Three NIMH-funded collaborative research hubs are exploring the factors behind the high suicide rates among American Indian (AI) and Alaska Native (AN) youth and designing and testing approaches to preventing suicide. In each hub, research centers and tribal or urban AI/AN leaders and organizations are working together to provide information on which to base effective, community-based, and culturally sensitive preventive approaches that are suitable for use in low-resource settings.
AI/AN youth have suicide rates that are among the highest of any demographic group in the U.S.; based on data from the Centers for Disease Control and Prevention, the rates of suicide in the AI/AN population have been increasing since 2003. Suicide rates vary among communities, however, and the reasons for the variation are not clear. One of the goals of the work is to explore elements that promote resilience, including the degree of adherence to cultural spirituality, community engagement, and participation in traditional practices.
NIMH solicited research proposals to establish three research hubs with ongoing collaborative relationships with AI/AN communities. In addition to prevention research, the hubs’ activities include outreach and dissemination aimed at promoting community engagement in research and enabling communities to use science-based information to develop prevention programs.
- The Alaska Native Collaborative Hub for Research on Resilience: This hub’s research team is studying the association of cultural, community, and institutional protective factors with incidence of suicide and suicide-related behavior in 64 rural and remote AN villages. In addition, in a subset of these communities, researchers will test the contribution of these protective factors to youth resilence from suicide risk. The hub aims to develop a tool that AN communities can use to assess local community-level strengths and to guide efforts to enhance factors that contribute to resilience. The hub is working with research partners in three Alaska regions with the highest suicide rates and will ultimately disseminate the assessment tool through the state. Researchers from the University of Alaska Fairbanks, the University of Minnesota, and the University of Massachusetts Amherst are collaborating in the work of this hub.
- The Southwest Hub for American Indian Youth Suicide Prevention Research: This hub builds on a long-lasting and productive partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe and Navajo Nation, and includes a tribally mandated suicide surveillance and follow-up system run by the Apache Tribe (and being replicated by Navajo Nation). The research team is evaluating two brief culturally sensitive suicide prevention interventions that make use of task-shifting, in which paraprofessional or lay health care workers provide care in low resource areas. In this study, one of the interventions is delivered by paraprofessional community mental health workers (New Hope); the other by tribal elders to promote longer-term resilience (Elders’ Resilence). In addition to testing these approaches and factors that contribute to their effectiveness, the researchers are examining the acceptability and sustainability of these interventions in other AI/AN populations.
- The Collaborative Hub to Reduce the Burden of Suicide among Urban American Indian and Alaska Native Youth: Although much research related to suicide in AI/AN youth has taken place in rural areas, many AI/AN youth reside in urban settings.This hub is evaluating factors that affect implementation of an existing evidence-based suicide prevention program—Screening, Brief Intervention, and Referral to Treatment (SBIRT)—for urban AI/AN youth. In this program, behavioral health clinicians are incorporated in primary care practices. The research team will also compare the effectiveness of this approach in preventing suicide-related outcomes with an intervention that combines SBIRT with either six or twelve months of follow-up caring text messages, which are intended to improve SBIRT retention and increase social and cultural connectedness. This research is taking place in Seattle and Albuquerque with researchers from the University of Colorado Denver and Washington State University.
The National Institute on Minority Health and Health Disparities (NIMHD) is also providing funding for this initiative. Findings from this research—built on strong partnerships among the communities, local tribal governments, and researchers—will inform ongoing efforts to sustainably reduce the burden of youth suicide in AI/AN communities.