Suicide Prevention Screening Outcomes Among a Sample of American Indian/Alaska Native and Other Youth: Results from the Hope and Wellness Screening Toolkit

Background: From 2011-2019, American Indian Health and Family Services in Detroit, MI, and the University of Michigan collaborated on the “Manidookewigashkibjigan Sacred Bundle: R.E.S.P.E.C.T. Project" which focused on suicide prevention among high-risk American Indian/Alaska Native (AI/AN) youth. As part of this project, a team of community members, families, youth, staff, and researchers developed an AI/AN-focused, youth-specific suicide risk screening toolkit. AIHFS conducted 731 suicide risk screenings with youth ages 9-25 in behavioral health and community settings. Preliminary outcomes from these screenings are reported here.

Methods: Assent (ages 9-17) and consent (ages 18-25) to participate was obtained, trained suicide prevention gatekeepers facilitated youths’ completion of the suicide prevention screening called the “Hope and Wellness Screening” (N=578). The survey contained standard measures of suicide risk, including depression symptoms and suicidality (PHQ-9), substance use (CRAFFT ages 10-17; AUIDIT and DAST ages 18-24). More than half of youth screened were female (56.5%), about two-thirds (62%) were AI/AN alone or in combination with another race (pooled group), the average age was 15.5 years. Associations between PHQ-9 outcomes, substance use, and demographics were evaluated using Chi-square, and differences across categorical variable groups using Mann-Whitney and Kruskal-Wallis tests.

Results: The same proportion of AI/AN and non-AI/AN youth reported past month suicidal ideation (6%), 14.8% of AI/ANs vs.11.9% of non-AI/ANs reported a lifetime suicide attempt. The mean PHQ-9 score for AI/AN youth was 5.17 (SD: 5.05), 25% scored positive; for non-AI/AN youth, the mean score was 4.53 (SD: 4.90), and 23% scored positive. Chi-square results show positive PHQ-9 (score ≥10) was significantly associated with age group (9-13, 14-17, 18-25), gender, and adult substance use measures. Males accounted for 29% of AI/AN positive PHQ-9 scores, vs. 43.5% of those for non-AI/ANs. PHQ-9 scores were significantly different across the three age groups. Kruskal-Wallis and Mann-Whitney tests on PHQ-9 scores by gender across age groups found significantly different scores among the three age groups for AI/AN youth (p<0.05) but not for youth of other races; similarly PHQ-9 scores differed by gender only among AI/AN youth ages 14-17 (p<0.05).

Implications: These preliminary suicide risk screening data are consistent with findings that suicidality increases through adolescence but brings attention to ages 14-17 as a potentially sensitive period to build resilience and decrease risk. While men, particularly AI/ANs, have high suicide rates, we report lower portions of positive depression screenings and significant gender differences in PHQ-9 scores for AI/AN youth in middle adolescence. These findings may implicate a conspicuous lack of traditional risk factors for certain high-risk groups such as AI/AN youth. More research is needed to understand and develop effective methods of early identification and intervention for suicide and mental illness among youth.