Suicide Attempts Among American Indian and Alaska Native Youth

CONTEXT: American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. OBJECTIVE: To identify risk and protective factors associated with suicide attempts among native male and female adolescents. DESIGN: The 1990 National American Indian Adolescent Health Survey. SETTING: Schools of reservation communities in 8 Indian Health Service areas. PARTICIPANTS: Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth. MAIN OUTCOME MEASURES: Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. RESULTS: Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. CONCLUSIONS: A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.