# data[].attributes.attachment_link.readable_text
Indigenous overrepresentation in the criminal justice system
PDF Version
May 2019

Research and Statistics Division

Indigenous people are overrepresented in Canada's criminal justice system as both victims and as people accused or convicted of crime.

There are only a few national data sources that provide criminal justice statistics disaggregated by Indigenous identity. National data that does exist to identify Indigenous people in the criminal justice system include the General Social Survey (GSS) on self-reported victimization, police-reported homicide statistics, and data on provincial/territorial and federal custody.

This fact sheet uses data from the 2014 General Social Survey (GSS) on Victimization. Every five years, the GSS on Criminal Victimization presents data on Canadians aged 15 years and older who report having been victimized in the previous twelve months. For comparison's sake, the survey focuses on eight specific categories of crime: sexual assault, robbery, physical assault, theft of personal property, break and enter, theft of motor vehicle or parts, theft of household property, and vandalism. This fact sheet also uses data from special studies conducted by the Canadian Centre for Justice Statistics at Statistics Canada, Statistics Canada's Homicide Survey, and the correctional surveys from Statistics Canada: Adult Correctional Services Survey (ACS); Integrated Correctional Services Survey (ICSS); and Canadian Correctional Services Survey (CCSS).

Indigenous people, in particular women, are more likely to be victims of crime

In 2014, 28% of Indigenous people (aged 15+) reported being victimized in the previous 12 months, compared to 18% of non-Indigenous Canadians. The rate of violent victimization among Indigenous people was more than double that of non-Indigenous people (163 incidents per 1,000 people vs. 74 incidents per 1,000 people).

Indigenous women had an overall rate of violent victimization that was double that of Indigenous men and close to triple that of non-Indigenous women. The rate of violent victimization for Indigenous women in 2014 was 220 violent incidents per 1,000 people, while the rate for Indigenous men was 110 per 1,000. The rate of violent victimization reported by non-Indigenous women was 81 per 1,000, and for non-Indigenous men was 66 per 1,000. Indigenous women also reported a sexual assault rate of 115 incidents per 1,000 population, much higher than the rate of 35 per 1,000 reported by non-Indigenous women.

Researchers can use analysis strategies to study particular risk factors for victimization. When controlling for various risk factors, Indigenous people are no more at risk of violent victimization than their non-Indigenous counterparts. Rather, the higher rates of victimization observed among Indigenous people appear to be related to the increased presence of other risk factors-such as experiencing childhood maltreatment, perceiving social disorder in one's neighbourhood, having been homeless, using drugs, or having fair or poor mental health.

However, high victimization rates among Indigenous women cannot be fully explained by risk factors of victimization. Even when controlling for various risk factors, Indigenous identity was a risk factor for violent victimization of Indigenous women. Notably, Indigenous women were more likely to report experiencing both physical and sexual maltreatment as a child than their male counterparts. Such childhood maltreatment is a risk factor for victimization.

Indigenous people are overrepresented as homicide victims and people accused of homicide

In 2017, there was a 32% increase in the rate of homicides for Indigenous women victims (4.22 per 100,000 Indigenous women) from the previous year. In comparison, the homicide rate for Indigenous men (13.40 per 100,000 Indigenous men) increased by 2% in 2017. The homicide rate for Indigenous men has been increasing consistently since 2014.

More than one-third (38%) of persons accused of homicide in 2017 were identified by police as Indigenous. This proportion has been increasing since 2014 when 31% of persons accused of homicide were Indigenous. The rate of Indigenous people accused of homicide in 2017 was 12 times higher than the rate of non-Indigenous accused (11.12 vs. 0.93 per 100,000 population).

In 2017, the rate of Indigenous men accused of homicide (18.05 per 100,000 Indigenous men) was 11 times higher than the rate of non-Indigenous men (1.69 per 100,000 non-Indigenous men). The rate of Indigenous men accused of homicide in 2017 was four times higher than the rate of Indigenous women accused (4.33 per 100,000 Indigenous women).

