In 1988 an Indian tribe located in the back country of New Mexico
experienced annual rates of suicide and of suicide attempts that were 15 times
higher than for the rest of the United States. The rates were five times
higher than for other New Mexico Indian tribes, and suicidal activity was
increasing among the tribe's youth.
So in 1990, the tribal council, with the aid of the U.S. Indian Health
Service, launched a suicide prevention program directed toward its
adolescents. Five years later, 20- to-24-year-olds were targeted as well.
The goals of the program included identifying suicide risk factors specific
to the tribe, focusing on specific individuals or families at high suicide
risk, providing such individuals and families with mental health services, and
confronting suicide-related issues such as alcoholism, domestic violence,
unemployment, and so forth. By 2002, the program had a staff of 57. Today, its
annual budget is about $1 million.
Researchers have conducted a study to determine whether the program has
reduced suicidal behaviors among members of this tribe, which, to protect the
tribe's privacy, they refer to as the Western Athabaskan Tribal Nation. It
appears that it has, the investigators reported in the July American
Journal of Public Health.
The lead researcher was Philip May, Ph.D., a professor of family and
community medicine at the University of New Mexico.
May and his colleagues gathered data documenting the tribe's annual number
of suicide attempts and completed suicides two years before the suicide
prevention program began—that is, in 1988—as well as after it
started, with the last follow-up conducted in 2002. The group then analyzed
the data to determine whether there were any changes in the number of suicide
attempts or suicides during these years.
There were 20 suicide attempts a year on average before the program got
underway in 1990, the researchers found. This average dropped to nine by the
program's second year and then to four by 2002.
Moreover, the group aged 19 to 24 experienced the greatest decline in
suicide attempts. The annual frequency of 11 attempts before the program got
under way remained unchanged during the first two years after the program was
launched, but subsequently declined to three in 2000 and one in 2002.
Youth aged 11 to 18 experienced a significant drop in suicide attempts as
well. The annual frequency of attempts before the program began was 15. It
decreased to two by the second year of the program, rose briefly to five in
1996, but returned to two during the period 2000 to 2002.
In contrast to the suicide-attempt findings, the annual frequency of
completed suicides did not fall during the years of the study. The number of
suicides for the tribe was one or two a year before the suicide prevention
program was launched, and it remained the same even by the 2002 follow-up.
The suicide prevention program can probably be credited with the decline in
suicide attempts that occurred during the period of the study, May and his
colleagues concluded, especially since the dip occurred among tribal members
under age 25—the age group primarily targeted by the program.
Concomitantly, it may be that the program was unsuccessful in reducing
suicides per se during the years of the study, May and his team acknowledged.
Because most suicides among New Mexico Indians have historically occurred
among tribal members younger than age 35 years, have frequently involved
alcohol, have been instigated by firearms or hanging, and have been
characterized as impulsive, they said, "one would expect suicide
completions to be more resistant to programmatic intervention and prevention
than gestures and attempts."
Nonetheless, they pointed out, it could be that the suicide prevention
program is halting suicides to some degree since "no increase in suicide
completions occurred on the reservation during the period of the
program" and since "there is some evidence that suicide
completions may have decreased for the target population, although the numbers
are too small for statistical inference."
May told Psychiatric News that other tribal communities and Indian
Health Service officials have contacted him and his coauthors for more details
about the program so that they can try to replicate it.
The study was funded by the U.S. Indian Health Service, Centers for Disease
Control and Prevention, and the Indian tribe that implemented the suicide
An abstract of "Outcome Evaluation of a Public Health Approach
to Suicide Prevention in an American Indian Tribal Nation" is posted at<www.ajph.org/cgi/content/abstract/95/7/1238>.▪
Am J Health Syst Pharm