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OBJECTIVE: Indigenous knowledge and practices promote American Indian/Alaska Native (AI/AN; Native) communities' health and well-being. Historical losses and continued oppression have resulted in disproportionately higher AI/AN youth suicide rates. This article describes the development of a new national resource guide titled "CULTURE FORWARD" for tribal leaders and stakeholders to support youth suicide prevention efforts through cultural strengths. METHOD: The CULTURE FORWARD guide was developed over 6 months through a community-engaged process. We conducted nine roundtables and eight interviews with a wide variety of community members, leaders, and providers representing 36 diverse tribal communities and geographic regions. Participants discussed AI/AN youth risk and protective factors, successful community efforts to prevent suicide, and content and dissemination ideas. A comprehensive literature review complemented qualitative findings. A diverse and representative National Advisory Editorial Board guided content and design throughout development. RESULTS: Qualitative data were analyzed iteratively and thematically. Across all listening sessions, culture was identified as a key protective factor against AI/AN youth suicide. Five themes related to cultural strengths informed guide chapters. Each chapter includes an introduction; how that theme helps prevent Native youth suicide; a review of academic literature, community stories and programs; action steps; and additional resources. CONCLUSIONS: CULTURE FORWARD honors and empowers communities by weaving strands of knowledge, stories, and practical resources highlighting Native communities' strengths to protect against Native youth suicide. The guide is free online and print copies are being distributed nationally. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Indígenas Norte-Americanos , Prevenção do Suicídio , Adolescente , Humanos , Fatores de ProteçãoRESUMO
The opioid crisis in the United States has received national attention and critical resources in the past decade. However, what has been overlooked is the effect the opioid crisis may be having on a three-decade suicide crisis among American Indian and Alaska Native (AIAN) communities that already have too few resources to address behavioral and mental health issues. This paper describes recent epidemiological trends associated with both opioid overdose and suicide at a national level for AIANs and the rest of the United States. We used data reported by the Centers for Disease Control and Prevention to report historical trends of opioid overdose and suicide for AIAN and non-AIAN populations. We found alarming and potentially correlated trends of opioid use and suicidality among AIAN populations. We highlight both current and future research that will be essential to understanding and addressing the unique intersection between opioid and suicide risk and protective factors to inform dual prevention and intervention efforts among AIAN populations with potential relevance to public health response among other at-risk populations.
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Indígena Americano ou Nativo do Alasca , Overdose de Opiáceos/etnologia , Overdose de Opiáceos/mortalidade , Epidemia de Opioides/tendências , Suicídio/etnologia , Suicídio/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Humanos , Pessoa de Meia-Idade , Sindemia , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto JovemRESUMO
The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicide-specific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.
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Medição de Risco , Prevenção do Suicídio , Suicídio , Adolescente , Criança , Humanos , Suicídio/estatística & dados numéricosRESUMO
Suicide is the second leading cause of death for American Indian (AI) young adults. Alcohol use is a well-established risk factor for suicide. On average, AIs ages 12 to 20 exhibit the second-highest rate of binge drinking compared to all other ethnic groups. The current study investigated the relation between alcohol use and suicide ideation in an AI sample and examined these relations in the context of the interpersonal theory of suicide (ITS). It was hypothesized that perceived burdensomeness and thwarted belongingness would each significantly moderate the relations between alcohol use and suicide ideation in an AI sample. College students who self-identified as American Indian (N = 84) completed measures of alcohol use and associated problems, perceived burdensomeness and thwarted belongingness, and suicidality. Results indicated that perceived burdensomeness significantly moderated the relation between alcohol use and suicide ideation, and this interaction was significant at high levels of perceived burdensomeness. However, thwarted belongingness was not a significant moderator of the relation between alcohol use and suicide ideation. Findings suggest that AI young adults who engage in increased alcohol use may be at increased risk for suicide, especially if they also experience stronger perceptions of being a burden on others. The current study provides support for continued examinations of the relationship between alcohol use and suicide to inform culturally appropriate interventions for AI young adults.