Indigenous adults are overrepresented in custody and the numbers are increasing

Saskatchewan can report unique persons entering custody to provide more accurate data than admissions counts

Over a three year period in Saskatchewan, the number of unique Indigenous men who entered custody decreased from 4,137 in 2015/2016 to 4,080 in 2017/2018, which represents a 1% decrease. In contrast, the number of unique non-Indigenous men who entered custody decreased from 1,621 to 1,492, which represents an 8% decrease. The number of unique men, where Indigenous identity is unknown, decreased 19% from 296 to 241.

Indigenous youth are overrepresented in custody and the numbers are increasing

Indigenous youth are overrepresented in both custody and community supervision, making up 48% of custody admissions and 39% of community admissions in 2017/2018 in the reporting jurisdictions.

Overrepresentation in custody is more pronounced for Indigenous women

In 2017/2018, Indigenous adult men accounted for 28% of the men admitted to custody in the provinces and territories. Indigenous women made up a greater proportion of custody admissions than their male counterparts, accounting for 42% of the women admitted to custody. Compared to 2007/2008, the number of admissions of Indigenous men to provincial/territorial custody increased 28% while the number of admissions of Indigenous women increased 66% in the provinces and territories.

There is more criminal justice system re-contact among Indigenous people

Statistics Canada conducted a special study using record linkage procedures to explore an individual's re-contact with the criminal justice system. A re-contact study with the Saskatchewan justice system found that Indigenous people were significantly more likely than non-Indigenous people to have re-contact with police following correctional involvement (80% vs. 57%).

Footnotes

Footnote 1

Footnote 2

Footnote 3

Footnote 4

Footnote 5

Footnote 6

Footnote 7

Statistics Canada. 2017. " Aboriginal peoples in Canada: Key results from the 2016 census."(The Daily). Statistics Canada catalogue no. 11-001-X.

Footnote 8

Footnote 9

Footnote 10

Footnote 11

Footnote 12

Footnote 13

Footnote 14

Footnote 15

Footnote 16

Footnote 17

Footnote 18

Footnote 19

# data[].attributes.attachment_link.title
JustFacts - Indigenous overrepresentation in the criminal justice system

# data[].attributes.attachment_link.description
Department of Justice Canada’s Internet site

# data[].attributes.attachment_link.readable_text
In Canada, official statistics have consistently documented at the national level what is highlighted above in the Intimate Femicide in Ontario study: Indigenous women are significantly more likely to be killed by male partners than non-Indigenous women in Canada. In fact, Indigenous women and girls are overrepresented as victims of femicide more generally. For example, about four percent of the Canadian population is Indigenous and female yet they represented 24 percent of homicide victims in 2015. Despite their higher risk of intimate femicide, however, some research shows that Indigenous women and girls are also often killed by male acquaintances and strangers.

This fact was brought to light by the Sisters in Spirit grassroots initiative launched in 2005 by the Native Women's Association of Canada (NWAC) who documented that, by 2010, over 580 Indigenous women and girls across Canada were murdered or went missing. Among the findings was that Indigenous women and girls were more often killed by male acquaintances or strangers than by male partners, although official statistics indicate that they remain eight times more likely to be killed by male partners than non-Indigenous women.

The initial estimate of femicide documented by the grassroots initiative has risen to almost 1,200 since the Royal Canadian Mounted Police (RCMP) began investigating the issue following the Sisters in Spirit campaign. After repeated calls for an inquiry into the treatment of Indigenous women and girls, the Canadian government launched the National Inquiry into Missing and Murdered Indigenous Women and Girls in 2016. The mandate is to report on systematic causes of all forms of violence against Indigenous women.

The Sisters in Spirit initiative highlighted various systemic issues including the impunity of many of the perpetrators, similar to what is being documented in other world regions. Their study found that nearly half of the cases involving indigenous women and girls remain unsolved and no charges were laid in about 40 percent of the cases. These figures continue to be contested and debated by others, including the RCMP, who reported clearance rates that were much higher, ranging from 80 to 100 percent. The proportion of those that resulted in charges or convictions is not currently known.

Regardless, it is now recognized, most recently in the inquiry's interim report, that the high risk of violence experienced by Indigenous women and girls stems, in large part, from a failure of police and others in the criminal justice system to adequately respond to, or provide for, the needs of Indigenous women and girls.

