American Indian and Alaska Native (AIAN) populations contend with disproportionately high rates of suicide. The study of protective factors is essential for highlighting resilience and formulating potential interventions for suicide. We systematically review factors that are posited to protect against suicide attempts for AIAN peoples. Seventeen (12 journal articles, five theses/dissertations) articles met inclusion criteria. Results indicate that protective factors are typically situated at one of four levels of analysis: individual (e.g., self-esteem), family (e.g., parent caring), community (e.g., positive adult relationships), and cultural (e.g., cultural spiritual orientation). Notably, there were trends in protective factors across age, sex, and geographic region. Based on these findings, we propose recommendations for moving the field forward in future identification of protective factors as a means of AIAN suicide prevention.

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Objectives: American Indians and Alaska Natives (AIANs) experience significant disparities in their prevalence of suicidal ideation, attempts, and deaths when compared to all other racial/ethnic groups in the United States. In this systematic review (SR), we aim to examine the methodologies employed in AIAN suicide research during the past decade to highlight successful methodological practices and provide suggestions for improving future research. Method: The authors followed guidance by Siddaway et al. (2019) for conducting SRs. The databases PsycINFO, Ovid Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center, Bibliography of Native North Americans, Sociological Abstracts, and Academic Search Premier were searched for scientific articles published between 2010 and June 5, 2020 that specifically focused on AIAN suicide. The search yielded 937 citations; 240 full-text articles were screened for inclusion, and 72 articles were included in this review. Results: Findings revealed significant heterogeneity among methodologies employed in the corpus, making it difficult to draw robust conclusions about AIAN suicide. Notably, research partnerships that were initiated by an AIAN Tribal Nation in collaboration with a research team yielded meaningful contributions and positive outcomes as compared to traditional community-based participatory research approaches. Finally, several critical gaps in the literature emerged including a lack of data on sexual and gender minority AIANs, urban, and multiracial AIANs. Conclusions: Based on these findings, we propose the following recommendations: (a) standardize the assessment of suicide; (b) increase partnerships between Tribal Nations and researchers; and (c) pursue research centering specific high-risk populations (e.g., urban, sexual and gender minority, and multiracial AIANs).

American Indian/Alaska Natives (AI/ANs) experience disproportionate rates of suicide, but current strategies for suicide prevention have not reduced these health disparities. Therefore, to gain insight into factors that may affect risk trajectories for suicide attempts (SAs) among AI/ANs, we conducted a systematic review of the literature. Forty-five articles met inclusion criteria for the final corpus. Results demonstrate that substance use, depression/hopelessness, childhood maltreatment, violent victimization, and friend/family-member death by suicide serve as robust predictors for SAs. For AI/AN youths specifically, risk-taking behaviors, family conflict, and school environment were associated with SAs. Notable differences in risk factors were identified across age, sex, and region. Limitations of this body of evidence are described, including heterogeneity in study design, measurement, and sampling. Predicated on these findings and limitations, we suggest four key strategies to advance the study of risk factors for AI/AN communities to prevent AI/AN suicide.

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