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Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Indígena Americano ou Nativo do Alasca/psicologia , Relações Interpessoais , Suicídio/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino , Distância Psicológica , Fatores de Risco , Ideação Suicida , Adulto JovemRESUMO
BACKGROUND: This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS: Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION: Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION: Clinical Trials NCT03543865, June 1, 2018.
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Indígenas Norte-Americanos/psicologia , Prevenção do Suicídio , Suicídio/etnologia , Adolescente , Criança , Feminino , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores de Proteção , Projetos de Pesquisa , Resiliência Psicológica , Fatores de Risco , Ideação Suicida , Adulto JovemRESUMO
Racial microaggressions are a contemporary form of subtle discrimination that occur in everyday exchanges, and are associated with a variety of negative mental health outcomes, including suicide ideation. Previous work (e.g., Torres-Harding, Andrade, & Romero Diaz, 2012) has identified 6 dimensions of racial microaggressions: invisibility, criminality, low-achieving/undesirable culture, sexualization, foreigner/not belonging, and environmental invalidations. The current study examined whether the 6 dimensions of racial microaggressions were associated with increased suicide ideation through perceived burdensomeness and thwarted belongingness among 135 African American young adults. Results indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relationship between 3 racial microaggression dimensions (i.e., invisibility, low-achievement/undesirable culture, and environmental invalidations) and suicide ideation. These results imply that for African American college students, experiencing certain dimensions of racial microaggressions was associated with higher levels of perceived burdensomeness, which in turn was related to increased levels of suicide ideation. Clinical and societal implications are discussed. This study found that specific types of racial microaggressions were associated with higher levels of perceptions of being a burden on others, which in turn was associated with higher levels of suicide ideation in a sample of African Americans. These findings are important as they demonstrate 1 possible avenue through which racial microaggressions can negatively impact mental health. (PsycINFO Database Record
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Agressão/psicologia , Negro ou Afro-Americano/psicologia , Preconceito/etnologia , Preconceito/psicologia , Autoimagem , Ideação Suicida , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVE: Recent research has indicated that historical loss may play an important role in the experience of depression symptoms in American Indian/Alaska Native people. Increased frequency of historical loss thinking has been related to symptoms of depression and other pervasive psychological outcomes (i.e., substance abuse) in American Indian and Canadian First Nations communities. The current study investigated how aspects of ethnic minority experience relate to the incidence of historical loss thinking and symptoms of depression in American Indian adults. METHOD: Data are presented from 123 self-identified American Indian college students (ages 18-25, 67.50% female) who participated in the study in return for course credit and/or entrance into a raffle for gift cards. Participants completed the Adolescent Historical Loss Scale (AHLS), Scale of Ethnic Experiences (SEE), and the Center for Epidemiologic Studies-Depression Scale (CES-D). Indirect effects of ethnic experience on symptoms of depression through historical loss thinking were calculated with nonparametric bootstrapping procedures. RESULTS AND CONCLUSIONS: Results indicated that a strong ethnic identification, desire to predominantly socialize with other American Indians, and perceptions of discrimination were associated with increased historical loss thinking. Feelings of comfort and assimilation with the mainstream American culture were negatively related to historical loss thinking. Only perception of discrimination was directly related to symptoms of depression; however, ethnic identification and the preference to predominantly socialize with other American Indians were both indirectly related to elevated depressive symptoms through increased historical loss thinking. The clinical implications for these results are discussed. (PsycINFO Database Record
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Depressão/psicologia , Indígenas Norte-Americanos/psicologia , Estudantes/psicologia , Pensamento/fisiologia , Adolescente , Adulto , Canadá/etnologia , Cultura , Discriminação Psicológica/fisiologia , Etnicidade , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Percepção/fisiologia , Identificação Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
American Indians (AIs) experience increased suicide rates compared with other groups in the United States. However, no past studies have examined AI suicide by way of a recent empirically supported theoretical model of suicide. The current study investigated whether AI suicidal ideation can be predicted by two components: thwarted belongingness and perceived burdensomeness, from the Interpersonal-Psychological Theory of Suicide (T. E. Joiner, 2005, Why people die by suicide. Cambridge, MA: Harvard University Press). One hundred seventy-one AIs representing 27 different tribes participated in an online survey. Hierarchical regression analyses showed that perceived burdensomeness significantly predicted suicidal ideation above and beyond demographic variables and depressive symptoms; however, thwarted belongingness did not. Additionally, the two-way interaction between thwarted belongingness and perceived burdensomeness significantly predicted suicidal ideation. These results provide initial support for continued research on the components of the Interpersonal-Psychological Theory of Suicide, an empirically supported theoretical model of suicide, to predict suicidal ideation among AI populations.