Femicide can be used to describe the killings of indigenous women and girls. Given the role of racialized violence and the documented impunity of some of the perpetrators, the term 'feminicide' which has become more common in Latin American countries may also be appropriate given that it is meant to capture the impunity of perpetrators and the inadequate state responses to these crimes. Because gender remains an important determinant of their risk of lethal violence in some contexts compared to Indigenous men, femicide has been used to describe these killings.

[For example, http://www.independent.co.uk/news/world/americas/canadas-femicide-epidemic-brings-calls-for-inquiry-9687855.html]

# data[].attributes.attachment_link.title
Murdered and Missing Indigenous Women and Girls

# data[].attributes.attachment_link.description
In Canada, official statistics have consistently documented at the national level what is highlighted above in the Intimate Femicide in Ontario study: Indigenous women are significantly more likely to be killed by male partners than non-Indigenous women in Canada. In fact, Indigenous women and girls are overrepresented as victims of femicide more generally.

# data[].attributes.attachment_link.readable_text
Families of missing and murdered Indigenous women and girls met with participants of the 2016 National Roundtable at a separate gathering yesterday to discuss directly with provincial and territorial leaders their recommendations for achieving justice and ending violence.

Ontario Premier Kathleen Wynne provided an update on the Canada-wide prevention and awareness campaign committed to at the 2015 National Roundtable.

Alberta Indigenous Relations Minister Richard Feehan shared an update on work underway through the Aboriginal Affairs Working Group to develop a socio-economic action plan for Aboriginal women. The plan will present a comprehensive account of the challenges and barriers that adversely impact socio-economic outcomes for Aboriginal women. It will share best practices and identify collaborative means to improve socio-economic outcomes of Aboriginal women.

Federal Ministers Jody Wilson-Raybould, Dr. Carolyn Bennett and Patty Hajdu provided an update on the engagement process and planning for a National Inquiry on missing and murdered Indigenous women and girls. Participants shared their support for a National Inquiry and views on how to best engage and reflect regional interests and perspectives.

All participants want to acknowledge the excellent work accomplished at the 2016 Justice Practitioners' Summit, and will work to examine all of the recommendations contained within the report. The Summit gathered together nearly two hundred participants from across Canada representing experts and practitioners in three key sectors: victim services; policing; and prosecutions.

Roundtable participants expressed support for ongoing efforts among all governments and organizations engaged in ending violence against Indigenous women and girls.

2016 National Roundtable on MMIWG participants included families of missing and murdered Indigenous women and girls, Manitoba Premier Greg Selinger, Ontario Premier Kathleen Wynne, federal Ministers of Justice, Indigenous Affairs and Status of Women, provincial and territorial Ministers, Assembly of First Nations National Chief Perry Bellegarde, Congress of Aboriginal Peoples National Chief Dwight Dorey, Inuit Tapiriit Kanatami President Natan Obed, Métis National Council President Clément Chartier, Native Women's Association of Canada President Dawn Lavell-Harvard, Pauktuutit Inuit Women of Canada President Rebecca Kudloo, Les Femmes Michif Otipemisiwak / Women of the Métis Nation President Melanie Omeniho.

View the full list of participants to the 2016 National Roundtable on MMIWG here.

# data[].attributes.attachment_link.title
MMIWG Missing and Murdered Indigenous Women and Girls and Ending Violence - Assembly of First Nations - AFN

# data[].attributes.attachment_link.description
Families of missing and murdered Indigenous women and girls met with participants of the 2016 National Roundtable at a separate gathering yesterday to discuss directly with provincial and territorial leaders their recommendations for achieving justice and ending violence. Ontario Premier Kathleen Wynne provided an update on the Canada-wide prevention and awareness campaign committed to at the 2015 National Roundtable.

# data[].attributes.attachment_link.title
UN report highlights 'abhorrent' housing conditions for Indigenous people

# data[].attributes.attachment_link.description
A United Nations report is highlighting the role "abhorrent" housing conditions play in the poverty and exploitation that Indigenous people face in Canada and around the world.

