A scoping review of Indigenous suicide prevention in circumpolar regions

Abstract

BackgroundSuicide is a serious public health challenge in circumpolar regions, especially among Indigenous youth. Indigenous communities, government agencies and health care providers are making concerted efforts to reduce the burden of suicide and strengthen protective factors for individuals, families and communities. The persistence of suicide has made it clear that more needs to be done.ObjectiveOur aim was to undertake a scoping review of the peer-reviewed literature on suicide prevention and interventions in Indigenous communities across the circumpolar north. Our objective was to determine the extent and types of interventions that have been reported during past decade. We want to use this knowledge to support community initiative and inform intervention development and evaluation.DesignWe conducted a scoping review of online databases to identify studies published between 2004 and 2014. We included articles that described interventions in differentiated circumpolar Indigenous populations and provided evaluation data. We retained grey literature publications for comparative reference.ResultsOur search identified 95 articles that focused on suicide in distinct circumpolar Indigenous populations; 19 articles discussed specific suicide-related interventions and 7 of these described program evaluation methods and results in detail. The majority of publications on specific interventions were found in North American countries. The majority of prevention or intervention documentation was found in supporting grey literature sources.ConclusionDespite widespread concern about suicide in the circumpolar world and active community efforts to promote resilience and mental well-being, we found few recorded programs or initiatives documented in the peer-reviewed literature, and even fewer focusing specifically on youth intervention. The interventions described in the studies we found had diverse program designs and content, and used varied evaluation methods and outcomes. The studies we included consistently reported that it was important to use community-based and culturally guided interventions and evaluations. This article summarizes the current climate of Indigenous circumpolar suicide research in the context of intervention and highlights how intervention-based outcomes have largely remained outside of peer-reviewed sources in this region of the world.

A scoping review

“…This, however, requires studies exploring and increasing our knowledge on Inuit and Sami culture and practices in the historical and modern context (Bals et al, 2010;DeCou et al, 2013;Kral et al, 2011;MacDonald et al, 2013;Omma et al, 2013), and culturally appropriate and evidence-based evaluations, and support of community capacity building around evaluations (Redvers et al, 2015). The need for identifying effective interventions of preventive strategies in the circumpolar region has also been underlined by many other scholars (Chachamovich et al, 2015;Crooks et al, 2017;Young et al, 2015).…”

“…These are listed in the appendices (page 44 Future research Redvers et al (2015) recommend that more culturally appropriate evaluation and community capacity building around evaluation be supported, and that these are shared in international journals in order to make them internationally accessible, since most of this literature is recorded in grey literature. The need for identifying effective interventions of preventive strategies in the circumpolar region has also been underlined by many other scholars (Chachamovich et al, 2015;Crooks et al, 2017;Young et al, 2015).…”

“…A great amount of the selected literature pointed out the importance of developing culturally and locally relevant interventions (Bals et al, 2010;Bjerregaard & Larsen, 2015;DeCou et al, 2013;Fraser et al, 2015;Redvers et al, 2015), to make them relevant for the indigenous populations by recognizing the contextual difference in challenges between indigenous and non-indigenous populations. This, however, requires studies exploring and increasing our knowledge on Inuit and Sami culture and practices in the historical and modern context (Bals et al, 2010;DeCou et al, 2013;Kral et al, 2011;MacDonald et al, 2013;Omma et al, 2013), and culturally appropriate and evidence-based evaluations, and support of community capacity building around evaluations (Redvers et al, 2015).…”

“…A great amount of the selected literature pointed out the importance of developing culturally and locally relevant interventions (Bals et al, 2010;Bjerregaard & Larsen, 2015;DeCou et al, 2013;Fraser et al, 2015;Redvers et al, 2015), for example to strengthen Inuit and Sami populations' traditional ways with the aim to prevent suicide (DeCou et al, 2013). One of the main findings in the report 'Sharing Hope', a comprehensive report that documented and evaluated best practices in mental wellness-related interventions in circumpolar regions, was the fact that "suicide prevention requires culturally-grounded solutions that are community-based and community-driven" (SDWG, 2015).…”

“…One of the main findings in the report 'Sharing Hope', a comprehensive report that documented and evaluated best practices in mental wellness-related interventions in circumpolar regions, was the fact that "suicide prevention requires culturally-grounded solutions that are community-based and community-driven" (SDWG, 2015). When looking at the regional differences of suicide rates over time, as done in Greenland, it becomes clear that strategies for prevention need to consider the different temporal patterns, disparities in living conditions and local context (Bjerregaard & Larsen, 2015 Broad community-based approaches for prevention can entail clinicians and frontline workers screening for risk factors in indigenous communities with attention to gender differences MIO, 2017aMIO, , 2017bMIO, , 2017dMota et al, 2012;Redvers et al, 2015;Reigstad & Kvernmo, 2017), enhancing teachers' ability to detect symptoms and problems as well as providing low threshold health services from primary school onwards Chachamovich et al, 2015;MIO, 2017aMIO, , 2017bMIO, , 2017d, and/or fostering parenting skills in young families Chachamovich et al, 2015;Kral et al, 2011;MIO, 2017aMIO, , 2017bMIO, , 2017d. The latter approach has shown to provide promising results such as decreasing rates of maladaptive behaviours and long-term mental health outcomes (Chachamovich et al, 2015).…”