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Depressão/psicologia , Indígenas Norte-Americanos/psicologia , Relações Interpessoais , Distância Psicológica , Ideação Suicida , Suicídio/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Análise de Regressão , Fatores de Risco , Adulto JovemRESUMO
In October 2021, the American Psychological Association apologized to people of color in the United States for its role in systemic racism. Spurred by a national racial reckoning, Indigenous Peoples have been regularly incorporated into initiatives redressing America's legacy of racism. Although Indigenous Peoples have been racialized during the formation of the United States, this process is intertwined with colonization-the systematic dispossession and exploitation of Indigenous communities by Europeans. We first examine how the American Psychological Association (APA) has been complicit in colonialism by failing to oppose government policies that disenfranchise Indigenous communities, which it recently recognized in a separate apology to First Peoples in the United States in February 2023 (American Psychological Association, APA Indigenous Apology Work Group [APA IAWG], 2023). Second, we explore methods for APA to reconcile historical and contemporary wrongs inflicted on Indigenous Peoples through transitional justice, an approach to addressing human rights violations that seeks justice and opportunities for healing (United Nations, 2008). In particular, we consider the implications that Truth and Reconciliation Commissions have for Indigenous Peoples. Third, we provide recommendations for APA to repair relations with Indigenous Peoples in education, research, and practice. We specifically interrogate what possibilities for truth, reconciliation, and healing exist vis-à-vis transitional justice in psychology. We conclude with the potential that APA has to advance meaningful structural reforms while cautioning against superficial efforts towards reconciliation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Povos Indígenas , Psicologia , Justiça Social , Humanos , Povos Indígenas/psicologia , Estados Unidos , Sociedades Científicas , Colonialismo , Racismo Sistêmico/prevenção & controle , RacismoRESUMO
BACKGROUND: Suicide and PTSD are pressing public health issues in the US, with discrimination and potentially traumatic experiences (PTEs) influencing mental health. However, the unique effects of these factors on Multiracial/ethnic adults' PTSD and suicidal thoughts/behaviors (STB) are not thoroughly researched. METHODS: Using a cross-sectional design, an online survey was conducted (N = 1012) from October to December 2022. Multivariable logistic regression models analyzed relationships between PTEs, discriminatory events, and mental health outcomes, accounting for sociodemographics. RESULTS: After adjusting for demographics, exposure to PTEs and discrimination correlated with heightened odds of PTSD and STB. Individual lifetime discrimination experiences and specific PTEs demonstrated varying associations with STB and PTSD. The study underscores discrimination's relevance as a risk factor. LIMITATIONS: The study's cross-sectional nature restricts causality or temporality interpretations. Moreover, the convenience sample of English-speaking online participants might not be reflective of all Multiracial/ethnic US adults. CONCLUSIONS: Findings underscore PTEs and discrimination's interconnectedness in Multiracial/ethnic mental health outcomes. Discrimination might pose similar risks to PTEs. Acknowledging discrimination as potential precursors for PTSD and STB aids accurate diagnosis and effective treatment planning. Incorporating racial/ethnic discrimination and traumatic experiences into PTSD conceptualization and assessment is pivotal. This knowledge informs tailored interventions and mental health education for this population.
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Transtornos de Estresse Pós-Traumáticos , Suicídio , Adulto , Humanos , Estados Unidos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Ideação Suicida , Estudos Transversais , Grupos RaciaisRESUMO
The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.
Structural violence of racism and colonization are social determinants of suicide.Collaborative and power-sharing implementation strategies can disrupt oppression.Strengths-based collectivist strategies can buffer structural suicide risk.
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Introduction: American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings. Methods: A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book. Results: The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books. Discussion: The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.
