Alcohol and suicide death among American Indians of New Mexico: 1980-1998

Emotion Regulation Strategies Predict PTSS During the COVID-19 Pandemic in an American Indian Population

Background

Poor emotion regulation is associated with post-traumatic stress symptoms (PTSS). However, limited prospective research prevents any directional conclusions. No known studies have assessed emotion regulation with PTSS in American Indians, a high-risk population for poor mental health outcomes. The present prospective study explored whether emotion regulation strategies (cognitive reappraisal, expressive suppression) predicted later PTSS related to the COVID-19 global pandemic in a solely American Indian sample.

Methods

American Indian participants (N = 210; Mean (SD) age = 54.85(13.08) years, 58.7% female) completed the Emotion Regulation Questionnaire (ERQ) during Phase 1 (a few weeks before pandemic declaration) and the Impact of Event Scale-Revised (IES-R) with respect to the COVID-19 pandemic during Phase 2 (7–8 weeks after pandemic declaration). Bivariate correlations and hierarchical linear regression analyses were utilized.

Results

ERQ reappraisal was negatively associated with IES-R total scores, such that higher reappraisal predicted lower PTSS. In contrast, ERQ suppression was positively associated with IES-R total scores, such that higher suppression predicted higher PTSS.

Conclusions

Greater suppression and lower reappraisal predicts PTSS in response to the COVID-19 pandemic in an entirely American Indian sample, providing critical information for future interventions in a population at high-risk for mental health disparities.

Reservation-Urban Comparison of Suicidal Ideation/Planning and Attempts in American Indian Youth

BACKGROUND

Our aim was to identify sex- and location-specific risk factors for suicide ideation/planning and attempts among American Indian youth.

METHODS

Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled years 2003 to 2011. Logistic regression was used to identify sex- and school location-specific risk behaviors and psychosocial factors for past 12-month ideation/planning and past 12-month attempts.

RESULTS

Contrary to our hypothesis, the prevalence of ideation/planning and attempts did not significantly differ between reservation/urban location; however, risk factors associated with suicidality did. Sadness/hopelessness was associated with both outcomes for all groups. However, violent victimization was associated with both outcomes only among girls. Lack of school safety was associated with attempts but not ideation/planning among all students. There were distinct differences in risk factors associated with both outcomes among boys.

CONCLUSIONS

The results indicate differences and similarities in risk behaviors and psychosocial factors associated with suicidality by sex and reservation/urban setting. Implications include screening potentially at-risk students for depression, violent victimization, substance use, and school safety and use of the findings by tribal and school programs in designing prevention and intervention programs.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6-2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

Identifying alcohol problems among suicide attempters visiting the emergency department

BACKGROUND

Many suicide attempters brought to our emergency department (ED) have been found to have alcohol problems, and this should be taken serious consideration because alcohol use disorder is a risk factor for suicide reattempt. In this study, we aimed to estimate the effectiveness of alcohol-related biochemical markers and Alcohol Use Disorder Identification Test Consumption (AUDIT-C) in suicide attempters who visited our ED based on the gold standard for clinical diagnosis used by psychiatrists for alcohol use disorder. Moreover, we aimed to search for a significant standard when clinicians make correct predictions about alcohol use disorder using these markers.

METHODS

Among the subjects who visited ED following a suicide attempt, a total of 203 subjects were selected. Following a psychiatric interview, the subjects who met the criteria for alcohol abuse or alcohol dependence according to DSM-IV-TR in the past year were defined as the "alcohol use disorder" group. Although some subjects did not meet these criteria, men with a weekly alcohol intake of ≥14 drinks and women with a weekly alcohol intake of ≥7 drinks were classified as the "risky drinking" group. AUDIT-C was used as a self-report; further, aspartate aminotransferase, gamma-glutamyltransferase (GGT), and carbohydrate-deficient transferrin (CDT) were assayed using standard methods, and GGT-CDT was calculated using this formula: 0.8 × ln(GGT) + 1.3 × ln(%CDT).

