Saturday, 15 January 2005 - 2:00 PM

This presentation is part of: Cultural Issues in Mental Health

Going It Alone: Suicidal American Indian Adolescents' Help Needed vs. Help Received

Purpose: Research consistently indicates that most suicidal youth receive no professional help. Studies rarely examine reasons for foregoing help when suicidal, although “help-negation” theory posits that hopelessness and isolation dampen depressed youth’s motivation to seek help. These issues especially touch American Indian youth, whose rates of suicidal behavior exceed youth’s national average. Therefore, this study sought to determine among American Indian youth 1) rates of formal and informal help-seeking when suicidal; 2) role of need for help in predicting such help-seeking; and 3) reasons for avoiding help when suicidal.

Methods: Data were collected in the third year of the longitudinal American Indian Multisector Help Inquiry (AIM-HI), a NIDA-funded study of American Indian youth in southwestern urban and reservation areas. In 2003, interviewers administered the Achenbach Youth Self Report (YSR) to 356 youth and asked if they ever thought about committing suicide or made an attempt. Youth reporting suicidality then indicated whether, when suicidal, they received help from a medical or mental health professional, any friends or family, or “anyone else…including a teacher, minister, or medicine man.” For each type of help avoided (professional, informal, and other), youth were asked the open-ended question, “What stopped you from going to [type of helper] for help with your suicidal thoughts or behaviors?” Text responses were coded for univariate analyses. Logistic regression models predicting receipt of help included, in addition to gender and income as control variables, the following indicators of need for help: 1) suicide attempt versus ideation only, 2) YSR score greater than 63, and 3) Diagnostic Interview Schedule diagnosis of depression during the study’s first wave.

Results: Almost 30% of youth reported a history of suicidal ideation, and 12% had attempted suicide. Only 40% used some type of formal help, but almost two-thirds consulted a friend or relative. One in four youth received no help at all when suicidal. Neither a suicide attempt nor a high YSR score increased the odds of having received help. Furthermore, lending support to help-negation theory, a diagnosis of depression made a youth almost four times less likely to have received any help when suicidal (OR = .28, p = .02). Although level of need did not differentiate help-seekers from help-avoiders, of the 61 youth who bypassed formal help, 23% stated they did not feel they needed help. Other prominent barriers to care included stigma, self-reliance, fear (especially of commitment), and feelings that no one could help or understand.

Implications for policy: Fewer than half of youth received formal help when suicidal, and these results indicate that youth who most need help are no more likely to receive it than those with fewer psychosocial problems. Almost all the barriers to care are potentially modifiable through education and policies that target attitudes about emotional problems and help-seeking. Furthermore, youth’s tendency to turn to family and friends underscores the need to educate communities about suicide prevention. Further research needs to examine if these results extend to other American Indian youth and to youth in general.

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