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American Indian and Alaska Native (AI/AN) people have the highest suicide rates of any racial or ethnic group in the United States, and their rate has been rising since 2003. In 2015, in the 18 states in CDC's National Violent Death Reporting System (NVDRS), the AI/AN suicide rate was 21.5 per 100,000 — more than 3.5 times the rate in the groups with the lowest rates.
The study
NVDRS is a state-based surveillance system that links death certificates, coroner or medical examiner reports and law enforcement reports to show who dies by violence, where and when they were injured, and what contributed.
- Data: all 2003–2014 suicides of people aged 10 and older in the 18 participating states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia and Wisconsin (states joined between 2003 and 2010).
- Comparison group: non-Hispanic White people, who have the second-highest suicide rate but at different ages — so differences may point to what is particular to AI/AN suicides beyond general risk factors.
- Results are adjusted odds ratios (aOR), controlling for age and sex.
1,531 AI/AN and 103,986 White suicides were recorded.
Who died
| AI/AN | White | |
|---|---|---|
| Aged 10–17 | 9.8% | 2.5% |
| Aged 18–24 | 25.9% | 8.6% |
| Aged 10–24 in all | 35.7% | 11.1% |
| Aged 25–44 | 43.4% | 32.3% |
| Aged 45–64 | 18.2% | 39.8% |
| Aged 65+ | 2.7% | 16.8% |
| Male | 77.7% | 77.7% |
| Lived in a nonmetropolitan area | 69.4% | 27.3% |
AI/AN decedents had 6.6 times the odds of living outside a metropolitan area.
How: firearms were the most common means in both groups (42.1% of AI/AN, 52.9% of White suicides), then hanging, strangulation or suffocation (39.7% and 22.5%).
What came before
Circumstances were known for 87.5% of AI/AN and 89.8% of White suicides, mostly from people who knew the decedent, as recorded by coroners, medical examiners and police.
More common among AI/AN decedents (adjusted odds ratio):
| Circumstance | AI/AN | White | aOR |
|---|---|---|---|
| Intimate partner problem | 39.1% | 29.4% | 1.2 |
| Argument preceded death | 19.7% | 10.8% | 1.4 |
| Suicide of a friend or family member contributed | 2.4 | ||
| Other death of a friend or family member contributed | 1.7 | ||
| Alcohol problem | 1.8 | ||
| Used alcohol in the hours before death | 2.7 | ||
| Positive alcohol test | 2.1 | ||
| Perpetrator of interpersonal violence in the past month | 6.8% | 3.3% | 2.0 |
| Criminal legal problem | 15.0% | 9.1% | 1.5 |
| Disclosed suicidal intent | 34.1% | 28.2% | 1.3 |
Less common among AI/AN decedents: a current diagnosed mental health problem (aOR 0.4), current mental health treatment (0.5), job problems (0.5) and financial problems (0.5).
Toxicology, among those tested: AI/AN decedents were more likely to test positive for marijuana (aOR 1.5) and amphetamines (1.4), and less likely for antidepressants (0.7) and opioids (0.5). Other substance problems did not differ significantly.
What it means
- Rural reach. About 70% of AI/AN decedents lived outside metropolitan areas, and they were less likely to have had a mental health diagnosis or treatment. Rural areas often have fewer mental health services — provider shortages, stigma, a lack of culturally competent care. Loan forgiveness and other financial incentives could help recruit providers to rural and nonmetropolitan areas.
- Early prevention for youth. With so many young AI/AN decedents, school-based programs can reach many young people at high risk — including in isolated areas. Programs building life skills and social-emotional learning for healthy relationships and conflict resolution may address the partner problems and arguments that often preceded AI/AN suicides.
- Contagion. A study in one tribe found suicidal behavior clustered in time and within close social networks. Postvention — such as survivor support groups — and safe media reporting (no sensational headlines, for example) should be considered.
- Alcohol. AI/AN youth aged 12–17 have the highest alcohol use of any group in earlier studies. Community measures — enforcing laws against sales to minors, raising alcohol taxes — and individual programs such as better access to substance abuse treatment and life skills programs for youth are needed.
- These differences — in alcohol use, interpersonal problems, access to mental health care — may reflect disproportionate exposure to poverty, historical trauma and other inequities, and should not be seen as inherent to AI/AN culture.
Comprehensive prevention designed for a specific community's needs has been linked with fewer suicides. Efforts should be culturally relevant and evidence-based at the individual, interpersonal and community levels, and allow for the differences among AI/AN communities.
Limitations
- AI/AN race is often misclassified on death certificates, undercounting AI/AN deaths, suicides included.
- NVDRS does not record tribal affiliation, so differences between tribes could not be studied, and results may not apply to every community.
- Whether decedents lived on reservations was not known.
- Mental health diagnoses and treatment come from informants and may be underreported.
- Only 18 states reported, so results may not represent elsewhere.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
Sources
Based on Leavitt RA, Ertl A, Sheats K, Petrosky E, Ivey-Stephenson A, Fowler KA, "Suicides Among American Indian/Alaska Natives — National Violent Death Reporting System, 18 States, 2003–2014," MMWR Morbidity and Mortality Weekly Report, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report also lists depressed mood as less likely among AI/AN decedents, but its confidence interval reaches 1.0, so it is left out here.
Licencia: CC0 1.0 (dominio público) · Adaptado de www.cdc.gov
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