RESULTS

In total, 88 subjects met the criteria for alcohol use disorder and 115 were included in the reference group. In the screening for alcohol use disorder, the AUC of AUDIT-C was 0.89 for men and 0.87 for women. In the screening for risky drinking, the AUC of AUDIT-C was 0.99 for men and 0.93 for women. Compared with other biochemical markers, AUDIT-C showed the highest AUC value for screening for both alcohol use disorder and risky drinking, with the trend being more prominent in men.

CONCLUSIONS

Among the biochemical markers, AUDIT-C yielded the highest sensitivity, specificity, and accuracy in diagnosing alcohol use disorder among suicide attempters in ED. Comparison of results revealed that the use of AUDIT-C with biochemical markers or its use alone can help screen for alcohol use disorder or risky drinking in clinical settings.

Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15-56) with self-reported histories of suicide ideation and/or attempt. Several factors were found to be central to acquiring resilience to suicide risk among AN/AI people across a wide age range: meaningful and consistent social connection, awareness about how one's suicide would negatively effect loved ones, and knowledge and utilization of available health services. Findings highlight the mutable nature of suicide risk and resilience, as well as the importance of interpersonal factors in suicidality.

A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known?

Related to a broader context of historical oppression, Indigenous peoples of the USA are overburdened with the mental health challenges that social workers tend to treat, including post-traumatic stress disorder (PTSD), depression, suicide and substance use disorders (SUD). The purpose of this systematic review is to use the Framework of Historical Oppression, Resilience and Transcendence (FHORT) to identify empirical research on risk and protective factors related to mental health and SUD amongst these populations. This systematic review includes peer-reviewed quantitative and qualitative research articles from 1980 to 2017 focusing on the mental health of US Indigenous adults. A total of thirty-eight peer-reviewed empirical articles met inclusion criteria. Results reveal adults within Indigenous populations are at a high risk for mental health outcomes, including PTSD, depression, suicide, SUD and comorbidity across these outcomes. Underlying risk factors across outcomes included historical oppression and loss, family problems and SUD. Protective factors tended to include family and social support and engagement with tribal cultural activities. Significant variability was identified based on gender and geographic regions. Given that protective factors tended to include cultural, familial and community tenets, holistic approaches are the most promising programmes for social workers to work towards.

The problem of suicide among Amerindians in Camopi-Trois Sauts, French Guiana 2008-2015

BACKGROUND

Suicide within the Amerindian community of Camopi (1741 inhabitants) in French Guiana has been an increasing problem widely reported in the media leading the French Government to mandate a parliamentary mission to investigate the matter. The purpose of the study was to describe this phenomenon and identify factors associated with suicide attempts.

METHODS

A retrospective observational study was conducted from the health centers' medical records. All suicide attempts and suicides committed between 2008 and 2015 by Amerindians living in Camopi and Trois Sauts were compiled. Contextual factors and suicide representations were also analyzed.

RESULTS

During the study period, the annual attempted suicide rate and the suicide rate were higher in the last 3 years. The overall annual rate was equal to 6.9/1741 or 396 per 100, 000 inhabitants for attempted suicide and 172 per 100,000 inhabitants for suicide, which is more than 10 times higher than the suicide rate in mainland France. The mortality rate was 30.4% versus 8.2% in mainland France. The 10-20 year-old age group represented 70% of suicide deaths. There was no significant difference between genders. A recent death and interpersonal conflict were the main stressful life events reported by respondents (55 and 52%, respectively). Alcohol addiction (30% of the respondents) was associated with suicide attempts under the influence of alcohol (p = 0.03). Repetition of suicide attempts was associated with cannabis consumption (p = 0.03). Depression was reported among 45% of the respondents. A third of respondents reported having been abused during their childhood. Over half of respondents reported that their suicide attempt was motivated by a spirit (58%).

