No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Indigenous Community-Level Protective Factors in the Prevention of Suicide: Enlarging a Definition of Cultural Continuity in Rural Alaska Native Communities
Abstract
Suicide research has focused primarily on risk factors at the individual level, overlooking the potential for community-level factors that confer protection from suicide. This study builds on the concept of cultural continuity from the Indigenous suicide prevention literature. It seeks to understand the collective influences shaping individual experiences across time and frames resilience as a culturally situated process that helps individuals to navigate challenges and facilitate positive health behaviors. A collaborative Alaska Native (AN) partnership designed the Protective Community Scale (PCS) to identify mutable community-level protective factors in rural AN communities hypothesized to reduce suicide among youth, who represent the highest risk demographic in this at-risk population. Study objectives were to (a) test the measurement structure of community-level protection from suicide, (b) select best functioning items to define this structure, and (c) test the association of community protection with community-level suicide deaths and attempts. In 65 rural AN communities, 3–5 residents (n = 251) were peer-nominated for their knowledge of local resources and completed the PCS in structured interviews. Findings show community members can reliably assess the theoretically rich, multidimensional community-level protective factor structure of cultural continuity with sufficient precision to establish its inverse association with community-level suicide. Community-level protection emerges as a promising approach for universal suicide prevention in Indigenous contexts that can guide multi-level strategies that expand beyond individual-level, tertiary prevention to focus on the continuity of cultural processes as resources to build protection. These findings point the field toward consideration of cultural continuity and community protection as key factors for Indigenous suicide prevention.
We examined the effectiveness of the Qungasvik (Tools for Life) intervention in enhancing protective factors as a universal suicide and alcohol prevention strategy for young people ages 12-18 living in highly affected rural Alaska Native communities. Four communities were assigned to immediate intervention or to a dynamic wait list. Outcomes were analyzed for 239 young people at four time points over two years of community intervention. Outcomes assessed two ultimate variable protective factors buffering suicide and alcohol risk, and three intermediate variable protective factors at the individual, family, and community level. Dose dependent intervention effects were associated with growth in ultimate but not intermediate variables. This evaluation of the Qungasvik intervention provides support for the effectiveness of its Indigenous strategies for suicide and alcohol misuse prevention in this rural Alaska Native setting. Though findings did not provide support for a theory of change where growth in ultimate variables is occasioned through effects on intermediate variables, research designs focused on young people who enter intervention at lower levels of preexisting protection hold promise for better understanding of intervention change processes. The Qungasvik intervention is responsive to an acute public health need for effective rural Alaska Native suicide and alcohol risk prevention strategies.
Compared with the general U.S. population, American Indian or Alaska Native (AI/AN) persons, particularly those who are not Hispanic or Latino (Hispanic) AI/AN, are disproportionately affected by suicide; rates among this group consistently surpass those among all other racial and ethnic groups (1). Suicide rates among non-Hispanic AI/AN persons increased nearly 20% from 2015 (20.0 per 100,000) to 2020 (23.9), compared with a <1% increase among the overall U.S. population (13.3 and 13.5, respectively) (1). Understanding characteristics of suicide among AI/AN persons is critical to developing and implementing effective prevention strategies. A 2018 report described suicides in 18 states among non-Hispanic AI/AN persons only (2). The current study used 2015-2020 National Violent Death Reporting System (NVDRS) data among 49 states, Puerto Rico, and the District of Columbia to examine differences in suicide characteristics and contributing circumstances among Hispanic and non-Hispanic AI/AN populations, including multiracial AI/AN. Results indicated higher odds across a range of circumstances, including 10 of 14 relationship problems (adjusted odds ratio [aOR] range = 1.2-3.8; 95% CI range = 1.0-5.3) and six of seven substance use problems (aOR range = 1.2-2.3; 95% CI range = 1.1-2.5), compared with non-AI/AN persons. Conversely, AI/AN decedents had reduced odds of having any current known mental health condition, any history of mental health or substance use treatment, and other common risk factors (aOR range = 0.6-0.8; 95% CI = 0.2-0.9). Suicide is preventable. Communities can implement a comprehensive public health approach to suicide prevention that addresses long-standing inequities affecting AI/AN populations (3).
Rationale.: This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise. Method.: Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses. Results.: Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention. Conclusion.: PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.
