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Suicide Among Alaska Natives

September 10, 2010

The Anchorage Daily News (ADN) editorial today (September 10, 2010) focused on Worldwide Suicide Prevention day and Suicide Prevention Week in Alaska. This is a sad topic, but one that does need focus. Alaska Native suicides are reported to be 500% higher than the national average. The regular population of Alaska reports 80% greater suicide rates than the national average. I have a lot of friends who are involved in suicide prevention, and I have a lot of friends and relatives who have suffered from suicide within their own family. It saddens me to think of the many lives negatively impacted by suicide.

As with every problem we tackle here at Chugachmiut, we are interested in looking at the root cause of the problem. Using our Lean Management principles, we ask the “5 Whys.” This description of the 5 Whys from Wikipedia describes the tool effectively.

“The real key is to encourage the troubleshooter to avoid assumptions and logic traps and instead to trace the chain of causality in direct increments from the effect through any layers of abstraction to a root cause that still has some connection to the original problem. Note that in this example the fifth why suggests a broken process or an alterable behavior, which is typical of reaching the root-cause level.”

Avoiding assumptions and logic traps is hard. We want to believe we have the answers to the problems that face us, and the first one we grab is the one we hold on to. Here is what the editors at ADN say is the solution: “Alaskans need to come together to mend the net.” This phrase is taken from a story that cites the advice of an Elder. The advice that is based on the Mend the Net analogy is two fold” (1) “we need to start talking again;” and (2) Hard work needs to be reinstated in our family units again.” Another mental health care professional says “There is more than one cause for the hopelessness that leads to suicide.” No other solutions are offered in the editorial.

Here is my stab at a root cause analysis. I know it is incomplete, but it does offer a long term plan to arrive at a solution.

The Adverse Childhood Experience Study (ACES) explored the relationship between 10 (originally 8 of them) experiences children have that negatively affect their neurobiological development. The information I am discussing comes from an article titled “Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span: Findings from the Adverse Childhood Experiences Study, Dube et al., JAMA,. December 26, 2001—Vol 286, No. 24.” For this article, 8 of the 10 ACEs were used. They are: (1) emotional abuse; (2) physical abuse; (3) sexual abuse; (4) battered mother; (5) household alcoholic/drug abuse; (6) mental illness in household; (7) parental separation or divorce; and (8) incarcerated household member. As I reported before in this blog, 33% of American Indians are reported in some studies to have 4 or more ACEs in their background. Only 12% of the population studied in the original ACES had 4 or more ACEs.

Here is the shocking data: having 4 ACEs in your childhood increase the likelihood of childhood/adolescent suicide attempts 12 fold over having no ACEs. There is a direct graded relationship between the number of ACEs, and the increasing likelihood of suicide attempts. Adults with 5 ACEs reach an 11 fold increase in risk for suicide attempts.

Quite obviously, many children/adolescents/adults never attempt suicide. However, they may think about it, and that is one relationship I have not yet found documentation for. But, if the number of ACEs increases the risks for attempting suicide, it must also increase the rates of successfully committing suicide.

What the ACES suggests is that reducing the prevalence of ACEs will reduce the risk for suicide attempts. The question now becomes how do we reduce the prevalence of ACEs?

Because we cannot prevent the ACEs that have already been accumulated by our adult population, we can only look at mitigating the impact of those ACEs, that is, try to reduce the attempts at committing suicide. This is where having appropriate trauma informed therapies can help. There is increasing evidence that becoming informed about the neurobiological changes caused by having multiple ACEs in childhood can lead to finding resolutions to the trauma, and that neurobiological patterns can be successfully altered. By making trauma informed services available to adults, we have a good likelihood of reducing the number of successful suicide attempts.

For children/adolescents, rapid intervention and trauma informed therapy appear to allow a quicker resolution for the trauma, and provide better coping skills. Children/adolescent brains appear to be more resilient.

Parents with multiple ACEs have a greater likelihood of perpetuating the spread of trauma to their children because of the impact of their own ACEs on their behaviors. Our divorce rate is very high, parental abandonment is significant, alcohol/drug abuse rates are the topic of substantial discussion, and our population experiences higher rates of incarceration at the hands of the dominant culture than other populations. Depression rates among Alaska Natives are quite high, as are other mental illnesses. Our rates of domestic violence, particularly as victims, are also high. As we help our adult population deal with the consequences of their multiple ACEs, we must also start building our skills: at parenting and at building healthy relationships. It will, in my opinion, require a dialogue that includes the taboo topic of poor parenting. While we do not want to blame our parents for the negative consequences poor parenting has on our children, we do need to discuss the topic and arrive at a consensus on how to achieve the change needed in order to reduce the numbers of ACEs among our child/adolescent population.

The kind of services we need in rural and urban Alaska to address our issues in the way I am recommending are extremely low. However, I truly believe that this provides us our greatest chances for success in reducing the risk of suicide among our population. It also provides us with our greatest change to be successful in reducing the other risky behaviors that children/adolescents/adults with higher ACEs adopt to cope with their unresolved childhood trauma.

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