Predicting Suicidal Ideation Among Native American High Schoolers in California

Background/Purpose: Suicide is a racialized health disparity as Native American young die by suicide at a disproportionately higher rate compared to their white counterparts. Despite prevention efforts, suicide continues to be the leading cause of non-accidental death for Native American young people. This shortcoming has urged a (re)examination of key theoretical constructs to better direct suicide prevention efforts in tribal communities. Mainstream suicidology has been criticized for overemphasizing a psycho-centric conceptualization of suicide-related behavior.

This paper uses Indigenous Wholistic Theory to guide a (re)examination of the multi-level factors that may influence suicidal ideation among Native American young people in California. This theoretical framework introduces and situates the multi-level factors that may influence suicide-related behavior in a manner culturally relevant to the lived experienced of Native American youth. A computational, algorithmic approach is employed to identify which combination of wholistic factors can predict suicidal ideation among Native American high schoolers in California.

Methods: Data and Sample: The California Health Kids Survey (CHKS) is a school-based, multi-modular survey administered annually to students across California. Data was drawn from self-identified Native American high schoolers in grades nine through twelve from the 2019-2020 school year (N = 2,609).

Measure of Suicidal Ideation: The presence of suicidal ideation was measured using a self-reported response. Participants were asked “During the last 12 months, did you ever seriously consider attempting suicide?” (0 = No; 1 = Yes).

Predictors of Suicidal Ideation: For the individual domain, factors included: sex: gender minority status and sexual minority status; academic performance; and substance use stratified according to lifetime use of alcohol, tobaccos and vapes, cannabis and use of other drugs. For the emotional-social domain, factors included: foster care placement; school-based victimization; parent education level; internalization of positive substance use education; and access to alcohol and other drugs. For the mental-political domain, factors included depressive symptoms. For the physical-economic, factors included: homelessness; and breakfast consumption.

Statistical Analysis: To select the optimal predictors of suicidal ideation, least absolute shrinkage and selection operator (lasso) penalized regression was employed. Lasso regression shrinks the coefficients of the least influential variables to zero, effectively removing them from the model to identify the best subset of predictors.

Results: Using lasso regression with a mean lambda of 0.0078412, the model identified ten out of the 17 predictors that were significant in predicting which Native American high schoolers would report experiencing suicidal ideation. These predictors included: depressive symptoms; school-based victimization; sexual and gender minority status; lifetime use of alcohol, vapes, and cannabis; breakfast consumption; access to alcohol and other drugs; and parent education level.

Conclusions: This study identifies multi-level factors that are relevant in (re)conceptualizing suicide-related behavior among Native American youth beyond a psycho-centric model. The multiplicity of multi-level factors found in this study highlights the need for a culturally relevant understanding of suicidal ideation among Native American high school students. By identifying those at risk, practitioners can intervene early and prevent suicide through culture-based approaches.