American Indian and Alaska Native (AIAN) populations contend with disproportionately high rates of suicide. The study of protective factors is essential for highlighting resilience and formulating potential interventions for suicide. We systematically review factors that are posited to protect against suicide attempts for AIAN peoples. Seventeen (12 journal articles, five theses/dissertations) articles met inclusion criteria. Results indicate that protective factors are typically situated at one of four levels of analysis: individual (e.g., self-esteem), family (e.g., parent caring), community (e.g., positive adult relationships), and cultural (e.g., cultural spiritual orientation). Notably, there were trends in protective factors across age, sex, and geographic region. Based on these findings, we propose recommendations for moving the field forward in future identification of protective factors as a means of AIAN suicide prevention.
The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.
Background: Researchers frequently use the responses of individuals in clusters to measure cluster-level constructs. Examples are the use of student evaluations to measure teaching quality, or the use of employee ratings of organizational climate. In earlier research, Stapleton and Johnson (2019) provided advice for measuring cluster-level constructs based on a simulation study with inadvertently confounded design factors. We extended their simulation study using both Mplus and lavaan to reveal how their conclusions were dependent on their study conditions. Methods: We generated data sets from the so-called configural model and the simultaneous shared-and-configural model, both with and without nonzero residual variances at the cluster level. We fitted models to these data sets using different maximum likelihood estimation algorithms. Results: Stapleton and Johnson’s results were highly contingent on their confounded design factors. Convergence rates could be very different across algorithms, depending on whether between-level residual variances were zero in the population or in the fitted model. We discovered a worrying convergence issue with the default settings in Mplus, resulting in seemingly converged solutions that are actually not. Rejection rates of the normal-theory test statistic were as expected, while rejection rates of the scaled test statistic were seriously inflated in several conditions. Conclusions: The defaults in Mplus carry specific risks that are easily checked but not well advertised. Our results also shine a different light on earlier advice on the use of measurement models for shared factors.
The majority of research on children with incarcerated parents has focused on documenting main effects and adjustment problems among children and families. Although the focus on problems has been crucial in mobilizing support for this population, the field is now at a critical turning point where researchers are calling for more attention to resilience. We argue here that a family resilience perspective is useful in considering child and family level processes that may mitigate the harmful impact of parental incarceration. In contributing to a family resilience agenda, we first review evidence that points to parental incarceration as a risk to children. We then examine research that highlights children’s competence in the face of adversity as well as adaptive family processes, such as parenting and contact with the incarcerated parent, that contribute to children’s well-being. We offer recommendations for methodological innovation aimed at assessing competence, evaluating interventions, and incorporating multimethod approaches that capture dynamic processes and developmental change. We conclude with practice and policy implications and emphasize how a family resilience agenda suggests the need to contextualize developmental and family strengths within broader systems of discrimination and oppression.
Background: The concept of resilience offers a strengths-based framework for interventions to enhance Indigenous adolescent social and emotional well-being. Resilience interventions in or with schools encompass individual, social, and environmental factors that encourage health-promoting behaviors and assist adolescents in navigating toward resources that can sustain their health and well-being in times of adversity. This scoping review examined the literature on resilience-enhancing interventions for Indigenous adolescent students in Canada, Australia, New Zealand, and the United States (CANZUS nations). Intervention strategies, adherence to theoretical constructs, and outcomes were analyzed.
Methods: A systematic search was conducted of intervention studies aimed at improving Indigenous adolescent resilience and published in CANZUS nations between January 1990 and May 2016. Eleven peer-reviewed databases and 11 websites and clearing houses were searched for relevant studies. Following double-blinded screening, a total of 16 intervention papers were included for analysis. Study characteristics were identified and study quality was assessed using appropriate assessment tools.
Results: Twelve interventions (75%) were delivered in school settings and four (25%) were community-based, conducted in partnership with schools. Seven publications (44%) reported interventions focused exclusively on fostering individual resilience. Another seven (44%) included components that aimed to build staff, school, and/or community capacity to support adolescent resilience, and two (12.5%) had community/school capacity-building as the primary focus. Culturally based approaches to enhancing resilience were evident in most studies (81%). The publications documented the use of a range of program models, processes, and activities aligned with resilience theory. Positive outcomes were reported for improved individual assets (e.g., strengthened self-esteem and Indigenous identity), environmental resources (e.g., increased peer support and social/community connection), and increased community capacity (e.g., increased youth training and leadership opportunities). On average, study quality was assessed as moderate to high. The strongest evidence of intervention effectiveness was for improvements in mental health symptoms and outcomes.
