Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System

Suicide deaths among the White Mountain Apache tribe in Arizona dropped by nearly 40 percent between 2006 and 2012 compared to the previous six-year period due to community-based efforts, according to a new study by researchers at Johns Hopkins Bloomberg School of Public Health.

From 2001 to 2006, the suicide rate among 15- to 24-year-olds in the White Mountain Apache tribe was 13 times greater than the general U.S. population, and seven times the rate for all American Indians and Alaska Natives.

When the tribe realized the extent of the disparity, they reached out to their long-time partner, the Johns Hopkins Center for American Indian Health, to analyze surveillance data and to help develop and implement a comprehensive prevention program.

The significant reduction came after legislation was passed to develop a surveillance system and an intensive prevention program that identified and prioritized those with suicidal ideation and/or attempts.

“Suicide is a public health problem that many don’t see as preventable,” said study leader Mary Cwik, Ph.D., a clinical psychologist and researcher at the Johns Hopkins Center for American Indian Health at the Bloomberg School.

“In recent years, suicide deaths have surpassed deaths due to motor vehicle crashes, and suicide is the leading cause of death globally for girls between the ages of 15 and 19. This study shows how a courageous community, the White Mountain Apache Tribe, used legislation and community mental health workers to successfully address suicide as a public health crisis.”

Specifically, the tribe initiated training for adults to identify at-risk youth:

  • two school-based programs, one calling upon elders to promote cultural engagement and the other promoting coping and problem-solving skills;
  • screening and interventions in the tribe’s emergency rooms to connect those who attempt suicide or experience a binge drinking or drugging episode with counseling;
  • and a community-based media campaign to promote prevention education.

The tribe developed a unique community surveillance system that tracks and triages suicide deaths, attempts, and suicidal thoughts with technical assistance from the Johns Hopkins researchers.

After an incident is reported, Apache outreach workers follow up with in-person visits to verify what happened, listen to the individual’s story, provide emotional support, and connect individuals to care. These staff members also follow up to monitor the individual’s welfare over time.

The findings support previous research showing that suicide is preventable with comprehensive, community-based efforts. It is also one of the only studies to show reduction in both attempts and deaths.

“We are proud of our Tribal Council for passing a law in support of a community-based suicide prevention surveillance system,” said Novalene Goklish, B.S., outreach team supervisor and member of the White Mountain Apache Tribe who was involved in the study. “We are determined to let our Apache people who are hurting know that there is real help for them.”

Overall, suicide rates dropped in the community by 38.3 percent, while national rates remained stable or rose. This included a 60 percent decrease among the 25-to-34-year-old group and a 37 percent decline among those between the ages of 20 and 24.

While the disparity remains, the trend is encouraging. From 2001 to 2006, 41 Apache tribal members died of suicide, while 29 died from 2007 to 2012. The annual number of attempts also decreased from 75 in 2007 to 25 in 2012.

“Suicide is a multifaceted and complicated public health problem,” Cwik said. “There is still a lot of work to do, particularly in understanding how to prevent clusters of deaths, or what we call ‘contagion,’ especially among young people.

“It is imperative to sustain locally driven efforts, especially after seeing these promising results. The surveillance system and linked prevention programs have shown they can save many young lives.”

The researchers and the tribe have been approached by at least 10 other tribes in need. They believe their program will not only help American Indians, but other communities at high risk for suicide.

Population of focus: American Indian and Alaska Native youth

Links to resource:

Date: 2016

Organization: Johns Hopkins Center for American Indian Health and the White Mountain Apache tribe

Journal: American Journal of Public Health