1 Suicide Among Aboriginal People in Canada The Aboriginal Healing Foundation Research Series 2007 Aboriginal Healing Foundation Published by: Aboriginal Healing Foundation 75 Albert Street, Suite 801, Ottawa, Ontario K1P 5E7. Phone: (613) 237-4441. Toll-free: (888) 725-8886. Fax: (613) 237-4442. Email: Website: Design & Production: Aboriginal Healing Foundation Printed by: Dollco Printing Print version: ISBN 978-1-897285-49-7. Electronic version: ISBN 978-1-897285-51-0. Unauthorized use of the name Aboriginal Healing Foundation and of the Foundation's logo is prohibited. Non-commercial reproduction of this document is, however, encouraged. This project was funded by the Aboriginal Healing Foundation but the views expressed in this report are the personal views of the author(s).
2 Ce document est aussi disponible en fran ais. Suicide Among Aboriginal People in Canada Prepared for The Aboriginal Healing Foundation By Laurence J. Kirmayer Gregory M. Brass Tara Holton Ken Paul Cori Simpson Caroline Tait 2007. Table of Contents Executive xv 1. The Scope of this Definitions of Suicide and Suicidal Methods of Studying Clinical Epidemiological Ethnographic Outline of This 2. The Epidemiology of Suicide Among Aboriginal People in The Demography of Aboriginal People in The Prevalence of Suicide in Aboriginal The Prevalence of Suicidal Ideation and Age Gender Marital Changes Over Time: Period and Cohort Suicide Methods of 3. Origins of Suicide : Individual Vulnerability and Psychiatric Previous Suicidal Ideation and Alcohol and Substance Developmental Temperament and Personality Fetal Alcohol Parenting and Child Childhood Separation, Loss, and Family Childhood Physical and Sexual Hopelessness, Problem Solving, and Reasons for Sexual Interpersonal Physical iii Table of Contents The Interaction of Risk and Protective 4.
3 Origins of Suicide : Social Suffering and Social Structure and Poverty and Reserves, Settlements, and Urban Family and Social Disorganization and Cultural-Historical Culture Change, Modernization, and Forced The Impact of the Residential School Sexual Abuse in Residential Communities Without Intergenerational Effects of Residential Linking Residential Schools to The Child Welfare System and Systematic The Extension of Child Welfare to Aboriginal Impact of the Sixties Scoop ..75. Cultural Continuity, Community Wellness, and Collective 5. What Works in Suicide Prevention?..81. Levels of Effective Suicide Prevention Primary Prevention Means School-Based Suicide Prevention Peer Support Community-Based Gatekeeper Mass Secondary Prevention: Early Intervention and The Role of Professionals and Mental Health Tertiary Prevention or 6.
4 Conclusion: Understanding and Preventing An Integrative Perspective on Adapting Prevention Practices for Aboriginal 100. Scale and Location of 101. iv Table of Contents Access to 102. Availability of Aboriginal Mental Health 102. Privacy and 102. Cultural and Linguistic 103. Rapidity of Social and Cultural 104. Best Practices Guidelines for Suicide 104. Overall 106. Planning and 107. 107. 108. 108. 109. 110. Appendix A) Recommended Suicide Prevention and Mental Health Promotion Training 113. Applied Suicide Intervention Skills Training (ASIST).. 113. 5-Day Suicide Prevention Training for Aboriginal 114. White Stone: Aboriginal Youth Suicide Prevention Training for Youth 115. Community-Based Suicide Prevention Program (CBSPP).
5 116. Zuni Life Skills Development Curriculum (ZLSD).. 118. Jicarilla Suicide Prevention 119. Northwest Territories Suicide Prevention Training (NTSPT).. 120. Contact Information for Recommended Suicide Prevention 122. Appendix B) Additional Resources: Manuals and Tool 125. Aboriginal Youth: A Manual of Promising Suicide Prevention 125. National Inuit Youth Suicide Prevention 125. National Aboriginal Youth Suicide Prevention Strategy Program 125. Acting on What We Know: Preventing Youth Suicide in First 125. Assessment and Planning Tool Kit for Suicide Prevention in First Nations 126. Aboriginal Healing and Wellness Strategy Suicide Prevention and Intervention Resource 127. Appendix C) Additional Resources: 129.
