A Social-Ecological Approach to Understanding Urban American Indian Youth Suicide Prevention

Background and Purpose: American Indian (AI) youth have the highest rates of suicide among all ethnic groups in the United States, with rates 62% above the national average for youth ages 10-25 (Centers for Disease Control and Prevention, 2014). Prior research suggests that most AI communities view suicide as a social or even societal phenomenon, rooted in historical injustices and contemporary inequities.

This study uses a social-ecological framework to examine existing barriers and resources for addressing AI youth suicide in an urban setting.  In addition, this presentation highlights the importance of understanding the cultural and historical context that frames AI youth suicide prevention efforts.

Methods: Face-to-face interviews ranging from 45 minutes to two hours were conducted with 15 American Indian respondents age 13 to 79, with an average age of 39.33, including eight men and seven women.  Twelve respondents had completed high school, four of which reported some college.  Nine participants had personally known someone who had attempted suicide. Respondents were identified by staff at an Urban Indian Health Organization (UIHO). The UIHO has a longstanding research partnership with a Midwestern university.  Inductive thematic analysis was used to identify themes in the data and limited the analysis to participants’ explicitly stated understandings. 

Findings: Thematic analysis resulted in twenty-two themes, which can be categorized by level of analysis: intrapersonal, community, cultural, and historical.  Intrapersonal sources of support, such as friends or family members, were identified as a central resource for youth suicide prevention.  Participants framed the importance of these resources in terms of cultural values related to mutual support, important characteristics of helpers, and traditional ways of sharing knowledge.  Challenges at this level included a lack of knowledge about suicide among community members, the potential for stressful home environments to contribute to youth’s problems, and reluctance in the community to talk about suicide or personal problems generally.

Participants indicated the presence of some formal mental health services in the community, but noted that these were largely undesirable.  This was seen as a consequence of invisibility of AI’s within the broader cultural context, inadequate government support, and a long history of negative institutional experiences.  Additionally, characteristics of the urban environment, such as inadequate public transportation, reduced access to these services.  At the same time, values and beliefs in the AI community were seen as conflicting with the requirements of professional services and formal interventions.  For example, life experience and trust were seen as the most important characteristics for potential helpers, rather than formal mental health training.

Conclusion and Implications: Findings suggest that urban AI youth can more easily access intrapersonal resources for suicide prevention. Community members also face a number of challenges that make formal resources inaccessible.  These resources and challenges can best be understood by examining cultural and historical contexts that frame the current community and intrapersonal environment. It is thus imperative that those who wish to conduct suicide prevention activities in AI communities strive to understand existing values and beliefs as well as historical experiences related to this topic.