Suicide Prevention

Suicide Prevention broadly covers all work across the continuum of activities in Prevention and Early Intervention, SEWB/Healing, Postvention, Crisis Response, Training, and Clinical Services.

Armstrong, G., Ironfield, N., Kelly, C.M., Dart, K., Arabena, K., Bond, K., Reavley, N., & Jorm, A.F. (2018). Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are experiencing suicidal thoughts and behaviourBMC Psychiatry, 18.

Background: Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions. Methods: The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non- Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important. Results: From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines. Conclusions: Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

Dickson, M.J., Cruise, K., McCall, A.C., & Taylor, J.P. (2019). A systematic review of the antecedents and prevalence of suicide, self-harm and suicide ideation in Australian Aboriginal and Torres Strait Islander youth. International Journal of Environmental Research and Public Health, 16(17).

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous (sic) minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous (sic) youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the non indigenous (sic) population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

Dudgeon, P., & Holland, C. (2018). Recent developments in suicide prevention among the Indigenous peoples of Australia. Australasian Psychiatry, 26(2), 166-169.

Objectives: Suicide is an Aboriginal and Torres Strait Islander (hereafter ‘Indigenous’) population health issue. Over 2015–2016, the Aboriginal and Torres Strait Islander Suicide Prevention Project (ATSISPEP) aimed to identify success factors in Indigenous suicide prevention. Conclusions: For non-Indigenous practitioners working with indigenous clients at risk of suicide, ATSISPEP identified important considerations to make treatment more effective. The start is acknowledging the differences in the historical, cultural, political, social and economic experiences of Indigenous peoples, and their greater exposure to trauma, psychological distress and risks to mental health. These mental health difficulties are specific and more prevalent amongst Indigenous peoples and communities due to the ongoing impacts of colonisation in Australia including a range of social determinants impacting on the well-being of Indigenous peoples today. Working effectively with Indigenous clients also includes being able to establish culturally safe work environments, and the ability of non-Indigenous practitioners to work in a culturally competent and trauma-informed manner. There are also considerations regarding time protocols and client follow-up. Further, postvention responses might be required. Supporting selective suicide prevention activity among younger people (and other groups at increased risk) and community-level work is an important complement to working with Indigenous individuals at risk of suicide.

Hearn, S., Wanganeen, G., Sutton, K., & Isaacs, A. (2016). The Jekkora group: An Aboriginal model of early identification, and support of persons with psychological distress and suicidal ideation in rural communities. Advances in Mental Health, 14(2), 96-105.

Objective: To describe a community developed Aboriginal model for early identification and referral of people with psychological distress and suicidal ideation.Method: A description of an Aboriginal mental health service model is presented, as established at the Njernda Aboriginal Corporation, Echuca, Victoria.Results: The model is presented under five headings: Setting; Recruitment and appointment of Voluntary Trained Support Persons; Identifying persons at risk; Follow-up and referral by Voluntary Trained Support Persons; Expansion and Sustainability.Conclusions: The Jekkora group model is in its early stages of implementation and no evaluation data are available on its outcomes. However, the model has potential to enable early identification, treatment and follow-up support for Aboriginal people in distress that is undisclosed. Factors that support its acceptability in the community are that the model was developed by Aboriginal people for their community. The network of voluntary trained and untrained support persons might help strengthen bonds and build resilience in the community. Implications: The principles used in this model can be used to develop models for suicide prevention in other settings.

Isaacs, A. N., & Dudgeon, P. (2016). Ground realities in building effective Aboriginal suicide prevention strategiesAdvances in Mental Health, 14(2), 79-81.

Lopez-Carmen, V., McCalman, J., Benveniste, T., Askew, D., Spurling, G., Langham, E., & Bainbridge, R. (2019). Working together to improve the mental health of Indigenous children: A systematic review. Children and Youth Services Review104, 104408.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools.  Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among the nine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

Nasir, B., Hides, L., Kisely, S., Ranmuthugala, G., Nicholson G., Black, E., Gill, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2016). The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: A systematic review. BMC Psychiatry, 16(1), 357. 

