or substance abuse. Although this study had a very small sample size and cannot necessarily be fully extrapolated to all AIAN women, the National Crime Victimization Survey found that Native American women were more likely to be victims of rape or sexual assault (5.8/1000) and intimate partner violence (23.2) than American black, white, and Asian women from 1993 to 1998. In the sample of Northern Plains reservation residents mentioned by Alcántara and Gone, females and young people had comparatively higher suicidal thoughts, plans, and attempts. Dillard, et al. conducted a study of a tribally owned and operated health center in Anchorage, Alaska, where a majority 58% of suicide-related visits were by women.Dillard, D. A., Avey, J. P., Robinson, R. F., Smith, J. J., Beals, J., Manson, S. M. and Comtois, K. A. (2017), Demographic, Clinical, and Service Utilization Factors Associated with Suicide-Related Visits among Alaska Native and American Indian Adults. Suicide Life Threat Behav, 47: 27–37.
In a study of 212 Native youths (of the average age of 12) living on or near reservations in the upper Midwestern United States, Yoder et al. found that the girls were more than twice as likely to think of suicide than the boys. American Indian and Alaska Native women are at a higher rate to experience violence with 84% experiencing violence in their lifetime and 56% experiencing sexual violence. Along with that more than 1/3 of female rape victims have contemplated suicide with 13% attempting it Along with that, AIAN are twice as likely to experience PTSD compared to the average population.
Urban and reservation A report by Berman compiling findings about the environments and suicides of young Alaska Native men shows that suicide rates among young Alaska Native men are twice as high in small rural communities than in urban areas, though rates within the rural communities are heterogeneous. Alcántara and Gone, citing a 2004 study by Freedenthal and Stiffmann of Native American youths in the Southwestern United States, report that those who had lived two-thirds of their lives in an urban areas had lower suicidal ideation than those who had lived two-thirds of their lives on a reservation. However, there was no significant difference in lifetime attempted suicide between the urban- and reservation-reared populations. Differences in psychological risk factors were also found between the urban- and reservation-reared youth. Urban youth suicide was associated with history of physical abuse, attempt or completion by a friend, and family history of suicide. Reservation youth suicide was associated with depression, conduct disorder, cigarette smoking, family history of substance abuse, and perceived discrimination.
Protective factors and prevention