# data[].attributes.attachment_link.readable_text
The housing needs in Inuit communities are the highest amongst all populations in Canada, with 40 per cent of Inuit living in overcrowded housing compared with six per cent of Canadians as a whole. In 2011, the "core" housing need - meaning the number of people needing access to suitable housing - was 33.6 per cent for Inuit, compared with 12.5 per cent Canada-wide.

Throughout Inuit Nunangat, a deep and costly housing crisis has persisted for decades. It began in the second half of the 20th century when more Inuit began to live in permanent settlements. In some cases, Inuit were forced to relocate to other settlements by federal, provincial and territorial governments because their communities were seen as too small or too remote to provide services. Commitments were made to provide housing to Inuit settling in these communities, but the housing provided was extremely inadequate. Many spent their first few years living in the communities in tents because no housing was available when they were relocated. Communities were instantly overcrowded, and households were ill-equipped by all standards, let alone those living in Arctic and Subarctic conditions.

Inuit experience enormous stress from the negative effects of overcrowded and inadequate housing.

Chart showing the barriers to housing in the Inuit regions

Inuit communities lack the numerous and diverse housing options available in southern Canada. The housing continuum for most Inuit communities is generally restricted to public housing units for the majority of Inuit, government staff housing subsidized by employers and very expensive single-family dwellings that are limited to the few communities large enough to have private housing markets.

Because housing affects every aspect of life, including work, health, education and family, it is crucial that quality housing be made available to everyone. Inuit experience enormous stress from the negative effects of overcrowded and inadequate housing. The Inuit population is the youngest population in the country, with a median age of 23. Throughout Inuit Nunangat, the chronic lack of housing stifles youth social mobility, with overcrowding linked to increased health problems for youth, who often find it difficult to get enough sleep or find a quiet place to study and do their homework. Having access to appropriate and affordable housing is critical for improving education and learning along with health and well-being.

Today, Inuit are involved in the direct management of housing in their communities. In addition to managing housing directly, each Inuit land claims organization has well-established and reliable construction divisions and economic development organizations that were created to ensure the maximum level of benefits remain in Inuit communities.

The solutions for improving housing outcomes will not look the same for all regions. Each Inuit region is unique in terms of housing delivery, roles and responsibilities (the nature of partnerships within each jurisdiction for the delivery of housing) and specific housing needs. In addition to inconsistent or non-existent access to federal housing funding, as described above, the criteria associated with federal and provincial programs generally do not result in appropriate housing solutions for Inuit communities.

View of a typical Inuit community that lacks the diverse housing options available in Southern Canada

Affordability is the biggest barrier to increasing private home ownership or rental options for Inuit in Inuit Nunangat. Housing construction and operation and maintenance costs in Inuit communities are extremely high. When combined with the high cost of living and the low income levels of many Inuit families, renting or owning a home, without significant subsidies, is impossible. The federal government's national housing strategy (a 10-year, $40-billion plan announced in late 2017) and subsequent policies and programs must take into consideration how these high costs drastically and negatively impact life in Inuit communities. The government must commit to work in partnership with Inuit to find ways to reduce the costs associated with lot development, construction and operations and maintenance, including the transportation of materials. Having access to direct, flexible investments would ensure that Inuit authorities can make the most impact toward addressing the needs in their communities.

Targeted efforts in the Inuit regions are leading to improved housing designs that will hopefully begin to spread further throughout Inuit communities, helping to ensure the sustainability of housing in Inuit Nunangat. One example of an improved design is a prototype duplex constructed in Nunavik, Que., following collaboration from a number of partners. A second example is a sixplex design under construction in Nunatsiavut by the Nunatsiavut government.

# data[].attributes.attachment_link.description
The housing needs in Inuit communities are the highest amongst all populations in Canada, with 40 per cent of Inuit living in overcrowded housing compared with six per cent of Canadians as a whole. In 2011, the "core" housing need - meaning the number of people needing access to suitable housing - was 33.6 per cent for Inuit, compared with 12.5 per cent Canada-wide.

