“Apache Culture Is so Relation-Based”: Social Influences of Suicide Risk and Protective Factors in White Mountain Apache Youth

Introduction: American Indian/Alaska Native (AI/AN) youth have the highest suicide mortality rate compared to other ethnic groups in the U.S. The White Mountain Apache Tribe (WMAT) and Johns Hopkins Center for American Indian Health have a 25-year partnership and have been conducting community-based research and culturally tailored intervention development to reduce suicide in the WMAT community. The current qualitative study aimed to refine an ecologically-based suicide risk and protective factors model by examining social influences of suicide risk in WMAT youth.

Methods: This qualitative study included 32 WMAT community members (75% female) who were recruited through snowball and convenience sampling. Three 60-90 minute roundtable meetings were conducted (n = 2 youth; n = 1 adults) with 6-12 participants. These roundtable discussions were led by a trained research assistant who used a semi-structured interview guide with questions related to individual, institutional, interpersonal, and broad social factors associated with WMAT youth suicide.

Results: We took an iterative approach to data analysis and began with a data immersion phase. Two independent analysts read each transcript from the roundtable discussions twice prior to coding. They read the transcripts a third time and generated initial descriptive codes for basic activities and processes within the data. Finally, the data analysts conducted secondary-cycle coding to develop thematic concepts regarding social influences of WMAT youth suicide. Themes that emerged from data include suicide contagion, normalization of violence, substance use, concern about community negativity, bullying, spirituality, trauma, social support, spirituality, and Apache strengths.

Conclusions: The current qualitative study provides a better understanding of the social influences of WMAT youth suicide. Results showed 10 major themes emerging from community perspectives about the impact of social networks in WMAT youth suicide. This community-derived information can be used to develop interventions by engaging protective social networks, including family, and emphasize Apache strengths and culture.