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Rollman JE, Thomas M, Mercer Kollar LM, Ports KA, Clelland C, Satter DE, David-Ferdon C. American Indian and Alaska Native violence prevention efforts: a systematic review, 1980 to 2018. Inj Epidemiol 2024; 8:72. [PMID: 38504377 PMCID: PMC10949553 DOI: 10.1186/s40621-024-00488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Violence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations. METHODS A review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population. RESULTS A total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results. CONCLUSIONS This review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations.
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Affiliation(s)
- Jeffrey E Rollman
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - M Thomas
- Independent Researcher, Gulf Breeze, FL, 32563, USA
| | - Laura M Mercer Kollar
- Division of Violence Prevention, Centers for Disease Control and Prevention, National Center for Injury Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA.
| | - Katie A Ports
- American Institutes for Research, 10 South Riverside Plaza, 6th Floor, Chicago, IL, 60606, USA
| | - Carmen Clelland
- Indian Health Service, 5600 Fishers Lane, Rockville, MD, 20857, USA
- Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, 1825 Century Boulevard, Atlanta, GA, 30345, USA
| | - Delight E Satter
- Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, 1825 Century Boulevard, Atlanta, GA, 30345, USA
| | - Corinne David-Ferdon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Atlanta, GA, 30341, USA
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Hodgson C, Godfrey T, DeCoteau RN, Allison-Burbank JD, Taylor-Piliae R. Social-Ecological Resilience of Indigenous Adolescents in the United States and Canada: A Situation-Specific Nursing Theory. ANS Adv Nurs Sci 2024; 47:3-15. [PMID: 36927940 DOI: 10.1097/ans.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
For the past decade, resilience research with American Indian/Alaska Native and First Nations/Métis/Inuit adolescents has improved our understanding of how adolescents overcome mental health challenges. A new situation-specific theory is presented to guide nurses in applying the evidence to their practice with Indigenous adolescents in the United States and Canada. The social-ecological resilience of indigenous adolescents (SERIA) theory was derived from integrating ( a ) existing social-ecological frameworks by Bronfenbrenner, Ungar, and Burnette and Figley, ( b ) findings from a systematic review of 78 studies about resilience factors for mental health of Indigenous adolescents, ( c ) clinical experience, and ( d ) Indigenous knowledge.
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Affiliation(s)
- Christine Hodgson
- College of Nursing, University of Arizona, Tucson (Drs Hodgson, DeCoteau, Godfrey, and Taylor-Piliae); and Johns Hopkins Center for American Indian Health, Baltimore, Maryland (Dr Allison-Burbank)
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Ali AZ, Wright B, Curran JA, Newton AS. Review: Patient engagement in child, adolescent, and youth mental health care research - a scoping review. Child Adolesc Ment Health 2023; 28:524-535. [PMID: 36494910 DOI: 10.1111/camh.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement. METHOD We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis. RESULTS Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample. CONCLUSIONS Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Barlow A, Haroz EE, O’Keefe VM, Brockie T, Manson SM, Allen J, Wexler L, Buchwald D, Rasmus S, Goklish N, Ivanich J, Stifter M, Cwik M. New Collaborative Research on Suicide Prevention, Practice, and Policy With American Indian and Alaska Native Communities Holds Promise for All Peoples. Health Promot Pract 2023; 24:841-851. [PMID: 36863761 PMCID: PMC10474247 DOI: 10.1177/15248399221116630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Youth suicide is increasing in the United States, with deaths among younger people of color driving this upward trend. For more than four decades, American Indian and Alaska Native (AIAN) communities have suffered disproportionate rates of youth suicide and years of productive life lost compared to other U.S. Races. The National Institute of Mental Health (NIMH) recently funded three regional Collaborative Hubs to carry out suicide prevention research, practice, and policy development with AIAN communities in Alaska and rural and urban areas of the Southwestern United States. The Hub partnerships are supporting a diverse array of tribally-driven studies, approaches, and policies with immediate value for increasing empirically driven public health strategies to address youth suicide. We discuss unique features of the cross-Hub work, including: (a) long-standing Community-Based Participatory Research processes that led to the Hubs' innovative designs and novel approaches to suicide prevention and evaluation, (b) comprehensive ecological theoretical approaches that contextualize individual risk and protective factors in multilevel social contexts; (c) unique task-shifting and systems of care approaches to increase reach and impact on youth suicide in low-resource settings; and (d) prioritization of strengths-based approaches. The work of the Collaborative Hubs for AIAN youth suicide prevention is generating specific and substantive implications for practice, policy, and research presented in this article at a time when youth suicide prevention is a dire national priority. Approaches also have relevance for historically marginalized communities worldwide.
