Suicide in Canadian Aboriginal Populations: Emerging Trends in Research and Intervention
A Report Prepared for the Royal Commission on Aboriginal Peoples
Laurence J. Kirmayer, MD, FRCPC
with
Barbara Hayton, MD, CCFP
Michael Malus, MD
Vania Jimenez, MD, CCFP
Rose Dufour, RN, PhD
Consuelo Quesney, MA
Yeshim Ternar, PhD
Terri Yu, MD
Nadia Ferrara, MAT
Scope and outline of report
Suicide is an index of the severe social problems faced by Aboriginal peoples in Canada. The aboriginal suicide rate is three times that of the total Canadian population. From the ages of 10 to 29, Aboriginal youth on reserves are 5 to 6 times more likely to die of suicide than their peers in the general population (Medical Services Branch Steering Committee on Native Mental Health, 1991). Despite widespread concern about these alarming statistics, there continues to be a lack of epidemiological data, ethnocultural information on suicide and evaluation studies of intervention programs. Our aim in this report is to review the scientific literature to situate the problems of Aboriginal peoples within the larger context of suicide in Canadian society so as to identify those features that are shared in common with the dominant society and those that are distinctive for Aboriginal groups. In such comparisons, there is a tendency to attribute any difference between groups to distinctive cultural or historical factors but economic problems, geographic differences and issues of scale (i.e. the size of communities and the degree of infrastructure) may also account for observed differences. Hence, comparative studies with statistical techniques that control for other possible explanations are needed. This document is based on Medline, PsyLit and SocLit searches of the literature on suicide and Native peoples conducted in February and March of 1993 as well as consultations with researchers and review of the Royal Commission hearing transcript extracts on suicide. We have focused on more recent literature although we are indebted to earlier reviews of the literature on suicide (Hawton, 1986; Maris, Berman, Maltsberger & Yufit, 1992) and suicide among Native peoples in particular (May, 1990; Peters, 1981; Thompson & Walker, 1990). In many cases, we have had to rely on research in the U.S. since comparable Canadian studies are lacking. We have made no attempt to survey or assess popular and self-help literature on topics related to suicide as this has been undertaken by other groups for the Royal Commission. Many issues pertaining to Aboriginal culture and mental health that are only touched on in this report are discussed in more detail in a second report we have prepared for the Royal Commission entitled "Emerging Trends in Research on Mental Health Among Canadian Aboriginal Peoples."
Outline
In subsequent parts of this introductory section, we provide definitions of technical terminology and offer some general comments on the integration of social and psychiatric perspectives in models of suicide. The second major section addresses basic demographic data on Aboriginal peoples and descriptive epidemiological statistics on suicide in North America. We summarize variations in the prevalence of suicide and attempted suicide by age, gender, socioeconomic status, and other demographic factors. Particular attention is given to the marked changes in suicide rate that have occurred in recent times as well as to variations across geographical location and ethnocultural group. Section 3 summarizes research on risk and protective factors for suicide. Subsections address factors involving: the physical and social environment; constitution, temperament or developmental experiences; interpersonal relationships; alcohol and substance abuse; suicidal ideation and previous attempts; psychiatric disorders; social structure and economy; cultural traditions; and the impact of culture change. In Section 4, we summarize what is known about the efficacy of interventions for suicide prevention. The introductory subsection presents a table outlining types of interventions that have been proposed. We then consider detection, primary, secondary and tertiary prevention, and postvention (that is, the treatment of survivors). The conclusion to this section presents a summary of a comprehensive #state-of-the-art# approach to prevention. In the concluding section, we sketch a sociocultural perspective on suicide. We then summarize the gaps in our knowledge, emerging trends in research and promising approaches to intervention. Appendix A presents a brief summary of research methods to orient the interested reader.