Conclusion: Interventions indicated strong alignment with ecological and culturally based resilience theories and models. While the results of the studies indicate some positive impacts on the resilience of Indigenous adolescents, future evaluations should aim to ensure high study quality and focus on measuring strengths-based resilience outcomes.
Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person's environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area.
Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.
Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population.
Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.
When modeling latent variables at multiple levels, it is important to consider the meaning of the latent variables at the different levels. If a higher-level common factor represents the aggregated version of a lower-level factor, the associated factor loadings will be equal across levels. However, many researchers do not consider cross-level invariance constraints in their research. Not applying these constraints when in fact they are appropriate leads to overparameterized models, and associated convergence and estimation problems. This simulation study used a two-level mediation model on common factors to show that when factor loadings are equal in the population, not applying cross-level invariance constraints leads to more estimation problems and smaller true positive rates. Some directions for future research on cross-level invariance in MLSEM are discussed.
Despite its importance to structural equation modeling, model evaluation remains underdeveloped in the Bayesian SEM framework. Posterior predictive p-values (PPP) and deviance information criteria (DIC) are now available in popular software for Bayesian model evaluation, but they remain underutilized. This is largely due to the lack of recommendations for their use. To address this problem, PPP and DIC were evaluated in a series of Monte Carlo simulation studies. The results show that both PPP and DIC are influenced by severity of model misspecification, sample size, model size, and choice of prior. The cutoffs PPP < 0.10 and ΔDIC > 7 work best in the conditions and models tested here to maintain low false detection rates and misspecified model selection rates, respectively. The recommendations provided in this study will help researchers evaluate their models in a Bayesian SEM analysis and set the stage for future development and evaluation of Bayesian SEM fit indices.
Suicide and intentional self-harm are among the leading causes of death in the United States. To study this public health issue, epidemiologists and researchers often analyze data coded using the International Classification of Diseases (ICD). Prior to October 1, 2015, health care organizations and providers used the clinical modification of the Ninth Revision of ICD (ICD-9-CM) to report medical information in electronic claims data. The transition in October 2015 to use of the clinical modification of the Tenth Revision of ICD (ICD-10-CM) resulted in the need to update methods and selection criteria previously developed for ICD-9-CM coded data. This report provides guidance on the use of ICD-10-CM codes to identify cases of nonfatal suicide attempts and intentional self-harm in ICD-10-CM coded data sets. ICD-10-CM codes for nonfatal suicide attempts and intentional self-harm include: X71-X83, intentional self-harm due to drowning and submersion, firearms, explosive or thermal material, sharp or blunt objects, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, and other specified means; T36-T50 with a 6th character of 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, which are included if the 5th character is 2), intentional self-harm due to drug poisoning (overdose); T51-T65 with a 6th character of 2 (except for T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9, which are included if the 5th character is 2), intentional self-harm due to toxic effects of nonmedicinal substances; T71 with a 6th character of 2, intentional self-harm due to asphyxiation, suffocation, strangulation; and T14.91, Suicide attempt. Issues to consider when selecting records for nonfatal suicide attempts and intentional self-harm from ICD-10-CM coded administrative data sets are also discussed.
Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of a larger study of psychological autopsies conducted in Nunavut, Canada. The objective of this secondary analysis was to identify protective factors in the Inuit population of Nunavut by comparing people who died by suicide, people from the general population who attempted suicide, and people from the general population who never attempted suicide. This case-control study included 90 participants, with 30 participants in each group who were paired by birth date, sex, and community. Content analysis was first conducted on the clinical vignettes from the initial study in order to codify the presence of protective variables. Then, inferential analyses were conducted to highlight differences between each group in regards to protection. Findings demonstrated that (a) people with no suicide attempt have more protective variables throughout their lifespan than people who died by suicide and those with suicide attempts within the environmental, social, and individual dimensions; (b) people with suicide attempts significantly differ from the two other groups in regards to the use of services; and (c) protective factors that stem from the environmental dimension show the greatest difference between the three groups, being significantly more present in the group with no suicide attempt. Considering these findings, interventions could focus on enhancing environmental stability in Inuit communities as a suicide prevention strategy.
