Preventing Suicidal Behavior Among American Indian and Alaska Native Adolescents and Young Adults

Abstract

From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.

Keywords: American Indian/Alaska Native (AI/AN); social determinants of health; suicidal behavior; suicide; youth.

Figure 1.

Number and ratio of people affected by suicidal thoughts and behaviors among non-Hispanic American Indian and Alaska Native adults aged 18 to 25 years, United States, 2018. Ratio defined as incidence of each behavior relative to the incidence of deaths due to suicide. Data on number of deaths from National Vital Statistics System. Data on number of hospitalizations determined by first ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code listed in the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project–National Inpatient Sample. Data on number of suicide attempts and number of people who seriously considered suicide from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.

Figure 2.

Number and ratio of people affected by suicidal thoughts and behaviors among adults aged 18 to 25 years, United States, 2018. Ratio defined as incidence of each behavior relative to the incidence of deaths due to suicide. Data on number of deaths from the National Vital Statistics System. Data on number of hospitalizations determined by first ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code listed in the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project–National Inpatient Sample. Data on number of suicide attempts and number of people who seriously considered suicide from Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.

Figure 3.

Suicide rates per 100 000 population, by race and ethnicity and age group, United States, 2015-2019. Abbreviation: AI/AN, American Indian and Alaska Native. Data source: Centers for Disease Control and Prevention.

Figure 4.

Unemployment rate, by race and ethnicity and age, United States, 2013-2017. Data source: US Census Bureau. Abbreviation: AI/AN, American Indian and Alaska Native.

Figure 5.

Life skills stress-coping model, American Indian Life Skills Development Curriculum. Reprinted with permission from Praeger/ABC-CLIO. Source: LaFromboise and Fatemi.