Native Americans

The term American Indian/Alaska Natives (AI/AN) encompasses many ethnic and cultural groups, tribes and traditions. North Dakota has a rich culture of American Indian traditions and cultures. Unless other otherwise noted, the statistics mentioned on this page are national statistics and not specific to North Dakota. It is important to note that suicide rates vary among the tribes.

The reasons why suicide rates are high among the AI/AN population, and especially in the youth, are multi-faceted and complex. In particular, AI/AN individuals tend to have more serious mental health disorders which are related to suicide including anxiety, substance use and depression. In 2004-2008 data, the suicide rate for AI/AN was 14.68 per 100,000, which was higher than the overall U.S. rate of 11.15 per 100,000. AI/AN males ages 20 to 24 had the highest rate of suicide in the United States across all racial/ethnic/ages, which was 47.47 per 100,000. Suicide is ranked as the second leading cause of death in ages 10 to 34. Suicide is ranked as the eighth leading cause of death for AI/AN of all ages.

Adolescents tend to be at a higher risk for suicide than adults. There is a wide variance of suicide attempt rates that are reported across the United States, but adolescents consistently come in higher than adults. Completed suicides also are typically seen at a higher rate in the AI/AN youth. In 2007 in youth ages 15 to 24, the completed suicide rate in AI/AN youth was 20.04 per 100,000 compared to 6.85 per 100,000 for youth overall.

There are very few evidence-based programs that are adapted for American Indian and Alaska Native cultures. This is important to note as we say that mental disorders are a risk factor for suicide and are highly treatable with effective treatment. Not all treatments are effective when crossing the cultural barriers. Ideal treatment will be evidence-based and culturally-appropriate within the American Indian population.

Strengths or protective factors

There are several protective factors that seem to translate across all racial boundaries:

• Effective clinical care for mental, physical and substance use disorders.
• Restricted access to highly lethal means.
• Strong connections to family and support networks.

There also are several protective factors that are specific to the AI/AN culture:

• Culture: Nationwide, tribes with lower suicide had a greater presence of cultural facilities, self-government, the title to their traditional lands, and services such as education, police, fire, health-care delivery and child and family services. People living a more traditional life reported feelings of greater happiness, more frequent use of religion and spirituality to cope with stress and less use of drugs and alcohol.
• Spirituality: Commitment to cultural spirituality is significantly associated with a reduction in suicide attempts. 
• Family connectedness: Connectedness to family and discussing problems with family and friends are protective factors. 

Risk Factors

There are several risk factors that affect all people no matter race or ethnicity:

• A previous suicide attempt.
• A mental health or substance use disorder.
• Family history of mental illness, substance use or suicidal behavior.
• Access to lethal means.
• Barriers to care.
• Lack of social support.
• Perceived or real losses.

There are several risk factors that seem to occur more often in the AI/AN cultures:

• Alcohol and drug use: In 2005-2006 of American Indians/Alaska Natives, 37.1 percent of suicide decedents tested for alcohol tested as legally intoxicated.
• Contagion: There is growing evidence that youth may be at particular risk because American Indian/Alaska Natives have considerable exposure to suicide.
• Discrimination: Discrimination was as important a predictor of suicide ideation as poor self-esteem or depression. 
• Mental health services access and use: In the national study, 10 to 35 percent of American Indian adolescents and young adults use professional health services during a suicidal episode. Mental health services aren't easily accessible due to:
  • Lack of funding.
  • Culturally inappropriate services.
  • Mental health shortages and high turnover rate for professionals.
  • Stigma of receiving mental health treatment.
• Historical trauma: Attempts to eliminate American Indian/Native American culture such as the removal of children who were sent to boarding schools, prohibition of the practice of language and culture contribute to high rates of suicide.
• Alienation: Alienation causes a loss of well-being when the individual feels emotionally disconnected from his or her family of origin or culture, which can lead to depression.
• Acculturation: Alaska Native tribal members with greater acculturation reported increased psychosocial stress, less happiness and greater use of drugs to cope with stress.  

Information adapted from the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center.