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Method: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used. Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. Conclusion: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Nasir B., Kisely, S., Hides, L., Ranmuthugala, G., Brennan-Olsen, S., Nicholson, G., Gill, N.,  Hayman, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2017) An Australian Indigenous community-led suicide intervention skills training program: Community consultation findings.  BMC Psychiatry, 17(1), 219.

Background: Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide. Methods: In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information. Results: Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities. Conclusions: Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.

Rouen, C., Clough, A., & West, C. (2019). Non-fatal deliberate self-harm in three remote Indigenous communities in far north Queensland, AustraliaCrisis: The Journal of Crisis Intervention and Suicide Prevention, 1–7.

Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential. Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia. Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011. Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers. Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

Shand, F., Mackinnon, A., O’Moore, K., Ridani, R., Reda, B., Hoy, M., Heard, T., Duffy, L., Shanahan, M., Jackson Pulver, L., & Christensen, H. (2019). The iBobbly Aboriginal and Torres Strait Islander app project: study protocol for a randomised controlled trialTrials, 20, 198-208.

Background: Suicide amongst Australian Aboriginal and Torres Strait Islander communities occurs at twice the rate of the general population and, with significant barriers to treatment, help-seeking prior to a suicide attempt is low. This trial aims to test the effectiveness of an app (iBobbly) designed with Aboriginal and Torres Strait Islander people for reducing suicidal ideation. Methods/Design: This is a two-arm randomised controlled trial that will compare iBobbly to a wait-list control condition. The trial aims to recruit Aboriginal and Torres Strait Islander participants aged 16 years and over to test iBobbly, which is a self-help app delivering content based on acceptance and commitment therapy. The primary outcome for the study is suicidal ideation, and secondary outcomes include depression, hopelessness, distress tolerance, perceived burdensomeness and thwarted belonging, and help-seeking intentions. Data will be collected for both groups at baseline, post-intervention (after 6 weeks of app use), and at 6 months post-baseline (with a final 12-month follow-up for the iBobbly group). Primary analysis will compare changes in suicidal ideation for the intervention condition relative to the wait-list control condition using mixed models. An examination of the cost-effectiveness of the intervention compared to the control condition will be conducted. Discussion: If effective, iBobbly could overcome many barriers to help-seeking amongst a group of people who are at increased risk of suicide. It may provide a low-cost, accessible intervention that can reach more people. This trial will add to a sparse literature on indigenous suicide prevention and will increase our knowledge about the effectiveness of e-health interventions for suicide prevention.

Shand, F., Torok, M., Cockayne, N., Batterham, P. J., Calear, A. L., Mackinnon, A., Martin, D., Zbukvic, I., Mok, K., Chen, N., McGillivray, L., Phillips, M., Cutler, H., Draper, B., Sara, G., & Christensen, H. (2020). Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, AustraliaTrials 21, 332.

Background:Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. Methods:We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. Discussion:If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally.

Tait, G., Carpenter, B., & Jowett, S. (2018). Coronial practice, Indigeneity and suicideInternational Journal of Environmental Research and Public Health, 15(4).

All available data suggest that, like many other indigenous peoples, Australian Aborigines (sic) are significantly more likely to kill themselves than are non-Aboriginal Australians. This statistical disparity is normally positioned an objective, ontological and undeniable social fact, a fact best explained as a function of endemic community disadvantage and disenfranchisement. This research explores the possibility that higher-than-normal Aboriginal suicide rates may also be a function of coronial decision-making practices. Based upon in-depth interviews with 32 coroners from across Australia, the following conclusions emerged from the data. First, coroners have differing perceptions of Indigenous capacity, and are less likely to have concerns about intent when the suicide is committed by an Indigenous person. Second, coroners have identified divergent scripts of Indigenous suicide, particularly its spontaneity and public location, and this supports rather than challenges, a finding of suicide. Third, the coronial perception of Indigenous life is a factor which influences a suicide determination for Indigenous deaths. Finally, the low level of Indigenous engagement with the coronial system, and the unlikelihood of a challenge to the finding of suicide by Indigenous families, means that a coronial determination of suicide is more likely.

