A scoping review of veteran suicide prevention programs in Native American communities and in the general population.

Abstract

Suicide is a major public health problem that disproportionately impacts veterans in the general U.S. population. Recent analyses indicate that American Indian and Alaska Native (AI/AN) veterans may be two to three times as likely as non-Hispanic White veterans to experience suicidal ideation. Although suicide prevention programs have been successfully implemented for many at-risk populations, to our knowledge, none have been designed or implemented for AI/AN veterans. To address this gap, we conducted a scoping review of suicide prevention programs with the objective of identifying promising strategies and lessons learned to identify promising practices for preventing suicide among AI/AN veterans. We conducted two parallel literature searches-a review of suicide prevention programs for the general U.S. adult population and AI/AN communities. We rated programs on 16 criteria, covering five domains-best practices in suicide prevention, U.S. Department of Veterans Affairs (VA) Office of Rural Health Promising Practice criteria, cultural fit, care coordination, and outcomes. Our findings indicate that many of the VA evidencebased or best practice programs are available system-wide, but none have been tailored for AI/AN veterans or the communities in which they live. Conversely, we found that many culturally specific programs implemented in AI/AN communities were rarely disseminated beyond tribal land and none were specifically developed for veterans. Based upon these findings, and to advance suicide prevention programs for AI/AN veterans, we propose a suicide prevention model that builds upon existing VA infrastructure to disseminate best practices to AI/AN communities and integrate tribal-specific cultural approaches to suicide prevention. Impact StatementAmerican Indian and Alaska Native (AI/ANs) Veterans are at higher risk of suicide than other Veterans, yet no suicide prevention programs exist that have been developed for this group. Given that AI/ANs also serve in the military at higher rates than any other race/ethnic group, it is critical to develop and deliver suicide prevention programs and services targeting AI/AN Veterans that are culturally acceptable and effective.

Introduction to the special issue: Improving access and quality of mental health care for diverse populations.

“…Given that American Indian/Alaska Native (AI/AN) individuals have higher rates of suicide than other racial/ethnic groups (Leavitt et al, 2018) and the trend of increasing rates of suicide among AI/AN veterans who use VA health care (Mohatt, Hoffmire, et al, 2022), Mohatt, Begay, et al (2023) conducted a scoping review of programs to identify strong practices for preventing suicide among AI/AN veterans. With the goal of creating suicide prevention programs to meet the needs of AI/AN veterans, the authors followed scoping review guidelines established by Arksey and O’Malley (2005).…”