Bayesian structural equation modeling (BSEM) has recently gained popularity because it enables researchers to fit complex models and solve some of the issues often encountered in classical maximum likelihood estimation, such as nonconvergence and inadmissible solutions. An important component of any Bayesian analysis is the prior distribution of the unknown model parameters. Often, researchers rely on default priors, which are constructed in an automatic fashion without requiring substantive prior information. However, the prior can have a serious influence on the estimation of the model parameters, which affects the mean squared error, bias, coverage rates, and quantiles of the estimates. In this article, we investigate the performance of three different default priors: noninformative improper priors, vague proper priors, and empirical Bayes priors—with the latter being novel in the BSEM literature. Based on a simulation study, we find that these three default BSEM methods may perform very differently, especially with small samples. A careful prior sensitivity analysis is therefore needed when performing a default BSEM analysis. For this purpose, we provide a practical step-by-step guide for practitioners to conducting a prior sensitivity analysis in default BSEM. Our recommendations are illustrated using a well-known case study from the structural equation modeling literature, and all code for conducting the prior sensitivity analysis is available in the online supplemental materials.
As a strengths-based alternative to Western notions of enculturation and acculturation theory, cultural continuity describes the integration of people within their culture and the methods through which traditional knowledge is maintained and transmitted. Through reviewing relevant, original research with Indigenous Peoples in Canada and the United States, the purpose of this metasynthesis is to describe and interpret qualitative research relating to cultural continuity for Indigenous Peoples in North America. This metasynthesis was conducted through the selection, appraisal, and synthesis of 11 qualitative studies. Across the selected studies, five key themes arose: the connection between cultural continuity and health and well-being, conceptualizations of cultural continuity and connectedness, the role of knowledge transmission, journeys of cultural (dis)continuity, and barriers to cultural continuity.
Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent's environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents.
Objective
To conduct a systematic literature review to assess the conceptualization, application, and measurement of resilience in American Indian and Alaska Native (AIAN) health promotion.
Data Sources
We searched 9 literature databases to document how resilience is discussed, fostered, and evaluated in studies of AIAN health promotion in the United States.
Study Inclusion and Exclusion Criteria
The article had to (1) be in English; (2) peer reviewed, published from January 1, 1980, to July 31, 2015; (3) identify the target population as predominantly AIANs in the United States; (4) describe a nonclinical intervention or original research that identified resilience as an outcome or resource; and (5) discuss resilience as related to cultural, social, and/or collective strengths.
Data Extraction
Sixty full texts were retrieved and assessed for inclusion by 3 reviewers. Data were extracted by 2 reviewers and verified for relevance to inclusion criteria by the third reviewer.
Data Synthesis
Attributes of resilience that appeared repeatedly in the literature were identified. Findings were categorized across the lifespan (age group of participants), divided by attributes, and further defined by specific domains within each attribute.
Results
Nine articles (8 studies) met the criteria. Currently, resilience research in AIAN populations is limited to the identification of attributes and pilot interventions focused on individual resilience. Resilience models are not used to guide health promotion programming; collective resilience is not explored.
Conclusion
Attributes of AIAN resilience should be considered in the development of health interventions. Attention to collective resilience is recommended to leverage existing assets in AIAN communities.
As part of the National Action Alliance for Suicide Prevention's American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance's prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e9. doi:10.2105/AJPH.2014.302517).
Suicide continues to be an epidemic in Indian Country, especially among young American Indians and Alaska Native (AI/AN) individuals. In Indian Country, suicide must be seen within the context of how historical and ongoing present-day trauma has impacted Native communities. The disparities in health, education, and employment opportunities, coupled with the high prevalence of violence and substance abuse, serve to both exacerbate mental health problems and disconnect Native youth from their community and culture. The combination of these stressors contributes to the alarmingly high rate of youth suicides in Indian Country. This article provides an overview of the nature of suicide in Indian Country and introduces promising practices of suicide intervention programs utilized within Indian Country. Additionally, recommendations for the future development of AI/AN suicide prevention programs are provided.
Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience.
