Global systematic review of the effects of suicide prevention interventions in Indigenous peoples

Abstract

ObjectiveSuicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide.MethodsWe searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies.FindingsWe included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before–after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before–after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias.ConclusionFor the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.

Systematic review of interventions addressing suicide among Indigenous adults and reporting Indigenous-specific content and involvement in the interventions

“…As in our review, Clifford et al (2013), Harlow et al (2014) reported favourable outcomes and limited high-quality evaluations of such interventions, with few studies employing experimental designs suggesting a need for more high-quality evidence to demonstrate intervention effectiveness. Similar conclusions were drawn by Leske et al (2020).…”

“…Clifford et al (2013) suggested that cultural adaptations or tailoring may increase acceptability to Indigenous peoples, and in our review, we observed varying degrees of cultural adaptations or centering, but also tailoring to increase study feasibility. Among our 10 studies, 9 were included in the review by Leske et al (2020) which had 24 studies. Our tenth study was published in 2020.…”

“…Our analysis also included a table describing tailoring, modifications, and fidelity to the interventions. Leske et al (2020) reviewed studies for community involvement in diagnosis, development, implementation, and evaluation of interventions using ranking and participation levels. As outlined in our results, it was critical in our review to include a detailed assessment to avoid a pan-Indigenous analysis and support Indigenous-specific reporting (Huria et al, 2019).…”

“…These countries share similar historical and present-day colonialism, state provisions of health and social services, and cultural and holistic worldviews of health and wellbeing. A third systematic review was recently conducted indicating cultural biases as limitations and omitting valuable Indigenous-derived data (Leske et al, 2020). A thorough review of the studies to assess methodological quality and Indigenous knowledges is needed including a critical discussion on Indigenous governance in intervention health research.…”

Suicide and suicide attempts in the Pacific Islands: A Systematic Literature Review

“… [34 , 49 , 53] For example, the gender roles and expectations placed upon young women in Indian-Fijian households, [5 , 37] the unique challenges of young people, [5 , 7 , 19] and the cultural preferences of Indigenous peoples. [66] For young people, these strategies could include further means restriction, awareness and skills training, and gatekeeper training programs with schools. [14] Interestingly, gender associations with suicidal behaviours were not as clear as in other Western Pacific countries such as Australia or New Zealand whereby there is a clear preponderance of suicide in men and suicide attempts in women.…”