Outcome Evaluation of a Public Health Approach to Suicide Prevention in an American Indian Tribal Nation

OBJECTIVES: We evaluated the efficacy of 15 years of a public health-oriented suicidal-behavior prevention program among youths living on an American Indian reservation. METHODS: All suicides, suicide attempts, and suicidal gestures were monitored. Age-specific analyses over time were used to assess outcomes. RESULTS: Both descriptive and linear regression analyses indicated that a substantial drop occurred in suicidal gestures and attempts. Suicide deaths neither declined significantly nor increased, although the total number of self-destructive acts declined by 73% (P=.001). CONCLUSIONS: Data from this community-based approach document a remarkable downward trend-measured by both magnitude and temporal trends in the specifically targeted age cohorts-in suicidal acts. The sequential decrease in age-specific rates of suicide attempts and gestures is indicative of the program's success.