# data[].attributes.attachment_link.readable_text
Skip to text

Text begins

Start of text box
Mental wellness resources and crisis help for First Nations people, Métis and Inuit
End of text box

Acknowledgments

We would like to acknowledge the review of preliminary findings and/or draft versions of the report by Indigenous organizations, including Inuit Tapiriit Kanatami, the Métis National Council, and the National Association of Friendship Centres, and federal departments including Indigenous Services Canada and Crown Indigenous Relations and Northern Affairs Canada. The analysis and the report were greatly strengthened by the suggestions and recommendations provided in the process. We also thank Jodie Golden, Public Health Agency of Canada ( PHAC) for reviewing the draft report for safe messaging.

Abstract

Suicide rates have consistently been shown to be higher among First Nations people, Métis and Inuit in Canada than the rate among non-Indigenous people; however, suicide rates vary by community, Indigenous group, age group and sex. The historical and ongoing impacts of colonization, forced placement of Indigenous children in residential schools in the 19th and 20th centuries, removal of Indigenous children from their families and communities during the "Sixties scoop" and the forced relocation of communities has been well documented. These resulted in the breakdown of families, communities, political and economic structures; loss of language, culture and traditions; exposure to abuse; intergenerational transmission of trauma; and marginalization, which are suggested to be associated with the high rates of suicide. While suicide among Indigenous people has been examined previously, studies were based on a decades-old cohort or used an area-based geozones approach. Past studies also examined suicides among only one or two Indigenous groups using the same methodology. Finally, they did not examine suicide among Indigenous people for some geographies such as on and off reserve, rural areas and small, medium and large population centres.

This article attempts to fill some of these knowledge gaps using the 2011 Canadian Census Health and Environment Cohort (CanCHEC), resulting from a record integration between the 2011 National Household Survey (NHS) and the Canadian Vital Statistics Database (CVSD). It presents suicide rates for the 2011 to 2016 time period among self-identifying First Nations, Métis, Inuit, and non-Indigenous people in private dwellings in Canada. It also explores the influence of socioeconomic factors in the disparity in risk of suicide between First Nations people, Métis, Inuit and non-Indigenous people in Canada.

Suicide rates among First Nations people, Métis and Inuit were significantly higher than the rate among non-Indigenous people. The rate among First Nations people (24.3 deaths per 100,000 person-years at risk) was three times higher than the rate among non-Indigenous people (8.0 deaths per 100,000 person-years at risk). Among First Nations people living on reserve, the rate was about twice as high as that among those living off reserve. However, suicide rates varied by First Nations band, with just over 60% of bands having a zero suicide rate. The rate among Métis (14.7 Note E: Use with caution deaths per 100,000 person-years at risk) was approximately twice as high as the rate among non-Indigenous people. Among Inuit, the rate was approximately nine times higher than the non-Indigenous rate (72.3 versus 8.0 deaths per 100,000 person-years at risk). Suicide rates and disparities were highest in youth and young adults (15 to 24 years) among First Nations males and Inuit male and females.

Socioeconomic factors, including household income, labour force status, level of education, marital status and geographic factors such as living on or off reserve (First Nations people) and community size (Inuit) accounted for a notable proportion of the disparity in risk of death by suicide among First Nations people (78%), Métis (37%) and Inuit (40%) adults, 25 years or older. However, due to limitations of the data, the role of other previously-identified factors such as historical and intergenerational trauma, community distress, cultural continuity, family strength and mental wellness were not explored here.

The findings from this study could contribute further to the understanding of suicide among First Nations people, Métis and Inuit in Canada, particularly with respect to the variability in suicide rates and socioeconomic factors associated with the disparity in suicide risk.

Introduction

First Nations people living on and off reserve, Métis and Inuit, die by suicide at a higher rate than non-Indigenous people. These suicides not only result in loss to family, friends and peers leading to immense grief and bereavement, but also to the community and society at large, in particular when the deceased is a young person. The impact of suicide is more widespread and severe in small Indigenous communities where many people are related and many experience similar personal and collective adversity.

The suicide rate for children and youth was previously reported to be 10 times higher among males and 22 times higher among females between 2005 and 2007 in areas with a high percentage of First Nations people compared with low-percentage areas. In Inuit Nunangat, the Inuit homeland made up of the Inuvialuit Region (northwest part of Northwest Territories), Nunavut, Nunavik (Northern Québec), and Nunatsiavut (Northern Labrador), the suicide rate among children and youth was 33 times higher than for the rest of Canada between 2004 and 2008. In fact, suicide is one of the leading causes of death among children and youth in areas with a high proportion of First Nations people and in Inuit Nunangat.