What is it like to grow up Yup'ik and come of age today in a traditional hunting-gathering community setting located in a remote region of Alaska? Current research describes a contemporary experience often laden with trauma and crisis. Youth in Yup'ik communities today face threats to their very survival as they encounter, early on, things that their ancestors never faced-including alcohol-related deaths, violence in many forms, and high rates of suicide among their young peers. Yet all is not despair for the youth growing up in these remote indigenous communities. Many youth grow-up to become skilled hunters, strong leaders, and able parents. This paper reports findings from the Alaskan Yup'ik site of the Circumpolar Indigenous Pathways to Adulthood (CIPA) study. The goal of this study is to identify strengths and resilience in youth living in a Yup'ik community in southwest Alaska. Interviews were conducted with 25 youth age 11-18, currently residing in a southwest Alaska community. Qualitative analysis revealed important connections between local stressors, community-level protective resources, and youth-driven, solution-focused strategies for overcoming hardship and learning the "ways how to live." Findings from this study contribute critical information on indigenous youth protection and resilience, including community and cultural resilience processes beyond the individual level, and enhance our understanding of the types of resources that can lead to improved outcomes for Alaska Native youth.
In this paper, we discuss the importance of community resilience for Aboriginal health and well-being. The concept of resilience has been used in developmental psychology and psychiatry to describe individuals' capacities to achieve well-being and thrive despite significant adversity. Resilience is also a useful concept in ecology where it draws attention to the ability of ecosystems to adapt to environmental stress through transformation. The study of community resilience builds on these concepts, to understand positive responses to adversity at the level of families, communities and larger social systems. Despite historical and ongoing conditions of adversity and hardship many Aboriginal cultures and communities have survived and done well. In this review, we critically assess the various definitions of resilience as applied to individuals. We then examine resilience as applied to families, communities and larger social systems. We examine links between the concept of resilience and social capital. We then consider interventions that can promote resilience and well-being in Aboriginal communities. These include strengthening social capital, networks and support; revitalization of language, enhancing cultural identity and spirituality; supporting families and parents to insure healthy child development; enhancing local control and collective efficacy; building infrastructure (material, human and informational); increasing economic opportunity and diversification; and respecting human diversity. We also discuss methods of measuring community resilience, examining advantages and disadvantages to each method. Community resilience is a concept that resonates with Aboriginal perspectives because it focuses on collective strengths from an ecological or systemic perspective.
Suicide rates among American Indian and Alaska Native (AI/AN) young people are significantly higher than other ethnic groups in the United States. Not only are there great differences when comparing AI/AN rates and those of other Americans, some tribal groups have very low rates of suicide while other Native communities have much higher rates. Despite this obvious variability, there is little research to help understand the factors associated with these differences. The current study considers the correlates of suicidal behavior in one rural Alaska Native region that suffers disproportionately from suicide. The analysis describes suicide behavior between the years 2001-2009, and considers the characteristics associated with both suicide deaths and nonfatal suicidal behavior. In multivariate analyses we identified gender, method of suicide and history of previous attempt as significant predictors of fatal suicide behavior, similar to results obtained from analyses on the same community's data from the previous decade. This descriptive study can offer some insights to shape prevention efforts in this and other rural, tribal communities.
This research report examines self-continuity and its role as a protective factor against suicide. First, we review the notions of personal and cultural continuity and their relevance to under-standing suicide among First Nations youth. The central theoretical idea developed here is that, because it is constitutive of what it means to have or be a self to somehow count oneself as continuous in time, anyone whose identity is undermined by radical personal and cultural change is put at special risk to suicide for the reason that they lose those future commitments that are necessary to guarantee appropriate care and concern for their own well-being. It is for just such reasons that adolescents and young adults—who are living through moments of es-pecially dramatic change—constitute such a high risk group. This generalized period of in-creased risk during adolescence can be made even more acute within communities that lack a concomitant sense of cultural continuity that might otherwise support the efforts of young persons to develop more adequate self-continuity warranting practices. Next, we present data to demonstrate that, while certain indigenous or First Nations groups do in fact suffer dra-matically elevated suicide rates, such rates vary widely across British Columbia's nearly 200 aboriginal groups: some communities show rates 800 times the national average, while in oth-ers suicide is essentially unknown. Finally, we demonstrate that these variable incidence rates are strongly associated with the degree to which BC's 196 bands are engaged in community practices that are employed as markers of a collective effort to rehabilitate and vouchsafe the cultural continuity of these groups. Communities that have taken active steps to preserve and rehabilitate their own cultures are shown to be those in which youth suicide rates are dramati-cally lower.
This brief report details a preliminary investigation into how community-level variability in knowledge of Aboriginal languages relate to "band"-level measures of youth suicide. In Canada, and, more specifically, in the province of British Columbia (BC), Aboriginal youth suicide rates vary substantially from one community to another. The results reported demonstrate that not only did this simple language-use indicator prove to have predictive power over and above that of six other cultural continuity factors identified in previous research, but also that youth suicide rates effectively dropped to zero in those few communities in which at least half the band members reported a conversational knowledge of their own "Native" language.
