Comprehensive Suicide Prevention Program Reduces Suicide Deaths and Attempts Among White Mountain Apache

Introduction: American Indians/Alaskan Natives (AIs/ANs) are disproportionately affected by suicide and disparities are largely concentrated within adolescents and young adult age groups (2.5 times the US all-races rate). Few prevention programs have been developed targeting suicide directly and very few are designed with or for AIs/ANs specifically. We evaluated the impact of a comprehensive youth suicide prevention program among the White Mountain Apache of Arizona since its implementation.

Methods: The White Mountain Apache have utilized a community-based, multitiered approach funded by SAMHSA-GLS from 2006-present. Universal-level interventions bring community agencies and key stakeholders together using a participatory approach and raising community awareness. Selected-level interventions included gatekeeper trainings, activities led by Elders, and in-school interventions. Indicated-level interventions included a brief emergency department-linked intervention for youth who made a suicide attempt. Community mental health workers and flexible delivery models are key to the program’s success. We examined Apache surveillance data for patterns and characteristics over time (2001-2006 vs. 2007-2012) and evaluated the impact of prevention activities.

Results: Suicide death rates decreased by 38% from 40.0 to 24.7/100,000, while national rates remained relatively stable during this time, between 10-13/100,000. Notable decreases were seen in ages 25-34 (-60%; 95.0 to 37.9/100,000) and 20-24 (-37%; 151.9 to 96/100,000). Suicide attempts declined over time with a total of 443 attempts verified through the surveillance system from 2007-2012. Alcohol use co-occurred in more than half of all deaths and attempts. Approximately 69% of attempts were by youth <25 years old and Apache women, particularly young mothers, seem to be at increased risk, with 60% of females (6 of 10) who died reported to be parents.

Conclusions: The initial period of strict community-wide, mandated surveillance (2001 to 2006) allowed the Apache to fund their comprehensive program of intensive interventions (2007 to present). These innovative data provide a unique opportunity for a natural experiment that allows comparison of rates from pre- to post-implementation. The data show that while the national suicide rate has slightly increased over time; the Apache rate has decreased—one of few studies to show changes in suicide deaths. This study also identifies areas of focus for continued suicide intervention and prevention programs in this community, particularly on alcohol abuse and supporting young parents. The program is unique because of the accuracy, quality and depth of local data and the longevity of the prevention activities driven by community needs and public health principles.