CONCLUSIONS

Despite limitations due to the small population size and limited time frame, this is the first study to describe the epidemiology of suicide among Amerindians living in Camopi. In contrast with other French territories, the suicide rate was very high, the sex ratio was balanced and younger age groups were most affected.

Alcohol use by suicide victims in the city of Sao Paulo, Brazil, 2011-2015

Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control which could trigger violent and self-harm behavior, with thus a potential association between alcohol consumption and suicide deaths. The objective of the present study was to assess the association between alcohol consumption and suicide deaths in the city of Sao Paulo, Brazil, from 2011 to 2015, and its relationship with socio-demographic characteristics of the victims and the circumstances of the suicide. A cross-sectional retrospective study was conducted by collection of data from 1,700 suicide victims subjected to examination of blood alcohol concentration (BAC) from toxicology reports from the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Alcohol was detected in blood samples of 30.2% of the victims and mean BAC levels were 1.73 ± 0.08 g/L. The mean age of the victims was 39.90 ± 0.75 years. The majority of the victims were male (74.6%) and the prevalence of positive BAC was higher amongst men (34.7%) than women (17.1%), p<0.05. The majority of the victims were white skinned (64.7%), but there was a higher proportion of victims with positive BAC among mulatto and black individuals, p<0.05. Hanging was the most prevalent suicide method in the sample (48.7%) and amongst men (55.4%), but amongst women it was jumping from a height (35%), p < 0.05.

Alcohol and suicide in the Nenets Autonomous Okrug and Arkhangelsk Oblast, Russia

BACKGROUND

High suicide rates in the Russian North are coupled with high alcohol consumption in the described populations.

OBJECTIVE

To investigate the potential role of alcohol consumption on suicides in the Nenets Autonomous Okrug (NAO) in 2002-2012 and to compare this information with corresponding data from the neighboring Arkhangelsk Oblast (AO).

DESIGN

Retrospective population-based mortality study.

METHODS

Data from autopsy reports were used to identify 252 cases of suicide in the NAO and 1,198 cases in the AO in the period 2002-2012. Postmortem blood alcohol content (BAC) was available for 228 cases in the NAO and 1,185 cases in the AO. BAC as well as other selected variables were compared between the NAO and the AO among women and men, different age groups, ethnic groups, and selected variables of suicide.

RESULTS

Alcohol was present in the blood of 74.1% of male and 82.9% of female suicide cases in the NAO, which was significantly higher than the proportions found in the AO (59.3% of male and 46.6% female cases). BAC<1.0‰ and between 2.0 and 3.0‰ were more frequently found among suicide cases in the NAO than those in the AO.

CONCLUSIONS

Our findings specify that alcohol drinking may be an essential risk factor for suicide in the NAO, and that this factor may be of greater importance in the indigenous population of the NAO than among Russians in the AO.

Alcohol-attributable mortality among American Indians and Alaska Natives in the United States, 1999-2009

OBJECTIVES

We describe the relative burden of alcohol-attributable death among American Indians/Alaska Natives (AI/ANs) in the United States.

METHODS

National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We calculated age-adjusted alcohol-attributable death rates from 1999 to 2009 for AI/AN and White persons by sex, age, geographic region, and leading causes; individuals of Hispanic origin were excluded.

RESULTS

AI/AN persons had a substantially higher rate of alcohol-attributable death than Whites from 2005 to 2009 in IHS Contract Health Service Delivery Area counties (rate ratio = 3.3). The Northern Plains had the highest rate of AI/AN deaths (123.8/100,000), and the East had the lowest (48.9/100,000). For acute causes, the largest relative risks for AI/AN persons compared with Whites were for hypothermia (14.2) and alcohol poisoning (7.6). For chronic causes, the largest relative risks were for alcoholic psychosis (5.0) and alcoholic liver disease (4.9).

