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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. (Am J Public Health. 2005;95:1238-1244. doi:10.2105/AJPH.2004.040410)
Recently, a number of scholars and officials have called for population-based public health strategies for preventing suicide in entire communities and racial/ethnic groups. Noting that approaches to suicide prevention are often narrowly based on psychiatric and individual dynamics, the surgeon general,1 the US Public Health Service,2 and the Institute of Medicine3 have voiced the need for a new, comprehensive understanding of suicidal behavior on which to base suicide prevention efforts. Three recent publications explain the rationale for a population-based approach to preventing suicidal behavior,3 calling suicide prevention a national imperative3 for public health intervention.4,5
American Indian/Alaska Native (AIAN) suicide studies and prevention programs have frequently been approached from a public health perspective,6-22 but detailed evaluation of such programs among American Indians/Alaska Natives has been quite rare in practice and in the literature.18 We describe an outcome evaluation of a suicide prevention program among the Western Athabaskan Tribal Nation (a pseudonym used to protect the identity of this tribe-one of several Athabaskan tribes in the southwestern United States-and its reservation) of New Mexico. This program is part of an ongoing effort to evaluate AIAN suicide trends, potential causes of these trends, and the efficacy of prevention programs in New Mexico19,23,24 (P. Serna, unpublished data, 1991; Western Athabaskan Tribal Nation, unpublished data, 2003).
An increase in suicidal activity among AIAN adolescents and young adults on this reservation in 1988 prompted the tribal council and community and the Indian Health Service (IHS) to work together to establish an adolescent suicide prevention...