To review the existing epidemiological literature on suicide and alcohol-related disorders and their social determinants in the U.S. Arctic, as it relates to U.S. government research and evaluation efforts, and to offer recommendations to boost research capacity in the U.S. Arctic and collaborations across the circumpolar Arctic as part of global health initiatives.
Synthetic literature review.
Published literature; federal and state reports on suicide and alcohol-related disorders; and federal databases on research and program evaluation in the U.S Arctic were reviewed, with a focus on epidemiological trends over the past 50 years.
Suicide and alcohol-related disorders play a significant role in health disparities in the U.S. Arctic, with evidence of a disturbing prevalence trend over the past 50 years. Important variations exist in suicide rates across different regions of Alaska with different majority populations of Alaska Native cultural groups - and, in selected key instances, within these regions - with immense implications for guiding effective prevention efforts. Consequences of alcohol abuse are severe and particularly significant in their impact upon Alaska Native people. Health-related conditions associated with alcohol abuse are among the leading causes of mortality.
Recommendations to boost research capacity in behavioural health in the U.S. Arctic are offered, specifically on strategies and methods of inquiry and analysis; distinctions between populations and communities in rural circumpolar contexts; and future epidemiological and implementation research.
The notions of resilience that have emerged in developmental psychology and psychiatry in recent years require systematic rethinking to address the distinctive cultures, geographic and social settings, and histories of adversity of indigenous peoples. In Canada, the overriding social realities of indigenous peoples include their historical rootedness to a specific place (with traditional lands, communities, and transactions with the environment) and the profound displacements caused by colonization and subsequent loss of autonomy, political oppression, and bureaucratic control. We report observations from an ongoing collaborative project on resilience in Inuit, Métis, Mi'kmaq, and Mohawk communities that suggests the value of incorporating indigenous constructs in resilience research. These constructs are expressed through specific stories and metaphors grounded in local culture and language; however, they can be framed more generally in terms of processes that include: regulating emotion and supporting adaptation through relational, ecocentric, and cosmocentric concepts of self and personhood; revisioning collective history in ways that valorize collective identity; revitalizing language and culture as resources for narrative self-fashioning, social positioning, and healing; and renewing individual and collective agency through political activism, empowerment, and reconciliation. Each of these sources of resilience can be understood in dynamic terms as emerging from interactions between individuals, their communities, and the larger regional, national, and global systems that locate and sustain indigenous agency and identity. This social-ecological view of resilience has important implications for mental health promotion, policy, and clinical practice.
Poor mental health among American Indian adolescents has been a matter of significant concern for the past two decades. This study extends the literature on acculturation within this population by investigating the relationship between hopelessness, levels of acculturation, and residence among American Indian adolescents. Utilizing data drawn from 438 adolescents across 67 American Indian tribes, our analyses show that American Indian adolescents who have bicultural competence (i.e., those who are adept in both Indian and White cultures) have significantly less hopelessness than do those with adeptness in only one culture or in neither culture. Our findings also show a significant difference by residence, with American Indians who live on reservations indicating less hopelessness than those living in urban or rural/nonreservation areas. Analysis of interaction effects suggests that the beneficial effect of adeptness in White culture is particularly true for American Indians living in urban areas.
This article discusses the use of cluster analysis in family psychology research. It provides an overview of potential clustering methods, the steps involved in cluster analysis, hierarchical and nonhierarchical clustering methods, and validation and interpretation of cluster solutions. The article also reviews 5 uses of clustering in family psychology research: (a) deriving family types, (b) studying families over time, (c) as an interface between qualitative and quantitative methods, (d) as an alternative to multivariate interactions in linear models, and (e) as a data reduction technique for small samples. The article concludes with some cautions for using clustering in family psychology research.