CONCLUSIONS

Proven strategies that reduce alcohol consumption and make the environment safer for excessive drinkers should be further implemented in AI/AN communities.

Suicide mortality among American Indians and Alaska Natives, 1999-2009

OBJECTIVES

We assessed national and regional suicide mortality for American Indian and Alaska Native (AI/AN) persons.

METHODS

We used 1999 to 2009 death certificate data linked with Indian Health Service (IHS) patient registration data to examine death rates from suicide in AI/AN and White persons. Analysis focused primarily on residents of IHS Contract Health Service Delivery Area counties; Hispanics were excluded. We used age-adjusted death rates per 100,000 population and stratified our analyses by age and IHS region.

RESULTS

Death rates from suicide were approximately 50% higher among AI/AN persons (21.2) than Whites (14.2). By region, rates for AI/AN people were highest in Alaska (rates = 65.4 and 19.3, for males and females, respectively) and in the Northern Plains (rates = 41.6 and 11.9 for males and females, respectively). Disparities between AI/AN and White rates were also highest in these regions.

CONCLUSIONS

A coordinated, multidisciplinary effort involving federal, state, local, and tribal health officials is needed to address this important public health issue.

The role of hope and optimism in suicide risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.

Blood alcohol concentration of suicide victims by partial hanging

During the investigated period, 2000-2007, 4249 suicides were reported in Slovenia, and 1061 autopsies of suicide deaths from the central, northwestern, and southwestern parts of Slovenia were conducted at the Institute of Forensic Medicine in Ljubljana. To identify a possible role of alcohol use in the selection of suicide method blood samples were collected during medicolegal autopsies of suicide victims in order to establish their blood alcohol concentration (BAC) level at the time of death. The study group consisted of 844 suicide victims that used violent suicide methods and 174 suicide victims that used non-violent suicide methods. Out of the group with violent suicide methods 184 (21.8%) suicide victims by partial hanging and 112 (13.3%) suicide victims by complete hanging were identified. The average age was higher in the group of suicide victims by partial hanging than in the group of suicide victims by complete hanging (p < 0.001; T = 3653; df = 294). The mean BAC was higher (T = 1.604; df = 278; p < 0.05) in the group of suicide victims by partial hanging (0.57 g/kg; SD ± 0.92) than in the group of suicide victims by complete hanging (0.40 g/kg; SD ± 0.82). The proportion of BAC positive suicide victims with blood alcohol concentration above 0.1 g/kg at the time of death was higher in the group of suicide victims who used non-violent suicide methods in comparison to the group of suicide victims who used violent suicide methods (p < 0.001; χ(2) = 14.988, df = 1). Partial hanging was almost twice as common as complete hanging. Higher BAC in the group of suicide victims by partial hanging and more BAC positive suicide victims in the group who died by non-violent suicide methods could give indications about the role of alcohol in the selection of suicide method.

Acute alcohol intoxication and suicide among United States ethnic/racial groups: findings from the national violent death reporting system

BACKGROUND

To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities.

METHODS

Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08 g/dl. Overall, 76% of decedents were tested for the presence of alcohol.

RESULTS

The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30 years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis.

CONCLUSIONS

Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30 years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.

Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo, Brazil

Suicide is one of the main causes of violent death worldwide, and has become a public health issue. Since alcohol consumption is associated with the increase in the number of suicides and hanging is one of the main methods used worldwide, the present study consists of an epidemiological analysis of BACs in victims of suicide by hanging autopsied in the State of Sao Paulo, Brazil. The objective of the present work was to establish an epidemiological profile and evaluate blood alcohol concentrations in victims of suicide by hanging in the State of São Paulo, Brazil, in the year of 2007. A cross-sectional retrospective study was conducted by collection of secondary data from autopsy reports of victims of hanging. According to the present study, positive results for alcohol were higher in male victims, but the mean BAC was higher in women.

