Suicide rates rose by 20% among American Indians/Alaska Natives

Suicide rates among American Indian or Alaska Native individuals increased nearly 20% from 2015 to 2020, compared with a less than 1% increase among the general American population, researchers reported in MMWR.

Deborah Stone, ScD, MSW, MPH, the lead behavioral scientist in the division of injury prevention with the CDC, and colleagues used data from the National Violent Death Reporting System (NVDRS) to examine differences in suicide characteristics and contributing circumstances among American Indian or Alaska Native (AI/AN) populations.

NVDRS data is a state-based surveillance system that collects information from death certificates, coroner or medical examiner reports, and law enforcement reports on the characteristics and circumstances of violent deaths, including suicide. The authors used data limited to those aged 10 years and older, as suicide intent in young children can be difficult to determine.

From 2015 to 2020, NVDRS reported a total of 3,397 suicides among AI/AN people and 179,850 suicides among non-AI/AN populations. Nearly three-quarters (74.6%) of suicides among AI/AN populations were in those aged 44 years or younger, compared with less than half (46.5%) of suicides in non-AI/AN populations. The highest percentage of suicides in AI/AN populations (46.9%) occurred in those aged 25 to 44 years.

Suicide rates among AI/AN populations rose from 20 per 100,000 individuals in 2015, to 23.9 per 100,000 in 2020 — an increase of nearly 20%. Stone and colleagues reported higher odds across a range of circumstances, including 10 of 14 relationship problems (adjusted OR range, 1.2-3.8; 95% CI range, 1-5.3) and six of seven substance use issues (aOR range, 1.2-2.3; 95% CI range, 1.1-2.5), compared with non-AI/AN populations.

AI/AN suicide decedents had higher odds of dying by hanging, strangulation or suffocation (aOR, 1.8) and lower odds of dying from a firearm injury (aOR, 0.7), compared with non-AI/AN suicide decedents, the authors wrote.

Compared with non-AI/AN suicide decedents, AI/AN suicide decedents were more likely to disclose suicidal intent before death (aOR, 1.2) and to have had previous suicidal thoughts or plans (aOR, 1.1). However, they were less likely to leave a note (aOR, 0.7).

The prevalence of known mental health diagnoses (41.5%; aOR, 0.7) and history of mental health or substance use treatment (29.5%; aOR, 0.7) were lower among AI/AN decedents than among non-AI/AN decedents (49.2% and 35.1%, respectively).

“Suicide prevention efforts among AI/AN populations must consider the context and consequences of current inequities as well as historical trauma, including intergenerational transmission, that continue to affect AI/AN persons, families, and communities today,” Stone and colleagues wrote. “Suicide is a complex problem with multiple contributing circumstances that affect different communities differently. A comprehensive public health approach to suicide prevention, with attention to strategies that aim to reduce health inequities among AI/AN persons, is needed.”