Utilizing GIS to Investigate Suicide Clusters in a Rural American Indian Community

Introduction: Using geospatial information to track suicidal behaviors within communities has not yet been explored. This may have particular importance in American Indian communities experiencing suicide epidemics. Cheung et al. found that areas within Australia with a higher concentration of indigenous individuals were at greater risk for suicide, but no studies have specifically focused on indigenous territory to locate focal points of suicide clustering (Cheung et al., 2013). Suicide can occur in geospatial clusters and via social contagion which makes identifying and providing timely prevention and postvention services of utmost importance. This study aims to determine the utility and feasibility of mapping suicide in a community in order to better inform interventions in high-risk communities.

Methods: GIS coordinates were collected as a part of the White Mountain Apache tribe’s suicide surveillance system between February 2014 and August 2015. Suicidal behavior is defined here as suicide deaths, suicide attempts, suicide ideation, non-suicidal self-injury, and binge substance use. Coordinates are collected by local paraprofessionals trained by university partners as public health technicians who regularly follow up on reported suicidal behavior to collect surveillance data and engage individuals and families in referral plans. The following outcomes were recorded: geographic location of suicidal acts, geographic location of suicidal individuals’ homes, reasons for suicidal behavior, and methods of suicidal acts in incident cases. US Census data was utilized to determine the underlying population of the community surrounding each suicidal event.

Results: 193 suicidal events were observed during an 18-month period. The majority of suicidal acts (82.6%) and suicidal individuals’ homes (85.0%) fell in three of the nine U.S. census tracts contained within the study reservation. The census tracts with the densest incidence of suicidal behavior reported 428.17 cases of suicide attempts, 626.12 cases of suicide ideation, 268.34 cases of non-suicidal self-injury, and 491.95 cases of binge substance use per 100,000 among the community’s youth, aged 10-25 years.

Conclusions: Geographically targeted suicide prevention efforts could improve the prevention team’s ability to respond to and reduce the incidence of suicidal behavior in this high-risk community. Follow-up studies should quantitatively assess the impact of spatially-informed interventions’ impact on youth suicide. A better understanding of the spatial dependence of suicidal behavior holds the potential to inform location-based suicide interventions that will save lives in the communities that need it the most.