Parental grief after a child's drug death compared to other death causes: investigating a greatly neglected bereavement population

This comparative survey contrasted 571 parents who lost children to various death causes: 48 to drug-related deaths and overdoses, 462 to suicide, 24 to natural death cases, and 37 to mostly accidental death cases. Groups were compared in terms of grief difficulties, mental health problems, posttraumatic stress, and stigmatization. Results did not show any appreciable differences in these respects between the suicide bereaved parents and those losing children to drug-related deaths. However, when the suicide and drug-related death survivors were specifically contrasted against accidental and natural death loss cases, a consistent pattern emerged showing the former group was consistently more troubled by grief and mental health problems than the latter two sub-groups. These differences remained when controls of time since the loss and gender differences were employed as covariates. These findings suggest that the powerful and intense stigma against drug use and mental illness, shared among the public-at-large, imposes challenges in healing of immense proportion for these parents as they find less compassionate responses from their significant others, following their losses.

Suicide notes among Native Americans, Hispanics, and Anglos

Suicide is a significant health problem, yet many questions regarding suicide remain unanswered. One of the most frequently asked questions is related to motive: "Why did that person complete suicide?" We explored motivations for completing suicide, especially with regard to cultural differences, by analyzing suicide notes written by Native Americans, Hispanics, and Anglos in New Mexico. Five categories emerged describing motivation: feelings of (a) alienation, (b) failure or inadequacy, (c) being psychologically overwhelmed; (d) the desire to leave problems behind, and (e) reunification in an afterlife. The largest difference to emerge between ethnic groups was in the alienation category, which included more Hispanics and Native Americans than Anglos. The overall lack of differences in motivation among the ethnic groups suggests that commonalities in suicidal behavior outweigh the differences. Practical implications for research and practice are discussed, along with strengths and limitations of the study.

Item response theory analysis of binge drinking and its relationship to lifetime alcohol use disorder symptom severity in an American Indian community sample

BACKGROUND

Item response theory (IRT) has been used to examine alcohol use disorder (AUD) symptoms and their psychometric properties but has not been previously applied to AUD symptoms from an American Indian sample.

METHODS

Lifetime DSM-IV AUD symptoms and binge drinking (5+ drinks men/4+ drinks women) at ≥1, ≥4, ≥8, and ≥15 days per month during the period of heaviest lifetime drinking criteria were assessed in 530 American Indian participants. Exploratory factor analysis was used to examine the factor structure of the 10 AUD symptoms and each alcohol consumption criterion. Two-parameter IRT models generated marginal maximum likelihood estimates for discrimination (a) and threshold (b) parameters for 10 DSM-IV AUD symptoms and each consumption criterion. Differential item functioning (DIF) analysis was used to assess AUD symptom severity in groups defined by gender and age at interview.

RESULTS

The AUD symptoms of "Withdrawal" and "Activities Given Up" were the most severe symptoms. "Tolerance" and "Social/Interpersonal Problems" were the least severe. All AUD symptoms fell on the moderate portion of the severity continuum, except "Withdrawal," which fell at the lower end of the severe portion. The consumption criterion of 5+/4+ (male/female) at ≥8 times per month demarcated the portion of the severity continuum where AUD symptoms began to occur at a probability of 50%. DIF analysis showed significant gender and age at interview differences for "Hazardous Use,""Tolerance," and "Activities Given Up," but not for the other AUD symptoms.

CONCLUSIONS

In this American Indian community sample, alcohol abuse and dependence did not represent distinct disorders. Only one AUD symptom was found outside the moderate portion of the underlying AUD severity continuum. Drinking 5+/4+ (male/female) drinks at a frequency of ≥8 times per month during the period of heaviest lifetime drinking was found to function well as both a risk and a diagnostic criterion for lifetime DSM-IV AUD. DSM-IV AUD symptom criteria, as currently assessed, may be limited in their ability to capture the full range of symptom severity of AUDs, at least in this high-risk population.