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Nativos do Alasca , COVID-19 , Indígenas Norte-Americanos , Criança , Humanos , Indígenas Norte-Americanos/psicologia , Pandemias , Prática de Saúde PúblicaRESUMO
Introduction: The COVID-19 pandemic exacerbated mental health concerns and stress among American Indians and Alaska Natives (AI/ANs) in the United States, as well as among frontline workers responding to the pandemic. Psychological First Aid (PFA) is a promising intervention to support mental wellbeing and coping skills during and after traumatic events, such as the COVID-19 pandemic. Since PFA is often implemented rapidly in the wake of a disaster or traumatic event, evidence evaluating its impact is lacking. This paper reports pilot evaluation results from a culturally adapted PFA training designed to support COVID-19 frontline workers and the AI/AN communities they serve during the pandemic. Methods: This study was designed and implemented in partnership with a collaborative work group of public health experts and frontline workers in AI/AN communities. We conducted a pre-post, online pilot evaluation of a culturally adapted online PFA training with COVID-19 frontline workers serving AI/AN communities. Participants completed a baseline survey and two follow-up surveys 1 week and 3 months after completing the PFA training. Surveys included demographic questions and measures of anxiety, burnout, stress, positive mental health, communal mastery, coping skills, PFA knowledge, confidence in PFA skills, and satisfaction with the PFA training. Results: Participants included N = 56 COVID-19 frontline workers in AI/AN communities, 75% were AI/AN, 87% were female, and most (82%) were between the ages of 30-59. Participants reported high satisfaction with the training and knowledge of PFA skills. Pilot results showed significant increases in positive mental health and social wellbeing and reductions in burnout from baseline to 3 months after completing the PFA training among frontline workers. There were no changes in communal mastery, coping skills, stress, or anxiety symptoms during the study period. Discussion: To our knowledge, this is the first pilot evaluation of a PFA training designed and culturally adapted with and for AI/AN communities. Given that many AI/AN communities were disproportionately impacted by COVID-19 and prior mental health inequities, addressing acute and chronic stress is of crucial importance. Addressing traumatic stress through culturally adapted interventions, including Indigenous PFA, is crucial to advancing holistic wellbeing for AI/AN communities.
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Adaptação Psicológica , Nativos do Alasca , COVID-19 , Humanos , COVID-19/psicologia , Projetos Piloto , Feminino , Masculino , Nativos do Alasca/psicologia , Adulto , Pessoa de Meia-Idade , Indígenas Norte-Americanos/psicologia , Estados Unidos , Primeiros Socorros , Saúde Mental , SARS-CoV-2 , Inquéritos e Questionários , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Estresse Psicológico/psicologiaRESUMO
Importance: There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective: To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants: This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures: Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results: Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance: This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.
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Indígena Americano ou Nativo do Alasca , Comportamento Autodestrutivo , Adulto , Feminino , Humanos , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/etnologia , Comportamento Autodestrutivo/prevenção & controle , Ideação Suicida , Tentativa de Suicídio/etnologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricos , Medição de Risco/etnologia , Medição de Risco/estatística & dados numéricos , Suicídio/etnologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Prognóstico , Modelos EstatísticosRESUMO
OBJECTIVE: To identify potential differential changes in youth suicide deaths associated with the coronavirus disease (COVID-19) pandemic to better inform suicide prevention strategies. METHODS: This cross-sectional study analyzed national suicide data for US youth aged 5 to 24 years from 2015 to 2020. Annual and monthly numbers of suicides were extracted overall and by sex, age, race and ethnicity, and method. Expected suicides were modeled from the trend in monthly deaths before COVID-19 (January 1, 2015-February 29, 2020), by using interrupted time-series analyses with quasi-Poisson regression. Rate ratios (RR) and corresponding 95% confidence intervals (CI) were used to compare expected and observed suicides during the first 10 months of COVID-19 (March 1, 2020-December 31, 2020). RESULTS: Among 5568 identified youth suicides during the 2020 pandemic, 4408 (79.2%) were male, 1009 (18.1%) Hispanic, 170 (3.3%) non-Hispanic American Indian/Alaska Native, 262 (4.7%) Asian/Pacific Islander, 801 (14.4%) Black, and 3321 (59.6%) white. There was a significant increase in overall observed versus expected youth suicides during the COVID-19 pandemic (RR = 1.04, 95% CI = 1.01-1.07), equivalent to an estimated 212 excess deaths. Demographic subgroups including males (RR = 1.05, 95% CI = 1.02-1.08), youth aged 5 to 12 years (RR = 1.20, 95% CI = 1.03-1.41) and 18 to 24 years (RR =1.05, 95% CI = 1.02-1.08), non-Hispanic AI/AN youth (RR = 1.20, 95% CI = 1.03-1.39), Black youth (RR = 1.20, 95% CI = 1.12-1.29), and youth who died by firearms (RR = 1.14, 95% CI = 1.10-1.19) experienced significantly more suicides than expected. CONCLUSIONS: Suicide deaths among US youth increased during COVID-19, with substantial variation by sex, age, race and ethnicity, and suicide method. Suicide prevention strategies must be tailored to better address disparities in youth suicide risk.