6 131. List of Figures Figure 2-1) Comparison of National Suicide and Self-Inflicted Injury Rates, Figure 2-2) Comparison of Suicide Rates of First Nations and General Population in Canada , 1980 Figure 2-3) Age-standardized Suicide Rate for Males by Region, . Table of Contents Figure 2-4) Age-standardized Suicide Rate for Females by Region, Figure 2-5) Average Annual Suicide Rate Among Inuit in Nunavut by Region, 1999 Figure 2-6) Average Annual Suicide Rate in British Columbia First Nations by Tribal Council, 1993 Figure 2-7) Average Annual Suicide Rate Among Inuit in Nunavut by Community, 1999 Figure 2-8) Comparison of Suicide Rates by Age Group, First Nations and Canadian Population, 1989 Figure 2-9) Suicide Rates in Nunavut by Sex and Age Cohort, 1999 Figure 2-10) Number of Deaths by Suicide in Nunavut, 1975 Figure 2-11) Number of Deaths by Suicide in Nunavik, 1972 Figure 2-12) Suicide Rates in Nunavut by Age, 1980 Figure 2-13)
7 Number of Deaths by Suicide in Nishnawbe Aski Nation, 1986 Figure 2-14) Suicide Rates in British Columbia First Nations, 1993 Figure 2-15) Suicide Rates in Alberta First Nations, 1992 Figure 3-1) Interaction of Individual Risk and Protective Factors in Figure 4-1) Youth Suicide Rates by Number of Cultural Continuity Factors in British Columbia First Nations, 1987 Figure 4-2) Transgenerational Effects of Residential School Figure 6-1) An Integrative Model of the Origins of Figure 6-2) Levels of Intervention in Suicide 105. List of Tables Table 2-1) Rates of Suicide Reported Among Aboriginal Groups in Table 3-1) Protective Factors Related to Mental Health in Aboriginal Table 4-1) Transgenerational Effects of Residential Table 5-1) Strategies of Illness Prevention and Health Table 5-2) Risk and Protective Factors Relevant to Suicide vi Preface This report was prepared under contract with the Aboriginal Healing Foundation, and supported by grants from the Fonds de la recherche en sant du Qu bec, the Conseil qu becois de la recherche sociale, and the Institute for Aboriginal Peoples Health of the Canadian Institutes for Health Research.
8 These agencies, however, bear no responsibility for its content. The literature review was undertaken with the assistance of Elizabeth Anthony, Margaret Cargo, Genevieve Garneau, Arlene Lalibert , Katherine Gofton, Elizabeth Guerrier, Melissa Mair, Chantal Robillard, Lara Stern, Hani Tamim, and Catherine Zygmuntowicz. Marcelle Durrum, Marsha Vicaire, and Claire Fantus provided editorial help. I thank Kay Berckmans, and Antonella Clerici for administrative support. The text of this report is based in large part on earlier papers and reports by the Aboriginal Mental Health Research Team (Kirmayer et al., 1993a; 1993b; 1994a; 1999). The contributors to these earlier reports were: Lucy Boothroyd, Louise Bujold-Brown, Rose DuFour, Nadia Ferrara, Kathryn Gill, Barbara Hayton, Vania Jimenez, Arlene Lalibert , Brenda Laronde Simpson, Michael Malus, Consuelo Quesney, Andr.
9 Smith, Yeshim Ternar, and Terri Yu. Laurence J. Kirmayer, MD. Montreal, May 2006. vii Abbreviations AAS American Association of Suicidology ACADRE Aboriginal Capacity and Developmental Research Environments ACYRN Aboriginal Community Youth Resilience Network AFN Assembly of First Nations AHF Aboriginal Healing Foundation AHWS Aboriginal Healing and Wellness Strategy ARBD Alcohol-related birth defects ASIST Applied Suicide Intervention Skills Training CASP Canadian Association for Suicide Prevention CBSPP Community-Based Suicide Prevention Program CI Confidence interval CIDI Composite International Diagnostic Interview CSP Centre for Suicide Prevention DIS Diagnostic Interview Schedule DSM Diagnostic and Statistical Manual FAE Fetal alcohol effects FAS Fetal alcohol syndrome FNIHB First
10 Nations and Inuit Health Branch of Health Canada INAC Indian and Northern Affairs Canada ITK Inuit Tapiriit Kanatami NAHO National Aboriginal Health Organization NAYSPS National Aboriginal Youth Suicide Prevention Strategy NIYC National Inuit Youth Council NTSPT Northwest Territories Suicide Prevention Training OR Odds ratio OSPN Ontario Suicide Prevention Network RHS First Nations Regional Longitudinal Health Survey RR Relative risk SPRC Suicide Prevention Resource Centre SSRI Selective serotonin reuptake inhibitor WHO World Health Organization ZLSD Zuni Life Skills Development Curriculum ix Glossary Ambivalence Ambivalence refers to a conflict between competing wishes or desires within the person; in the context of Suicide , for example, the ambivalent individual may simultaneously have both the desire to die and the desire to live.