American indians/alaska natives and substance abuse treatment outcomes: positive signs and continuing challenges

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Religion and suicide: Buddhism, Native American and African religions, Atheism, and Agnosticism

Research has repeatedly demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior. A clear understanding of the influence of religion on suicidality is required to more fully assess for the risk of suicide. The databases PsycINFO and MEDLINE were used to search peer-reviewed journals prior to 2008 focusing on religion and suicide. Articles focusing on suicidality across Buddhism, Native American and African religions, as well as on the relationship among Atheism, Agnosticism, and suicide were utilized for this review. Practice recommendations are offered for conducting accurate assessment of religiosity as it relates to suicidality in these populations. Given the influence of religious beliefs on suicide, it is important to examine each major religious group for its unique conceptualization and position on suicide to accurately identify a client's suicide risk.

Unnatural deaths in reindeer-herding Sami families in Sweden, 1961-2001

OBJECTIVES

Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families.

STUDY DESIGN

The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001.

METHODS

An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail.

RESULTS

Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims.

CONCLUSIONS

The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

Alcohol and Other Contextual Factors of Suicide in Four Aboriginal Communities of Quebec, Canada

Background: Aboriginal populations worldwide face increasing rates of suicide. Despite this recurring observation, little research has emerged from Aboriginal settings. Aims: This paper describes the psychosocial and behavioral characteristics of 30 consecutive adult suicides from four First-Nations communities in Quebec, Canada. Method: Psychological autopsies guided by the LEDS with family members of the deceased. Results: Suicide among this group is overrepresented by young single men. Alcohol intoxication at the time of death was reported for 22 cases in association with rapid acting out after the precipitating event for 20. All but two cases had a history of alcohol abuse, and drug use was also present in 23 cases. In 16 cases there had been a previous suicide attempt, 14 of which occurred during the previous year. The main socio-demographic characteristics of the communities were overcrowded living arrangements and no job status (90%). Seven cases were incarcerated or locked up at the time of death. Clustering of suicide was observed within seven nuclear families including 16 suicides. Conclusion: This study shows that Aboriginal suicide is the result of a complex interweaving of individual, familial, and socio-historical variables. The impact of contemporary social stressors on individual well-being must be addressed to prevent suicide in this community.

Race/ethnicity, substance abuse, and mental illness among suicide victims in 13 US states: 2004 data from the National Violent Death Reporting System

OBJECTIVE

To calculate the prevalence of substance abuse and mental illness among suicide victims of different racial/ethnic groups and to identify race/ethnicity trends in mental health and substance abuse that may be used to improve suicide prevention.

METHODS

Data are from the National Violent Death Reporting System (NVDRS), a state-based data integration system that, for 2004, includes data from 13 US states. The NVDRS integrates medical examiner, toxicology, death certificate, and law enforcement data.

RESULTS

Within participating states, for data year 2004, 6865 suicide incidents in which race/ethnicity are known were identified. This included 5797 (84.4%) non-Hispanic whites, 501 (7.3%) non-Hispanic blacks, 257 (3.7%) Hispanics, and 310 (4.5%) persons from other racial/ethnic groups. At the time of the suicide event, non-Hispanic blacks had lower blood alcohol contents than other groups. Non-Hispanic whites had less cocaine but more antidepressants and opiates. There were no differences in the levels of amphetamines or marijuana by race/ethnicity. Hispanics were less likely to have been diagnosed with a mental illness or to have received treatment, although family reports of depression were comparable to non-Hispanic whites and other racial/ethnic groups. Non-Hispanic whites were more likely to be diagnosed with depression or bipolar disorder and non-Hispanic blacks with schizophrenia. Comorbid substance abuse and mental health problems were more likely among non-Hispanic whites and non-Hispanic blacks, while Hispanics were more likely to have a substance abuse problem without comorbid mental health problems.