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Affiliation(s)
- A. Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E. E. Haroz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V. M. O’Keefe
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T. Brockie
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - S. M. Manson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J. Allen
- University of Minnesota Medical School, Duluth, MN, USA
| | - L. Wexler
- University of Michigan, Ann Arbor, MI, USA
| | - D. Buchwald
- Washington State University, Spokane, WA, USA
| | - S. Rasmus
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - N. Goklish
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- White Mountain Apache Tribe, Whiteriver, AZ, USA
| | - J. Ivanich
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M. Stifter
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. Cwik
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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5
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Sjoblom E, Ghidei W, Leslie M, James A, Bartel R, Campbell S, Montesanti S. Centering Indigenous knowledge in suicide prevention: a critical scoping review. BMC Public Health 2022; 22:2377. [PMID: 36536345 PMCID: PMC9761945 DOI: 10.1186/s12889-022-14580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention-typically involving individual-level efforts for behavioural change via mental health professional intervention-by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. METHODS A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. RESULTS Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. CONCLUSIONS Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.
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Affiliation(s)
- Erynne Sjoblom
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Winta Ghidei
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Marya Leslie
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Ashton James
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Reagan Bartel
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Sandra Campbell
- Librarian, Health Sciences, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Stephanie Montesanti
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada.
- School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
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6
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of prevention strategies, logics, and rationales. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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7
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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8
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Alfonso YN, Bishai D, Ivanich JD, O'Keefe VM, Usher J, Aldridge LR, Haroz EE, Goklish N, Barlow A, Cwik M. Suicide Ideation and Depression Quality of Life Ratings in a Reservation-Based Community of Native American Youths and Young Adults. Community Ment Health J 2022; 58:779-787. [PMID: 34455531 PMCID: PMC8933312 DOI: 10.1007/s10597-021-00883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/19/2021] [Indexed: 01/12/2023]
Abstract
Suicide among adolescents is a significant public health concern in the U.S., especially within American Indian and Alaska Native (AIAN) communities. Lack of quality of life (QoL) estimates for both suicide ideation and depression specific to the AIAN population hinders the ability to compare interventions in cost-effectiveness analysis. We surveyed 200 AI youth and young adults from the Fort Apache Indian Reservation to estimate utility weights for experiencing suicide ideation and depression. Our results indicate that, on a scale of 0-100, with higher scores indicating better health, the general community rates both suicide ideation and depression at 15.8 and 25.1, respectively. These weights are statistically significantly different and lower than for other cultures. Culturally specific QoL values will allow the comparison and identification of the most effective and feasible interventions to reduce the suicide burden among tribal communities.