Dudgeon, P., Milroy, J., Calma, T., Luxford, Y., Ring, I., Walker, R., Cox, A., Georgatos, G., & Holland, C. (2016). Solutions that work: What the evidence and our people tell us. Aboriginal and Torres Strait Islander suicide prevention evaluation project report. University of Western Australia.

Leske, S., Crompton, D., & Kõlves, K. Suicide in Queensland: 2019 annual report. Australian Institute for Suicide Research and Prevention, Griffith University.

The Suicide in Queensland Annual Report 2019 (Suicide in Queensland) provides recent suicide trends in Queensland to help target and inform suicide prevention activities in Queensland by understanding the circumstances in which suicides occurred. This report focuses on information from the years 2013 to 2018. The information comes from a public health surveillance system — the Queensland Suicide Register (QSR) and the interim Queensland Suicide Register (iQSR). Surveillance systems play an important role in many areas of public health. Public health surveillance is the ongoing capture, analysis and interpretation of health data (World Health Organization, 2014). This information is used to plan, implement and evaluate public health practice and share timely information with those who need to know to take prompt action to prevent further suicides (Centers for Disease Control, 1986).

Lowitja Institute. (2020). We nurture our culture for our future, and our culture nurtures us. Lowitja Institute for the Close the Gap Steering Committee. 

This year’s Close the Gap report sets out a blueprint for systemic reform, presenting 14 recommendations (see p.6-7 of the report) for Australian governments that must be urgently implemented to avoid further preventable deaths and protect Indigenous health, wellbeing, culture and Country. The report takes a strengths-based approach, featuring case studies of Aboriginal and Torres Strait Islander-led programs and initiatives that prove how the recognition of Aboriginal and Torres Strait Islander empowerment is vital to wellbeing. However, a strengths-based approach does not overlook the relationship of power and inequality on health outcomes or the responsibility of governments in leading systems reform. We cannot continue to create solutions inside a system that has not been designed for our needs.

The Healing Foundation. (2016). Talking family healing: East Kimberley gathering report. 

This report outlines discussions held at the family healing gathering Woorrb Yarrenkoo Ninggooneng Ngoodengig Woonjoo-gerring in Kununurra, Western Australia in November 2014. The gathering included more than 100 community members and agencies from the East Kimberley communities of Kununurra, Wyndham, Kalumburu, Warmun, Halls Creek, Fitzroy, Derby and Broome. Topics discussed include: family violence, child abuse and neglect, intergenerational trauma, and grief, loss and suicide. The report includes five recommendations of ways forward for the future.The gathering and report was a partnership between The Healing Foundation and Gawooleng Yawoodeng Aboriginal Corporation.

Dudgeon, P., & Bray, A., & Walker, R. (2020). Self-determination and strengths-based Aboriginal and Torres Strait Islander suicide prevention: an emerging evidence-based approach. In A. C. Page & W. G.K. Stritzke (Eds.), Alternatives to suicide: Beyond risk and toward a life worth living(pp. 237 – 256). Elsevier.

Ansloos, J. (2018). Rethinking Indigenous suicideInternational Journal of Indigenous Health13(2), 8–28.

While the last three decades have seen substantial investments in suicidology research within the Canadian context, rates of Indigenous deaths by suicide have remained relatively stable, and little remains known about effective means to reduce Indigenous deaths by suicide. A movement of critical suicidology scholars across health and social sciences is beginning to challenge the mainstream approach of suicidology research and suicide prevention, citing concerns about the ideological and epistemic foundations. In this article, the author highlights how these critiques are relevant to Indigenous contexts. Challenging a range of assumptions, the author considers the need to rethink the ideological foundations of research on Indigenous suicide. Finally, the author considers two methodological projects that are integral to forming a critical approach to Indigenous suicidology research and Indigenous suicide prevention praxis–culturally grounded research and decolonizing research.

