Two Navajo sisters in traditional clothing watch a sunset in Monument Valley.

Each November, the United States observes Native American Heritage month – a time to both celebrate Indigenous peoples past and present and to shine light on challenges faced by American Indian and Alaskan Native (AI/AN) communities. One key challenge is mental health and suicide. In this post, we aim to raise awareness and spread important information on the impact of and preventative measures aimed at reducing the rate of suicide in AI/AN communities.

Suicide Risk in AI/IN Communities

Compared to the general U.S. population, AI/AN communities are disproportionately affected by suicide (CDC, 2022). The rates of suicide among AI/AN individuals have been increasing since 2003. In 2015, rates were reported to be 3.5 times higher than other racial/ethnic groups with the lowest rates (CDC, 2022). The National Violent Death Reporting System (NVDRS) reported a 20% rise in suicide rates among AI/AN populations, from 20 per 100,000 individuals to 23.9 per 100,000 in 2020 (Stone et al., 2022). The highest percentage of suicides (46.9%) were among those aged 25-44 years (Stone et al., 2022). For youth and young adults ages 18-24, they are reported to have the highest rates of suicide across all demographic groups, with suicide identified as the second leading cause of death (CDC, 2022).

Supporting Mental Health for Indigenous Peoples

To combat the disproportionate rates of suicide among AI/AN communities, Tribal nations are seeking to utilize Tribal-specific suicide surveillance systems. The White Mountain Apache Tribe (WMAT) in Arizona mandated the implementation of the Celebrating Life Suicide Surveillance System from all schools, medical and social service staff, first responders and community members to aid in the reporting and identification of individuals at risk for suicide or displaying suicidal behaviors across their reservation (Cwik et al., 2014). For multiple years, this novel approach has allowed the collection of local data by the Tribe in partnership with Johns Hopkins University. This data collected has informed suicide prevention strategies and additional research initiatives including culturally tailored interventions.

Addressing AI/AN Suicide Surveillance System Challenges

Despite the successful model of the Celebrating Life system, Indigenous nations are still problem solving through common challenges to developing their own tailored suicide surveillance systems. Successful approaches build off established relationships with leadership and Tribal Epidemiology Centers, supported by the Indian Health Service and Centers for Disease Control, to facilitate knowledge transfer from researchers to communities. Surveillance systems should be driven by local needs, resources, and readiness. To recognize and uphold data sovereignty, Tribal leaders and outside researchers should have dialogue about the importance of this data and how it can be used or shared.

New surveillance system proposals should learn from the challenges of existing surveillance systems. The White Mountain Apache Tribe learned that intake data is sometimes missing in third party reports, substance use can challenge the classification of suicidal behavior in the system, and grant funding can make it challenging to sustain the program (Cwik et al, 2014). Surveillance systems are also broadly known to have limitations. These include the fact that data collection only occurs in clinical settings or coroner’s reports, a lack of detail, delays in data collection, and stigma and privacy concerns related to reporting (Suicide Prevention Research Center, 2018).

Advocating for Indigenous Suicide Surveillance Systems

Researchers, policymakers, and other stakeholders should advocate for suicide surveillance systems specific to AI/AN communities. This includes advocating for funding to support these systems and mandated reporting across the Tribal community where possible. The National Indian Health Board (NIHB) has cultivated a 2022 Legislative and Policy Agenda for Indian Health to reinforce Tribal sovereignty by ensuring the fulfillment of the U.S. government's treaty obligations to Tribal nations health and wellness. To strengthen Tribal public health capacity, the NIHB is advocating for the expansion of surveillance and epidemiology capabilities. Improving their capabilities will allow for more assistance from local, state and federal public health agencies while the Tribes and Tribal Organizations continue to conduct their own data collection and analyses.

Learn more at the Suicide Prevention Resource Center.


Disclaimer: This piece was written by Monica Desjardins (Public Health Analyst), Emily Hadley (Research Data Scientist), and Shelby Stockman Fisher (Epidemiologist) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.