Historical and contemporary factors influencing non-lethal suicidal behavior among reservation-based Native American youth

Background: Despite progress in understanding non-lethal suicidal behavior among youth in the United States little is known about the factors that contribute to this behavior among reservation based Native American youth.;Objectives: The purpose of this dissertation was to further the understanding of non-lethal suicidal behavior (suicide ideation and suicide attempt) among reservation based Native American youth, 15-24 years of aged, by examining the relationship between historical trauma, historical loss, contemporary trauma, individual trauma response, protective factors and lifetime suicide ideation and attempts in an understudied population. Design and methods: A cross-sectional correlational design was used. Data were collected using an anonymous web-based survey. Participants completed a self-report 187 item survey assessing individual experiences with suicide ideation and suicide attempt, and including historical trauma, historical loss, historical loss associated symptoms, exposure to violence, childhood trauma, perceived discrimination, substance use, depression, PTSD, communal mastery, and cultural identity.;Sample: 288 Native American youth 15-24 years of age from one reservation-two tribes in the northern plains participated in this study.;Findings: Lifetime suicide ideation and lifetime suicide attempt were highly prevalent in this sample. Of 288 participants 45.3% and 35.8% reported lifetime ideation and attempts, respectively, while 47.6 reported no ideation or attempts. Females reported more ideation (58.1 vs 41.9) and more attempts (55.0 vs 45.0) than males however, no significant gender differences were found across ideation or attempt. Historical loss, historical loss associated symptoms, perceived discrimination, exposure to violence, childhood trauma, substance use, PTSD, depression, suicide ideation and suicide attempt were highly prevalent in this sample. Significant predictors of lifetime suicide ideation include historical loss associated symptoms, physical neglect, emotional abuse, physical abuse, domestic violence exposure, witnessing violence, victim of violence, learning of violence, perceived discrimination, PTSD symptoms, depressive symptoms, methamphetamine use, prescription drug misuse, inhalant use, alcohol use, marijuana use as well as poly drug use. Those significant predictors of suicide attempt were historical loss associated symptoms, physical neglect, emotional abuse, physical abuse, domestic violence exposure, victim of violence, learning of violence, perceived discrimination, PTSD symptoms, depressive symptoms, methamphetamine use, prescription drug misuse, inhalant use, alcohol use, marijuana use and poly drug use. Independent predictors of suicide ideation include learning of violence, PTSD symptoms and poly drug use, while independent predictors of suicide attempt were emotional neglect, PTSD symptoms and poly drug use.;Over two thirds of the participants report they understand some of their tribal language while almost half report speaking some of their language. Half of the participants reported their family follows tribal culture but 65% of participants expect they will follow tribal culture as adults.;Conclusion: This dissertation provides support for the notion that historical trauma, historical loss, historical loss associated symptoms, exposure to violence, childhood trauma, perceived discrimination, PTSD symptoms, depressive symptoms, substance use, lifetime suicide ideation and lifetime suicide attempts are significant problems among this reservation youth and are cause for concern. Communal mastery had some protective capacity for historical loss associated symptoms, exposure to violence, domestic violence exposure, childhood trauma, PTSD symptoms, depression symptoms, and poly drug use. Cultural identity provided some protection for childhood trauma, PTSD symptoms, depression symptoms and poly drug use. Intervention strategies are needed to prevent suicide ideation and suicide attempts and the multiple associated factors.