CONCLUSION

The results support earlier research documenting differences in race/ethnicity, substance abuse, and mental health problems as they relate to completed suicide. The data suggest that suicide prevention efforts must address not only substance abuse and mental health problems in general, but the unique personal, family, and social characteristics of different racial/ethnic groups.

Reviewing suicide in Native American communities: situating risk and protective factors within a transactional-ecological framework

The alarming prevalence of suicidal behaviors in Native American communities remains a major concern in the 21st-century United States. Recent reviews have demonstrated that prevention programs and intervention efforts using transactional-ecological models have effectively reduced suicidal behaviors in the American Indian and Alaska Native populations sampled. As a result, this article adopts a transactional-ecological framework for conceptualizing suicidality and identifying points of intervention. Drawing on the most current empirical reports, the epidemiology of Native American suicidal behaviors is reviewed, while situating risk and protective factors within a biopsychosocial framework. Opportunities for intervention are discussed with a focus on the interactions between individuals and their environments, and the antecedent conditions leading to zones of heightened suicide risk.

Drinking frequency and quantity and risk of suicide among men

BACKGROUND

Individuals who die from suicide commonly have consumed alcohol immediately beforehand, often in large quantities. However, prospective cohort data on regular alcohol use as a risk factor for suicide are lacking.

METHOD

As part of the Health Professionals Follow-up Study, 47,654 men free of cancer prospectively reported their drinking habits, including average use, drinking frequency, and typical maximal use on repeated occasions beginning in 1986. Participants were followed for death to 2002.

RESULTS

A total of 136 men died from suicide during follow-up. Quantity of alcohol consumed per drinking day tended to be associated with a greater risk of suicide mortality, with an adjusted hazard ratio among men consuming 30.0 or more grams (more than two drinks) per drinking day of 2.42 (95% confidence interval, 0.75-7.80; P-trend 0.05). Average alcohol consumption, drinking frequency, and binge drinking were not independently associated with risk. The apparent relationship of quantity consumed per drinking day with risk was not substantially changed by adjustment for serious illness or other dietary factors and was most notable for suicide associated with firearm use.

CONCLUSIONS

Among men, risk of death from suicide tends to be associated primarily with quantity of alcohol consumed per drinking day, not with drinking frequency or overall alcohol consumption. This finding supports guidelines that limit consumption among men who choose to drink alcohol to two drinks or less per drinking day.

American Indians and suicide: a neglected area of research

Suicide is a major public health problem for American Indians in the United States. Published studies indicate that American Indians experience the highest rate of suicide of all ethnic groups in the United States. This article synthesizes the epidemiology and risk factors associated with suicide among American Indians, barriers to research, prevention, mental-health services, and recommendations for research and practice. The authors' recommendations arise from the current literature as well as interviews with practitioners and academics in the field of suicide prevention. The authors present significant substantive and methodological issues that inform research on suicide in American Indian communities, as well as existing contemporary interventions. Overall, socioeconomic characteristics, substance abuse, barriers to mental health services and acculturation play a role in the occurrence of suicide in American Indian communities. These findings suggest suicide is an important public health problem that needs to be addressed for American Indians.

Alcohol consumption and suicide

About 90% of people in Western countries use alcohol at some time in their lives, and 40% experience temporary or permanent alcohol-related impairment in some area of life as a result of drinking. Multiple sociocultural and environmental factors influence suicide rates, and thus studies conducted in one nation are not always applicable to other nations. Impulsivity and aggression are strongly implicated in suicidal behaviour. Constructs related to aggression and impulsivity confer additional risk for suicidal behaviour in people with alcohol dependence. Lower serotonin activity is tied to increased aggression/impulsivity, which in turn may enhance the probability of suicidal behaviour. Acute alcohol use is associated with suicide. Suicide completers have high rates of positive blood alcohol. Intoxicated people are more likely to attempt suicide using more lethal methods. Alcohol may be important in suicides among individuals with no previous psychiatric history. Alcohol dependence is an important risk factor for suicidal behaviour. Mood disorder is a more powerful risk factor for suicide among problem drinkers as age increases. All individuals with alcohol use disorders should be assessed for suicide, especially at the end of a binge or in the very early phase of withdrawal. Middle-age and older men with alcohol dependence and mood disorders are at particularly high risk.

