A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand

Abstract

BackgroundIndigenous peoples of Australia, Canada, United States and New Zealand experience disproportionately high rates of suicide. As such, the methodological quality of evaluations of suicide prevention interventions targeting these Indigenous populations should be rigorously examined, in order to determine the extent to which they are effective for reducing rates of Indigenous suicide and suicidal behaviours. This systematic review aims to: 1) identify published evaluations of suicide prevention interventions targeting Indigenous peoples in Australia, Canada, United States and New Zealand; 2) critique their methodological quality; and 3) describe their main characteristics.MethodsA systematic search of 17 electronic databases and 13 websites for the period 1981–2012 (inclusive) was undertaken. The reference lists of reviews of suicide prevention interventions were hand-searched for additional relevant studies not identified by the electronic and web search. The methodological quality of evaluations of suicide prevention interventions was assessed using a standardised assessment tool.ResultsNine evaluations of suicide prevention interventions were identified: five targeting Native Americans; three targeting Aboriginal Australians; and one First Nation Canadians. The main intervention strategies employed included: Community Prevention, Gatekeeper Training, and Education. Only three of the nine evaluations measured changes in rates of suicide or suicidal behaviour, all of which reported significant improvements. The methodological quality of evaluations was variable. Particular problems included weak study designs, reliance on self-report measures, highly variable consent and follow-up rates, and the absence of economic or cost analyses.ConclusionsThere is an urgent need for an increase in the number of evaluations of preventive interventions targeting reductions in Indigenous suicide using methodologically rigorous study designs across geographically and culturally diverse Indigenous populations. Combining and tailoring best evidence and culturally-specific individual strategies into one coherent suicide prevention program for delivery to whole Indigenous communities and/or population groups at high risk of suicide offers considerable promise.

A Community's Response to Gatekeeper Training

“…The issue of culture was raised by other researchers [23,31]. It has been concluded there was insufficient evidence to recommend gatekeeper training for indigenous persons in one systematic review of suicide prevention interventions [40].…”

Suicide, Mental Illness and Maori People

“…A system of beliefs that embraces and accepts mental diversity and considers it a gift will clash with a western system of beliefs that considers mental diversity as an illness and medicates and incarcerates people with these symptoms [19] [20]. Centuries of traditions have in place the social structure and social codes for the community to deal with mental diversity.…”

“…For example, one of the ways of reaching out to communities isolated through cultural and/or geographical differences is to train indigenous people in suicide prevention [19] [20]. Such approaches, under current suicide philosophy create more problems.…”

Increasing Indigenous self‐harm and suicide in the Kimberley: an audit of the 2005–2014 data

“…All training content should be culturally adapted and should include local information about accessibility to health care. Adapted programmes have shown promising results when tailored to specific populations, such as Aboriginal groups (85). Studies show that 25−50% of women who display suicidal behaviour saw a health-care provider in the preceding four weeks; therefore gatekeeper training provides an opportunity to begin interventions with these individuals (94).…”