Chandler and Lalonde broadened the scope of inquiry in suicide research by providing theoretical grounding and empirical support for the role of community, culture, and history in understanding Indigenous youth suicide and reimagining its prevention. Their work pushed the field to consider the intersectional process of individual and collective meaning-making in prevention of Indigenous suicide, together with the central role culture plays in bringing coherence to this process over time. Their innovation shifted the research focus to include the shared histories, contexts, and structures of meaning that shape individual lives and behaviors. We describe here a new generation of research extending their pathbreaking line of inquiry. Recent work aims to identify complex associations between community-level structures and suicidal behavior by collaborating with Alaska Native people from rural communities to describe how community protective factors function as preventative resources in their daily lives. Community engagement and knowledge co-production created a measure of community protection from suicide. Structured interviews with rural Alaska Native community members allowed use of this measure to produce relevant, accessible, and actionable knowledge. Ongoing investigations next seek to describe their mechanisms in shaping young people's lives through a multilevel, mixed-methods community-based study linking community-level protection to protection and well-being of individual youth. These efforts to understand the multiple culture-specific and culturally mediated pathways by which communities build on their strengths, resources, and practices to support Indigenous young people's development and reduce suicide risk are inspired by and expand on Chandler and Lalonde's remarkable legacy.
Multilevel structural equation modeling (MSEM) allows researchers to model latent factor structures at multiple levels simultaneously by decomposing within- and between-group variation. Yet the extent to which the sampling ratio (i.e., proportion of cases sampled from each group) influences the results of MSEM models remains unknown. This article explores how variation in the sampling ratio in MSEM affects the measurement of Level 2 (L2) latent constructs. Specifically, we investigated whether the sampling ratio is related to bias and variability in aggregated L2 construct measurement and estimation in the context of doubly latent MSEM models utilizing a two-step Monte Carlo simulation study. Findings suggest that while lower sampling ratios were related to increased bias, standard errors, and root mean square error, the overall size of these errors was negligible, making the doubly latent model an appealing choice for researchers. An applied example using empirical survey data is further provided to illustrate the application and interpretation of the model. We conclude by considering the implications of various sampling ratios on the design of MSEM studies, with a particular focus on educational research.
Background:
The Alaska Native Community Resilience Study (ANCRS) is the central research project of the Alaska Native Collaborative Hub for Research on Resilience (ANCHRR), one of three American Indian and Alaska Native (AIAN) suicide prevention hubs funded by the National Institute of Mental Health.
Objective:
This paper describes the development of a structured interview to identify and measure community-level protective factors that may reduce suicide risk among youth in rural Alaska Native communities.
Methods:
Multilevel, iterative collaborative processes resulted in: a) expanded and refined constructs of community-level protection, b) clearer and broadly relevant item wording, c) respectful data collection procedures, and d) Alaska Native people from rural Alaska as primary knowledge-gathering interviewers.
Lessons learned:
Moving beyond engagement to knowledge co-production in Alaska Native research requires flexibility, shared decision-making and commitment to diverse knowledge systems; this can result in culturally attuned methods, greater tool validity, new ways to understand complex issues and innovations that support community health.
Highlights
This study is only one of few that describe the development of a ground up prevention intervention.
This process can be replicated by other tribes to promote cultural beliefs, traditions and language.
The Elders’ Curriculum is an intergenerational approach that taps cultural and community strengths.
Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of a larger study of psychological autopsies conducted in Nunavut, Canada. The objective of this secondary analysis was to identify protective factors in the Inuit population of Nunavut by comparing people who died by suicide, people from the general population who attempted suicide, and people from the general population who never attempted suicide. This case-control study included 90 participants, with 30 participants in each group who were paired by birth date, sex, and community. Content analysis was first conducted on the clinical vignettes from the initial study in order to codify the presence of protective variables. Then, inferential analyses were conducted to highlight differences between each group in regards to protection. Findings demonstrated that (a) people with no suicide attempt have more protective variables throughout their lifespan than people who died by suicide and those with suicide attempts within the environmental, social, and individual dimensions; (b) people with suicide attempts significantly differ from the two other groups in regards to the use of services; and (c) protective factors that stem from the environmental dimension show the greatest difference between the three groups, being significantly more present in the group with no suicide attempt. Considering these findings, interventions could focus on enhancing environmental stability in Inuit communities as a suicide prevention strategy.
Studies comparing groups that are at different levels of multilevel data (namely, cross-level groups) using the same measure are not unusual such as student and teacher agreement in education or congruence between patient and physician perceptions in health research. Although establishing measurement invariance (MI) between these groups is important, testing MI is methodologically challenging because the groups compared for MI are at different levels with one group nested within the other group. We propose a multilevel confirmatory factor analysis (CFA) model that allows MI testing between cross-level groups at the between level and demonstrated testing MI between students and teachers using the promoting social interaction scale. Along with the demonstration, some methodological issues in implementing the proposed model (e.g., cluster invariance and reliability) and evaluating the model fit of multilevel CFA (e.g., ΔCFI and level-specific fit indices) and alternative approaches to the proposed model are discussed.
