Suicide Among Aboriginal People in Canada - …

1 Suicide Among Aboriginal People in CanadaThe Aboriginal Healing Foundation Research Series 2007 Aboriginal Healing FoundationPublished by: Aboriginal Healing Foundation75 Albert Street, Suite 801, Ottawa, Ontario K1P 5E7 Phone: (613) 237-4441 Toll-free: (888) 725-8886 Fax: (613) 237-4442 Email: & Production: Aboriginal Healing FoundationPrinted 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 reproduction of this document is, however, project was funded by the Aboriginal Healing Foundation but the views expressed in this report are the personal views of the author(s).Ce document est aussi disponible en fran Healing Foundation75 Albert Street, Suite 801, Ottawa, Ontario K1P 5E7 Phone: (613) 237-4441 Toll-free: (888) 725-8886 Fax: (613) 237-4442 Email: Aboriginal People heal themselvesSuicide Among Aboriginal People in CanadaPrepared forThe Aboriginal Healing FoundationByLaurence J.

2 KirmayerGregory M. BrassTara HoltonKen PaulCori SimpsonCaroline Tait2007iiiTable of ContentsPreface ..viiAbbreviations ..ixGlossary ..xi1. Introduction ..1 The Scope of this Report ..2 Definitions of Suicide and Suicidal Behaviour ..3 Methods of Studying Suicide ..5 Clinical Research ..5 Epidemiological Research ..5 Ethnographic Research ..8 Outline of This Report ..92. The Epidemiology of Suicide Among Aboriginal People in Canada ..11 The Demography of Aboriginal People in Canada ..11 The Prevalence of Suicide in Aboriginal Populations ..13 The Prevalence of Suicidal Ideation and Attempts ..20 Age Differences ..21 Gender Differences ..23 Marital Status ..24 Changes Over Time: Period and Cohort Suicide Clusters ..30 Methods of Suicide .

3 30 Summary ..313. Origins of Suicide : Individual Vulnerability and Resilience ..33 Psychiatric Disorders ..34 Previous Suicidal Ideation and Attempts ..36 Alcohol and Substance Use ..38 Gambling ..40 Developmental Factors ..40 Temperament and Personality Fetal Alcohol Effects ..41 Parenting and Child Rearing ..42 Childhood Separation, Loss, and Family Disruption ..42 Childhood Physical and Sexual Abuse ..43 Hopelessness, Problem Solving, and Reasons for Living ..45 Sexual Orientation ..47 Interpersonal Factors ..47 Physical Environment ..49 Resilience ..49 The Interaction of Risk and Protective Factors ..51 Summary ..54 Table of Contentsiv4. Origins of Suicide : Social Suffering and Survival ..55 Social Structure and Economy.

4 55 Poverty and Unemployment ..56 Reserves, Settlements, and Urban Settings ..57 Incarceration ..57 Family and Religion ..57 Social Disorganization and Traditionalism ..58 Cultural-Historical Factors ..59 Culture Change, Modernization, and Acculturation ..61 Acculturation ..61 Education ..64 Forced Assimilation ..65 The Impact of the Residential School System ..65 Sexual Abuse in Residential Schools ..67 Communities Without Intergenerational Effects of Residential Schooling ..69 Linking Residential Schools to Suicide ..70 The Child Welfare System and Systematic Out-Adoption ..73 The Extension of Child Welfare to Aboriginal Communities ..74 Impact of the Sixties Scoop ..75 Cultural Continuity, Community Wellness, and Collective Identity.

5 76 Summary ..785. What Works in Suicide Prevention? ..81 Levels of Prevention ..81 Effective Suicide Prevention Programs ..85 Primary Prevention Strategies ..86 Means Restriction ..86 School-Based Suicide Prevention Programs ..87 Peer Support Programs ..89 Community-Based Gatekeeper Training ..92 Mass Media ..92 Secondary Prevention: Early Intervention and Treatment ..93 The Role of Professionals and Mental Health Services ..94 Tertiary Prevention or Postvention ..95 Summary ..966. Conclusion: Understanding and Preventing Suicide ..97 An Integrative Perspective on Suicide ..97 Adapting Prevention Practices for Aboriginal Populations ..100 Scale and Location of Communities ..101 Access to Services ..102 Availability of Aboriginal Mental Health Workers.