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COVID-19 , Suicídio , Humanos , Masculino , Adolescente , Feminino , Pandemias , Estudos Transversais , EtnicidadeRESUMO
BACKGROUND: In recent years public health research has shifted to more strengths or asset-based approaches to health research but there is little understanding of what this concept means to Indigenous researchers. Therefore our purpose was to define an Indigenous strengths-based approach to health and well-being research. METHODS: Using Group Concept Mapping, Indigenous health researchers (N = 27) participated in three-phases. Phase 1: Participants provided 218 unique responses to the focus prompt "Indigenous Strengths-Based Health and Wellness Research " Redundancies and irrelevant statements were removed using content analysis, resulting in a final set of 94 statements. Phase 2: Participants sorted statements into groupings and named these groupings. Participants rated each statement based on importance using a 4-point scale. Hierarchical cluster analysis was used to create clusters based on how statements were grouped by participants. Phase 3: Two virtual meetings were held to share and invite researchers to collaboratively interpret results. RESULTS: A six-cluster map representing the meaning of Indigenous strengths-based health and wellness research was created. Results of mean rating analysis showed all six clusters were rated on average as moderately important. CONCLUSIONS: The definition of Indigenous strengths-based health research, created through collaboration with leading AI/AN health researchers, centers Indigenous knowledges and cultures while shifting the research narrative from one of illness to one of flourishing and relationality. This framework offers actionable steps to researchers, public health practitioners, funders, and institutions to promote relational, strengths-based research that has the potential to promote Indigenous health and wellness at individual, family, community, and population levels.
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OBJECTIVE: Explore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities. DESIGN: Convergence model of a mixed methods triangulation study. SETTING: Five American Indian reservation communities in the Midwest. PARTICIPANTS: One-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used. PHENOMENON OF INTEREST: Psychosocial outcomes associated with (or related to) diabetes and food stress. ANALYSIS: Quantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress. RESULTS: Food stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food. CONCLUSIONS AND IMPLICATIONS: Our findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.
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Diabetes Mellitus , Indígenas Norte-Americanos , Humanos , Indígenas Norte-Americanos/psicologia , Indígena Americano ou Nativo do Alasca , Diabetes Mellitus/epidemiologia , Grupos Focais , AlimentosRESUMO
Urban American Indian/Alaska Native peoples experience disproportionate levels of food insecurity when compared to the general US population. Through a collaborative research partnership between Native American Lifelines of Baltimore, an Urban Indian Health Program, and a Johns Hopkins Bloomberg School of Public Health student-led research team, food security was identified as a priority issue. A sequential explanatory mixed methods study was planned to explore food security and food sovereignty in the Baltimore Native community prior to the COVID-19 pandemic. Due to the local impact of COVID-19, a community-based participatory research approach guided the community-academic team to revise the original study and increase understanding of how the pandemic impacted food security in the community. This article highlights the lessons learned and strengths of using a community-based participatory approach to guide adaptations made due to COVID-19 to this research study. By utilizing a co-learning approach and emphasizing flexibility, we were able to collaboratively collect meaningful data to drive future community solutions to food insecurity while building an evidence base for policy changes to better support urban Native food security.