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Affiliation(s)
- Y N Alfonso
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - D Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J D Ivanich
- Department of Community and Behavioral Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - V M O'Keefe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J Usher
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - L R Aldridge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - E E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - N Goklish
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - A Barlow
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - M Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Watling D, Preece M, Hawgood J, Bloomfield S, Kõlves K. Developing an Intervention for Suicide Prevention: A Rapid Review of Lived Experience Involvement. Arch Suicide Res 2022; 26:465-480. [PMID: 33073734 DOI: 10.1080/13811118.2020.1833799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE While suicide prevention interventions should be informed by lived experience, there are no reviews examining involvement of lived experience (LE) thus far. This rapid review aimed to synthesize available studies using LE of suicidality to guide the development of suicide prevention interventions. METHOD A rapid review following PRISMA guidelines was conducted. Key electronic databases were searched for the literature for the last 10 years (2010 until June 2019) to identify studies that have incorporated the lived experience of people of suicide to develop a suicide prevention intervention. Key features of the LE intervention development process were synthesized and discussed. RESULTS A final 11 studies from 13 papers were selected for synthesis. Most studies employed focus groups (73%). Research questions focused on participant preferences, experiences, and recommendations for suicide prevention interventions. Considering the qualitative nature, majority of studies used thematic analyses to study participant responses and generate intervention components based on identified themes. Translation from research findings into a physical intervention was described in limited detail across all studies. The rapid review was limited to the literature about development of interventions using LE of suicide published in English in last 10 years. CONCLUSIONS With an increased focus on person-centered care and LE in suicide prevention, such valuable expertise should be integrated into intervention development. This review provides insight into the process to ensure responses to suicidal persons are well aligned with the needs of those they serve. HighlightsLimited studies have involved lived experience in the development of interventionsFocus groups and thematic analysis are common methods to develop interventionsLimited description of translating themes into intervention components is described.
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10
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Pham TV, Pomerville A, Burrage RL, Gone JP. An interview-based evaluation of an Indigenous traditional spirituality program at an urban American Indian health clinic. Transcult Psychiatry 2022:13634615221076706. [PMID: 35200047 DOI: 10.1177/13634615221076706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.
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Affiliation(s)
- Tony V Pham
- Department of Global Health and Social Medicine, 1811Harvard Medical School, Boston, MA
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Andrew Pomerville
- Department of Psychology, 1259University of Michigan, Ann Arbor, MI
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Rachel L Burrage
- Department of Social Work, 3949University of Hawaii at Mānoa, Honolulu, Hawaii
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Joseph P Gone
- Department of Anthropology, 1812Harvard University, Cambridge, MA
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11
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Skewes MC, Gameon JA, Grubin F, DeCou CR, Whitcomb L. Beliefs about causal factors for suicide in rural Alaska Native communities and recommendations for prevention. Transcult Psychiatry 2022; 59:78-92. [PMID: 33161888 PMCID: PMC8105422 DOI: 10.1177/1363461520963869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rural Indigenous communities in Alaska suffer staggeringly high rates of suicide. In close-knit Alaska Native villages, each suicide leaves a trail of affected family and community members in its wake. This research aimed to understand community perceptions of what causes suicide in rural Alaska Native villages and generate recommendations for prevention strategies. In-depth interviews were conducted with 25 Alaska Native university students who moved from rural villages to an urban area to attend college. All had been profoundly affected by others' suicides and shared their beliefs about causal factors and recommendations for prevention efforts. Perceived causes included resistance to seeking help or discussing personal problems, loss of culture, traumatic experiences, geographical and social isolation, lack of opportunity, substance abuse, and exposure to others' suicides. Participants believed that suicide is preventable and recommended multi-level approaches to address suicide disparities. They provided recommendations for potentially effective and culturally appropriate prevention strategies, including increasing cultural and social connections, educating community members about mental health, and increasing accessibility of counseling services/reducing barriers to mental health services utilization.