Baird, M. (2020) Perspectives of my lived experiences for addressing suicides among aboriginal communities in the North Queensland tropicsAlterNative – An International Journal of Indigenous Peoples, Vol. 16(3) 211 – 219

This article contextualises my perspectives of Indigenous knowledge within a cultural cosmology, used to address the suicide epidemic in an Indigenous community in the Far North Queensland Tropics of Australia. I use my personal narrative from the philosophical standpoint theory of an Indigenous female with first-hand experience of living under the residues of the Queensland Government Act (1897).

Baker, M., Sewell, T., Morris, T., McClintock, K., & Elkington, A. (2017). Waka Hourua, Ko Au, Ko Koe, Ko Tātou Māori suicide prevention community programme. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 3(2), 32-40.

In 2014, the first dedicated National Māori Suicide Prevention Programme: Waka Hourua was launched by Te Rau Matatini. One of its five streams was the operation of a National Coordination Centre for Māori Community Suicide Prevention. The major programme championed by the Centre included fostering Māori leadership, and building their capacity and capability to lead the development of whole of community plans. In drawing on what differentiates Waka Hourua from other programmes, it is the distinction of being privileged to work as informed insiders to Māori communities. This article provides an account of the Ko Au, Ko Koe, Ko Tātou Māori Suicide Prevention Community Programme and Māori Champions working in communities – the Pou Ārahi role.

Black, E.B., & Kisely, S. (2018). A systematic review: Non-suicidal self-injury in Australia and New Zealand’s Indigenous populationsAustralian Psychologist53(1), 3-12.

Objective: To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori). Method: We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ’s Indigenous populations. Results: Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI. Conclusions: Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.

Bloch-Elkouby, S., Gorman, B., Schuck, A., Barzilay, S., Calati, R., Cohen, L. J., Begum, F., & Galynker, I. (2020). The suicide crisis syndrome: A network analysisJournal of Counseling Psychology. 

Recent studies introduced the suicide crisis syndrome (SCS), a condition associated with imminent suicidal behavior and characterized by (a) a pervasive feeling of entrapment in which the escape from an unbearable life situation is perceived as both urgent and impossible (Criterion A) and (b) affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal (Criterion B). The goal of the present study was to use some of the analytic tools provided by network analyses to further the understanding of the psychological, emotional, cognitive, behavioral, and physiological processes involved in the SCS by testing (a) whether the different symptoms of the proposed syndrome are related to each other, (b) whether symptoms form meaningful clusters, and (c) whether certain symptoms are more central than others. The study included 500 outpatient and 223 inpatient participants. A network analysis of the participants’ scores on the various symptoms of the SCS was conducted. The network analysis suggested that most SCS symptoms are linked by strong connections and that entrapment and ruminative flooding are highly correlated with the other SCS symptoms. Three clusters of symptoms were identified, suggesting the existence of several interdependent psychological processes potentially involved in SCS phenomenology. Our findings support both the suggested symptoms of the SCS and the central role of entrapment in the proposed criteria for the syndrome. Emotional pain appears to be closely linked to entrapment and may belong in Criterion A.

Dallas-Katoa, W., Varona, G., Kipa, M., Dallas, R., & Leahy, H. (2019). Summary findings of an exploratory data gathering exercise on Māori suicide in Te Waipounamu. Journal of Indigenous Wellbeing, 4(1), 49-60.

This paper presents the findings of a recently completed exploratory data gathering exercise on Māori suicide in Te Waipounamu (South Island of New Zealand). The data gathering exercise was conducted through Te Pūtahitanga o Te Waipounamu, the Whānau Ora commissioning agency in the South Island. Data from the Coronial Services of New Zealand and relevant information from the District Health Boards were explored for the South Island. In-depth interviews with whānau (families) and a pilot survey on mental wellbeing were also conducted. Results from the exercise indicate that whānau access suicide intervention health services only after a suicide incident or suicide attempt. On the whole, these health services generally use a clinical/health-based approach. Whānau, however, pointed out that a culturally grounded whole-of-whānau approach is required to address issues around mental health and suicide, particularly among young whānau. Strengthening and maintaining cultural relational ties, networks, and whānau connections have been consistently identified by whānau in Te Waipounamu as important not only for Māori mental and emotional wellbeing more generally, but also for preventing suicide.