Social epidemiology of trauma among 2 American Indian reservation populations

OBJECTIVES

We examined the prevalence of trauma in 2 large American Indian communities in an attempt to describe demographic correlates and to compare findings with a representative sample of the US population.

METHODS

We determined differences in exposure to each of 16 types of trauma among 3084 tribal members aged 15 to 57 years through structured interviews. We compared prevalence rates of trauma, by gender, across the 2 tribes and with a sample of the US general population. We used logistic regression analyses to examine the relationships of demographic correlates to trauma exposure.

RESULTS

Lifetime exposure rates to at least 1 trauma (62.4%-67.2% among male participants, 66.2%-69.8% among female participants) fell at the upper limits of the range reported by other researchers. Unlike the US general population, female and male American Indians exhibited equivalent levels of overall trauma exposure. Members of both tribes more often witnessed traumatic events, experienced traumas to loved ones, and were victims of physical attacks than their counterparts in the overall US population.

CONCLUSIONS

American Indians live in adverse environments that place them at high risk for exposure to trauma and harmful health sequelae.

Outcome evaluation of a public health approach to suicide prevention in an american Indian tribal nation

OBJECTIVES

We evaluated the efficacy of 15 years of a public health-oriented suicidal-behavior prevention program among youths living on an American Indian reservation.

METHODS

All suicides, suicide attempts, and suicidal gestures were monitored. Age-specific analyses over time were used to assess outcomes.

RESULTS

Both descriptive and linear regression analyses indicated that a substantial drop occurred in suicidal gestures and attempts. Suicide deaths neither declined significantly nor increased, although the total number of self-destructive acts declined by 73% (P=.001).

CONCLUSIONS

Data from this community-based approach document a remarkable downward trend-measured by both magnitude and temporal trends in the specifically targeted age cohorts-in suicidal acts. The sequential decrease in age-specific rates of suicide attempts and gestures is indicative of the program's success.

Continuity of binge and harmful drinking from late adolescence to early adulthood

OBJECTIVE

To test the hypothesis that late adolescent drinking behavior (ages 17-20) is associated with harmful and binge drinking in early adulthood (ages 30-31).

METHODS

We used the National Longitudinal Survey of Youth (NLSY), a nationally representative longitudinal data set. We used harmful and binge drinking at ages 17 to 20 to predict harmful and binge drinking at ages 30 to 31, stratifying for gender and controlling for confounders.

RESULTS

Data were available on harmful drinking at both the adolescent and the early adult age period for 3790 individuals and on binge drinking for 2387 individuals. Harmful drinking during adolescence was significantly associated with harmful drinking at ages 30 to 31 for men only. Among male adolescents, 14% of harmful drinkers continued harmful drinking at ages 30 to 31, compared with 4% of nonharmful drinkers who became harmful drinkers. In Poisson regression models, binge drinking during adolescence was associated with binge drinking at ages 30 to 31 for both men and women, generating relative risks of 2.3 (95% confidence interval: 1.8-3.0) and 3.0 (95% confidence interval: 2.4-4.8), respectively. Half of binge-drinking male adolescents and one third of binge-drinking female adolescents engaged in binge drinking into early adulthood, compared with 19% for non-binge-drinking male adolescents and 8% of non-binge-drinking female adolescents.

CONCLUSIONS

Problem drinking during adolescence is associated with problem drinking in early adulthood. Efforts to prevent and treat adolescent problem drinking could have an impact on the progression of alcohol-related disease.