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Affiliation(s)
| | - Julie A. Gameon
- Department of Psychology, Montana State University, Bozeman, MT
| | - Fiona Grubin
- Johns Hopkins School of Public Health, Baltimore, MD
| | - Christopher R. DeCou
- Department of Psychiatry and Behavioral Sciences and Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA
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12
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Ko LK, Tingey L, Ramirez M, Pablo E, Grass R, Larzelere F, Cisneros O, Chu HY, D’Agostino EM. Mobilizing Established School Partnerships to Reach Underserved Children During a Global Pandemic. Pediatrics 2022; 149:e2021054268F. [PMID: 34737178 PMCID: PMC9153654 DOI: 10.1542/peds.2021-054268f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
The coronavirus disease 2019 pandemic has led to drastic public health measures, including school closures to slow the spread of severe acute respiratory syndrome coronavirus 2 infection. Reopening educational settings by using diagnostic testing approaches in schools can help accelerate the safe return of students and staff to on-site learning by quickly and accurately identifying cases, limiting the spread of severe acute respiratory syndrome coronavirus 2, and ultimately preventing unnecessary school and work absenteeism. Although the National Institutes of Health has identified community partnerships as the foundation for reducing health disparities, we found limited application of a community-based participatory research (CBPR) approach in school engagement. Guided by the CBPR conceptual model, we provide case studies of 2 established and long-standing school-academic partnerships built on CBPR processes and practices that have served as a research infrastructure to reach underserved children and families during the coronavirus disease 2019 pandemic. The process described in this article can serve as an initial platform to continue to build capacity toward increasing health equity.
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Affiliation(s)
- Linda K. Ko
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lauren Tingey
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Magaly Ramirez
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Elliott Pablo
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | - Ryan Grass
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | - Francene Larzelere
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | | | - Helen Y. Chu
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Emily M. D’Agostino
- Departments of Orthopaedic Surgery and Population Health Sciences, Duke University, Durham, North Carolina
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13
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Wakȟáŋyeža (Little Holy One) - an intergenerational intervention for Native American parents and children: a protocol for a randomized controlled trial with embedded single-case experimental design. BMC Public Health 2021; 21:2298. [PMID: 34922510 PMCID: PMC8684243 DOI: 10.1186/s12889-021-12272-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Trauma within Native American communities compromises parents’ parenting capacity; thus, increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children. Methods A randomized controlled trial with an embedded single-case experimental design will be used to determine effectiveness of the modular prevention intervention on parent-child outcomes and the added impact of unique cultural lesson-components. Participants include 1) Fort Peck Assiniboine and Sioux parents who have had adverse childhood experiences, and 2) their children (3–5 years). Parent-child dyads are randomized (1:1) to Little Holy One or a control group that consists of 12 lessons taught by Indigenous community health workers. Lessons were developed from elements of 1) the Common Elements Treatment Approach and Family Spirit, both evidence-based interventions, and 2) newly created cultural (intervention) and nutrition (control group only) lessons. Primary outcomes are parent (primary caregiver) trauma symptoms and stress. Secondary outcomes include: Parent depression symptoms, parenting practices, parental control, family routines, substance use, historical loss, communal mastery, tribal identity, historical trauma. Child outcomes include, externalizing and internalizing behavior and school attendance. Primary analysis will follow an intent-to-treat approach, and secondary analysis will include examination of change trajectories to determine impact of cultural lessons and exploration of overall effect moderation by age and gender of child and type of caregiver (e.g., parent, grandparent). Discussion Many Native American parents have endured adverse childhood experiences and traumas that can negatively impact capacity for positive parenting. Study results will provide insights about the potential of a culturally-based intervention to reduce parental distress – an upstream approach to reducing risk for childrens’ later substance misuse and suicidality. Intervention design features, including use of community health workers, cultural grounding, and administration in Head Start settings lend potential for feasibility, acceptability, sustainability, and scalability. Trial registration ClinicalTrials.gov: NCT04201184. Registered 11 December 2019.
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of outcomes. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Haroz EE, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021; 7:e24377. [PMID: 34473065 PMCID: PMC8446841 DOI: 10.2196/24377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.