6 102 Privacy and Confidentiality ..102 Table of Contentsv Cultural and Linguistic Diversity ..103 Rapidity of Social and Cultural Change ..104 Best Practices Guidelines for Suicide Prevention ..104 Overall Planning and Coordination ..107 Prevention ..107 Intervention ..108 Postvention ..108 Evaluation ..109 Conclusion ..110 Appendix A) Recommended Suicide Prevention and Mental Health Promotion Training Programs ..113 Applied Suicide Intervention Skills Training (ASIST) ..113 5-Day Suicide Prevention Training for Aboriginal Communities ..114 White Stone: Aboriginal Youth Suicide Prevention Training for Youth Educators ..115 Community-Based Suicide Prevention Program (CBSPP) ..116 Zuni Life Skills Development Curriculum (ZLSD).

7 118 Jicarilla Suicide Prevention Program ..119 Northwest Territories Suicide Prevention Training (NTSPT) ..120 Contact Information for Recommended Suicide Prevention Programs ..122 Appendix B) Additional Resources: Manuals and Tool Kits ..125 Aboriginal Youth: A Manual of Promising Suicide Prevention Strategies ..125 National Inuit Youth Suicide Prevention Framework ..125 National Aboriginal Youth Suicide Prevention Strategy Program Framework ..125 Acting on What We Know: Preventing Youth Suicide in First Nations ..125 Assessment and Planning Tool Kit for Suicide Prevention in First Nations Communities ..126 Aboriginal Healing and Wellness Strategy Suicide Prevention and Intervention Resource Kit ..127 Appendix C) Additional Resources: Organizations.

8 129 References ..131 List of FiguresFigure 2-1) Comparison of National Suicide and Self-Inflicted Injury Rates, 2000 ..14 Figure 2-2) Comparison of Suicide Rates of First Nations and General Population in Canada , 1980 1999 ..14 Figure 2-3) Age-standardized Suicide Rate for Males by Region, 1997 ..17 Figure 2-4) Age-standardized Suicide Rate for Females by Region, 1997 ..17 Figure 2-5) Average Annual Suicide Rate Among Inuit in Nunavut by Region, 1999 2003 ..18 Table of ContentsviFigure 2-6) Average Annual Suicide Rate in British Columbia First Nations by Tribal Council, 1993 2000 ..19 Figure 2-7) Average Annual Suicide Rate Among Inuit in Nunavut by Community, 1999 2003 ..19 Figure 2-8) Comparison of Suicide Rates by Age Group, First Nations and Canadian Population, 1989 1993.

9 22 Figure 2-9) Suicide Rates in Nunavut by Sex and Age Cohort, 1999 2003 ..23 Figure 2-10) Number of Deaths by Suicide in Nunavut, 1975 2003 ..26 Figure 2-11) Number of Deaths by Suicide in Nunavik, 1972 2001 ..27 Figure 2-12) Suicide Rates in Nunavut by Age, 1980 2003 ..27 Figure 2-13) Number of Deaths by Suicide in Nishnawbe Aski Nation, 1986 1995 ..28 Figure 2-14) Suicide Rates in British Columbia First Nations, 1993 2000 ..28 Figure 2-15) Suicide Rates in Alberta First Nations, 1992 2001 ..29 Figure 3-1) Interaction of Individual Risk and Protective Factors in Suicide ..53 Figure 4-1) Youth Suicide Rates by Number of Cultural Continuity Factors in British Columbia First Nations, 1987 1992 ..77 Figure 4-2) Transgenerational Effects of Residential School Experience.

10 79 Figure 6-1) An Integrative Model of the Origins of Suicide ..99 Figure 6-2) Levels of Intervention in Suicide Prevention ..105 List of TablesTable 2-1) Rates of Suicide Reported Among Aboriginal Groups in Canada ..16 Table 3-1) Protective Factors Related to Mental Health in Aboriginal Youth ..52 Table 4-1) Transgenerational Effects of Residential Schools ..72 Table 5-1) Strategies of Illness Prevention and Health Promotion ..83 Table 5-2) Risk and Protective Factors Relevant to Suicide Prevention ..84viiPrefaceThis 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.