Context
American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth.
Objective
To identify risk and protective factors associated with suicide attempts among native male and female adolescents.
Design
The 1990 National American Indian Adolescent Health Survey.
Setting
Schools of reservation communities in 8 Indian Health Service areas.
Participants
Eleven thousand six hundred sixty-six 7th-through 12th-grade American Indian and Alaska native youth.
Main Outcome Measures
Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls.
Results
Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors.
Conclusions
A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.
The National Strategy for Suicide Prevention highlights the importance of improving the timeliness, usefulness, and quality of national suicide surveillance systems, and expanding local capacity to collect relevant data. This article describes the background, methods, process data, and implications from the first-of-its-kind community-based surveillance system for suicidal and self-injurious behavior developed by the White Mountain Apache Tribe with assistance from Johns Hopkins University. The system enables local, detailed, and real-time data collection beyond clinical settings, with in-person follow-up to facilitate connections to care. Total reporting and the proportion of individuals seeking treatment have increased over time, suggesting that this innovative surveillance system is feasible, useful, and serves as a model for other communities and the field of suicide prevention. (Am J Public Health. Published online ahead of print April 22, 2014: e1-e6. doi:10.2105/AJPH.2014.301872).
This report discusses the rationale for and implications of the implementation of a new population standard for the age standardization (age adjustment) of death rates. The new standard is based on the year 2000 population and beginning with data year 1999, will replace the existing standard based on the 1940 population. This report also includes a technical discussion of direct and indirect standardization and statistical variability in age-adjusted death rates. Currently, at least three different standards are used among Department of Health and Human Services agencies. Implementation of the year 2000 standard will reduce confusion among data users and the burden on State and local agencies. Use of the year 2000 standard will also result in age-adjusted death rates that are substantially larger than those based on the 1940 standard. Further, the new standard will affect trends in age-adjusted death rates for certain causes of death and will narrow race differentials in age-adjusted death rates. Although age standardization is an important and useful tool, it has some limitations. As a result the examination of age-adjusted death rates should be the beginning of an analysis strategy.
Handbook of youth suicide prevention: Integrating research into practice
- A B Cole
- C M Armstrong
- S Rhoades-Kerswill
- S V Lopez
- J Elm
Cole, A. B., Armstrong, C. M., Rhoades-Kerswill, S., Lopez, S. V., &
Elm, J. (2021). Suicide among American Indian/Alaska Native
populations. In R. Miranda & E. L. Jeglic (Eds.), Handbook of
youth suicide prevention: Integrating research into practice (pp.
207-228). Springer International Publishing. https:// doi. org/ 10.
1007/ 978-3-030-82465-5_ 13
Personal persistence, identity development, and suicide: A study of Native and non-native North American adolescents. Monographs of the Society for Research in Child Development
- M J Chandler
- C E Lalonde
- B W Sokol
- D Hallett
- MJ Chandler
Chandler, M. J., Lalonde, C. E., Sokol, B. W., & Hallett, D. (2003).
Personal persistence, identity development, and suicide: A study
of Native and non-native North American adolescents. Monographs of the Society for Research in Child Development, 68(2),
1-130. https:// doi. org/ 10. 1111/ 1540-5834. 00246
General random effect latent variable modeling: Random subjects, items, contexts, and parameters
- T Asparouhov
- B Muthén
Asparouhov, T., & Muthén, B. (2016). General random effect latent
variable modeling: Random subjects, items, contexts, and parameters. In J. R. Harring, L. M. Stapleton, & S. N. Beretvas (Eds.),
Advances in multilevel modeling for educational research:
Addressing practical issues found in real-world applications (pp.
163-192). IAP Information Age Publishing.
Bayesian statistics for the social sciences
- D Kaplan
Kaplan, D. (2014). Bayesian statistics for the social sciences. Guilford
Press.
A systematic review of resilience research among Indigenous youth in contemporary Canadian contexts
- M Rowhani
- A Hatala
Rowhani, M., & Hatala, A. (2017). A systematic review of resilience
research among Indigenous youth in contemporary Canadian contexts. The International Journal of Health, Wellness, and Society,
7(4), 45-58. https:// doi. org/ 10. 18848/ 2156-8960/ CGP/ v07i04