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Affiliation(s)
- Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Pioche
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma Waugh
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Usher
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew C Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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O'Keefe VM, Cwik MF, Haroz EE, Barlow A. Increasing culturally responsive care and mental health equity with indigenous community mental health workers. Psychol Serv 2021; 18:84-92. [PMID: 31045405 PMCID: PMC6824928 DOI: 10.1037/ser0000358] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Leske S, Paul E, Gibson M, Little B, Wenitong M, Kolves K. Global systematic review of the effects of suicide prevention interventions in Indigenous peoples. J Epidemiol Community Health 2020; 74:1050-1055. [PMID: 32788303 DOI: 10.1136/jech-2019-212368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/30/2019] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide. METHODS We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies. FINDINGS We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before-after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before-after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias. CONCLUSION For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.
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Affiliation(s)
- Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia .,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Elise Paul
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Mandy Gibson
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Brock Little
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
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Cwik MF, O’Keefe VM, Haroz EE. Suicide in the pediatric population: screening, risk assessment and treatment. Int Rev Psychiatry 2020; 32:254-264. [PMID: 31922455 PMCID: PMC7190447 DOI: 10.1080/09540261.2019.1693351] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicide-specific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.
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Affiliation(s)
- Mary F. Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Victoria M. O’Keefe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E. Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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HAROZ EMILYE, WALSH COLING, GOKLISH NOVALENE, CWIK MARYF, O’KEEFE VICTORIA, BARLOW ALLISON. Reaching Those at Highest Risk for Suicide: Development of a Model Using Machine Learning Methods for use With Native American Communities. Suicide Life Threat Behav 2020; 50:422-436. [PMID: 31692064 PMCID: PMC7148171 DOI: 10.1111/sltb.12598] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Suicide prevention is a major priority in Native American communities. We used machine learning with community-based suicide surveillance data to better identify those most at risk. METHOD This study leverages data from the Celebrating Life program operated by the White Mountain Apache Tribe in Arizona and in partnership with Johns Hopkins University. We examined N = 2,390 individuals with a validated suicide-related event between 2006 and 2017. Predictors included 73 variables (e.g., demographics, educational history, past mental health, and substance use). The outcome was suicide attempt 6, 12, and 24 months after an initial event. We tested four algorithmic approaches using cross-validation. RESULTS Area under the curves ranged from AUC = 0.81 (95% CI ± 0.08) for the decision tree classifiers to AUC = 0.87 (95% CI ± 0.04) for the ridge regression, results that were considerably higher than a past suicide attempt (AUC = 0.57; 95% CI ± 0.08). Selecting a cutoff value based on risk concentration plots yielded 0.88 sensitivity, 0.72 specificity, and a positive predictive value of 0.12 for detecting an attempt 24 months postindex event. CONCLUSION These models substantially improved our ability to determine who was most at risk in this community. Further work is needed including developing clinical guidance and external validation.
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Affiliation(s)
- EMILY E. HAROZ
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - COLIN G. WALSH
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - NOVALENE GOKLISH
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and White Mountain Apache Tribe, Whiteriver, AZ, USA
| | - MARY F. CWIK
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - VICTORIA O’KEEFE
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - ALLISON BARLOW
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Asher BlackDeer A, Patterson Silver Wolf DA. Evidence Mapping: Interventions for American Indian and Alaska Native Youth Mental Health. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:49-62. [PMID: 33459197 DOI: 10.1080/26408066.2019.1624237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background: Suicide is the second leading cause of death for Native youth aged 15-24. Similarly, Native youth have a suicide rate 1.5 times higher than the general population and are at higher risk for depression and substance use. A persistent need remains for culturally specific mental health interventions for American Indian youth.Methods: In response to the push for research-supported interventions, evidence mapping has emerged as systematic, rigorous, and replicable analysis of evidence. The overall goal of this study is to utilize evidence mapping for mental health interventions for American Indian youth.Results: A total of 9 interventions were mapped as research-supported interventions for American Indian mental health. The interventions fell into one or more of four main categories: school-based services, cultural adaptations, culture as treatment, and community involvement.Discussion: Results of this study demonstrate the strength of culturally specific mental health interventions for American Indian youth. Future research should seek to evaluate promising practices for American Indian youth in order to increase available research-supported interventions. Additionally, future endeavors should seek to combine both Indigenous and Western approaches to practice with a particular focus on holistic wellness.