Eskin, M., Tran, U. S., Carta, M. G., Poyrazli, S., Flood, C., Mechri, A., Shaheen, A., Janghorbani, M., Khader, Y., Yoshimasu, K., Sun, J., Kujan, O., Abuidhail, J., Aidoudi, K., Bakhshi., Harlak, H., Moro, M. F., Phillips, L., Hamdan M., Abuderman, A., Tsuno, K., & Voracek, M. (2020). Is individualism suicidogenic? Findings from a multinational study of young adults from 12 countriesFront Psychiatry, 11, 259.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

Kral, M. J. (2012). Postcolonial suicide among Inuit in Arctic Canada. Culture, Medicine, and Psychiatry, 36,306-325.

Indigenous youth suicide incidence is high globally, and mostly involves young males. However, the Inuit of Arctic Canada have a suicide rate that is among the highest in the world (and ten times that for the rest of Canada). The author suggests that suicide increase has emerged because of changes stemming in part from the Canadian government era in the Arctic in the 1950s and 1960s. The effects of government intervention dramatically affected kin relations, roles, and responsibilities, and affinal/romantic relationships. Suicide is embedded in these relationships. The author also discusses the polarization between psychiatric and indigenous/community methods of healing, demonstrating that government-based intervention approaches to mental health are not working well, and traditional cultural healing practices often take place outside of the mainstream clinics in these communities. The main questions of the paper are: Who should control suicide prevention? What is the best knowledge base for suicide prevention?

Pollock, N. J., Naicker, K., Loro, A., Milary, S., & Colman, I. (2018). Global incidence of suicide among Indigenous peoples: A systematic review. BMC Medicine, 16, 145.

Background:Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations. Methods:We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations. Results:The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples. Conclusions:This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

Inuit Tapiriit Kanatami. (2019). Promising practices in suicide prevention across Inuit Nunangat: NISPS research and data collection project.

In the National Inuit Suicide Prevention Strategy (NISPS), suicide is identified as “the most urgent challenge facing our people” (Inuit Tapiriit Kanatami 2016, 4). Given the seriousness of the issue, and recognizing that more work is needed to mobilize Inuit knowledge for resilience and suicide prevention across Inuit Nunangat (one of the NISPS’s six priority areas), Inuit Tapiriit Kanatami (ITK) and the NISPS Working Group have a shared interest in:
• Developing a more complete picture of the actions and interventions currently in place to address the elevated rate of suicide across Inuit Nunangat;
• Gathering and sharing information about actions and interventions that appear to be effective/showing promise in addressing elevated rates of suicide among Inuit;
• Identifying opportunities to improve outcomes concerning suicide rates in Inuit Nunangat; and
• Identifying opportunities to effectively mobilize knowledge across the six areas noted above.
This report presents findings from an environmental scan that was undertaken to support these objectives. The scan involved a review of both grey and academic literature, and a series of key informant interviews with individuals who have experience working on suicide prevention and related initiatives across Inuit Nunangat. The literature review and interviews were organized around the following six topic areas:
1. Links between childhood adversity and suicide;
2. Promising practices with respect to addressing child sexual abuse across Inuit Nunangat;
3. Promising practices with respect to social emotional development in Inuit Nunangat;
4. Promising practices with respect to safe shelters focusing on children and youth within Inuit Nunangat;
5. Promising practices with respect to current supports for Inuit within the justice system with a specific focus addressing child sexual abuse; and
6. Promising practices with respect to parenting and family support programs.
Key informants were identified by ITK staff and the NISPS Working Group. 20 people were interviewed in total.

Ministry of Health. (2017). A strategy to prevent suicide in New Zealand: Draft for public consultation.