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O'Keefe VM, Haroz EE, Goklish N, Ivanich J, Cwik MF, Barlow A. Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide. BMC Public Health 2019; 19:1675. [PMID: 31830933 PMCID: PMC6909588 DOI: 10.1186/s12889-019-7996-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION Clinical Trials NCT03543865, June 1, 2018.
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Affiliation(s)
- Victoria M O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA.
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Jerreed Ivanich
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | | | - Mary F Cwik
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
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Cwik M, Goklish N, Masten K, Lee A, Suttle R, Alchesay M, O'Keefe V, Barlow A. "Let our Apache Heritage and Culture Live on Forever and Teach the Young Ones": Development of The Elders' Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:137-145. [PMID: 31313327 DOI: 10.1002/ajcp.12351] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The White Mountain Apache Tribe have developed an innovative curriculum that connects youth through Elders to their heritage, traditions, and culture, which has been proven to be a protective factor for native Americans. The development process took 4½ years and included community stakeholder buy-in, Elders' Council group formation, extensive formative work to identify content, iterative feedback between curriculum writers and Elders, and Elder training prior to implementation. Members of the Elders' Council have been visiting the local schools to teach youth about the Apache culture, language, and way of life since February 2014 reaching over 1000 youth. This approach demonstrates a promising upstream suicide prevention strategy. We discuss the process of development, implementation, and lessons learned, as this curriculum has potential for adaptation by other Indigenous communities.
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Affiliation(s)
- Mary Cwik
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Novalene Goklish
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Masten
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angelita Lee
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rosemarie Suttle
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melanie Alchesay
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Victoria O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Robinson J, Bailey E, Witt K, Stefanac N, Milner A, Currier D, Pirkis J, Condron P, Hetrick S. What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis. EClinicalMedicine 2018; 4-5:52-91. [PMID: 31193651 PMCID: PMC6537558 DOI: 10.1016/j.eclinm.2018.10.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence. METHODS We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people. FINDINGS Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited. INTERPRETATION Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.
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Affiliation(s)
- Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Eleanor Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, VIC 3121, Australia
| | - Nina Stefanac
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Vic 3010, Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Support Building Auckland Hospital, 2 Park Rd, Auckland 1142, New Zealand
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Cwik MF, Tingey L, Maschino A, Goklish N, Larzelere-Hinton F, Walkup J, Barlow A. Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001-2012. Am J Public Health 2016; 106:2183-2189. [PMID: 27736202 PMCID: PMC5105000 DOI: 10.2105/ajph.2016.303453] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the impact of a comprehensive, multitiered youth suicide prevention program among the White Mountain Apache of Arizona since its implementation in 2006. METHODS Using data from the tribally mandated Celebrating Life surveillance system, we compared the rates, numbers, and characteristics of suicide deaths and attempts from 2007 to 2012 with those from 2001 to 2006. RESULTS The overall Apache suicide death rates dropped from 40.0 to 24.7 per 100 000 (38.3% decrease), and the rate among those aged 15 to 24 years dropped from 128.5 to 99.0 per 100 000 (23.0% decrease). The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). National rates remained relatively stable during this time, at 10 to 13 per 100 000. CONCLUSIONS Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.
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Affiliation(s)
- Mary F Cwik
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - Lauren Tingey
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - Alexandra Maschino
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - Novalene Goklish
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - Francene Larzelere-Hinton
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - John Walkup
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
| | - Allison Barlow
- Mary F. Cwik, Lauren Tingey, Alexandra Maschino, Novalene Goklish, Francene Larzelere-Hinton, and Allison Barlow are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
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