In adults, the suicide rates (1991 to 2006) among First Nations people and Métis have been reported to be twice as high as that among non-Indigenous adults. The suicide rate among adults in Inuit Nunangat (1999 to 2003) was four times higher than the rate among all adults in Canada; the disparity was greater among men than women.

It is important to note, however, that national level suicide rates may underestimate regional or community level differences. For example, previous reports have shown that suicide rates among First Nations youth in British Columbia range from 0 to 633 deaths per 100,000 people by tribal council. In fact, the majority of these tribal councils had a zero or very low suicide rate. A similar regional variance has been seen among Inuit communities in Nunavut. The suicide rate varied from under 50 deaths per 100,000 in Whale Cove to just over 250 deaths per 100,000 people in Qikiqtarjuaq.

Several representatives of Indigenous peoples and governments, communities and government agencies have developed programs, policies or strategies to address the high suicide rate among First Nations people, Inuit and Métis. Development and evaluation of these require timely data on suicide rates. Many existing estimates of suicide rates are based on an older cohort (1991 Census cohort), which excluded non-tax filers and those under 25, or are from studies that used an area-based geozones approach. The latter classified areas with higher proportions of First Nations residents as First Nations "identity areas" or examined mortality rate in Inuit Nunangat as a proxy for the rate among Inuit. These approaches may have led to under or over estimation of suicide rates. In addition, past reports have only estimated suicide rates among one or two Indigenous groups using the same methodology. Finally, there are gaps in knowledge of suicide rates among Indigenous people for certain geographical areas, including urban areas and on or off reserve.

This article presents suicide rates among self-identifying First Nations, Métis, Inuit and non-Indigenous peoples, who lived in private dwellings (i.e., excluding those who were in collective dwellings and institutions), for the 2011 to 2016 time period. These findings are based on the 2011 Canadian Census Health and Environment Cohort (CanCHEC), which was developed by integrating records in the the 2011 National Household Survey (NHS) and the Canadian Vital Statistics - Deaths Database (CSVD from 2011 to 2016). Suicides that occurred over the follow up period of 5.63 years (from Census day on May 10, 2011 to end of follow-up on December 31, 2016) were used to generate age-standardized and age-specific mortality rates. These are presented as estimated number of deaths by suicide per 100,000 person-years at risk. The person-year concept is often used in cohort studies and represents unit of time when individuals are at risk of dying, and can be roughly understood as persons per year. Specifically, the article (1) presents suicide rates among First Nations people, Métis and Inuit alongside comparisons with the suicide rates of non-Indigenous people to explore disparities, a better understading of which could inform prevention strategies, (2) presents the estimated proportion of First Nations bands that experienced no suicides as an estimate of the variability in suicide rates, and (3) explores the role of socioeconomic and geographic factors in explaining the excess mortality from suicide among the three groups.

Results

Suicide among First Nations people in Canada

In the current analyses, among the 851,280 First Nations people (based on population estimates using the 2011 CanCHEC and its weights), including status and non-status individuals, living on and off reserve and in private dwellings in 2011, an estimated 1,180 people died by suicide between 2011 and 2016. This resulted in an age-standardized suicide rate of 24.3 deaths per 100,000 person-years at risk (Table 1), which was three times higher than the suicide rate among non-Indigenous people (8.0). The suicide rate was higher among males than females (29.6 versus 19.5, respectively). This pattern is similar to that seen among non-Indigenous people among whom males (12.3) also had a higher suicide rate than females (3.9). However, these numbers indicate that the disparity in suicide rates - measured by dividing the suicide rate among First Nations people by that among non-Indigenous people (or rate ratios [ RR]) - between First Nations and non-Indigenous peoples is higher among females than males (RR = 5.0 among First Nations females and RR = 2.4 among First Nations males; Table 1).

﻿

Suicide rates were highest among youth aged 15 to 24 (48.7; non age-standardized) (data not shown) when compared with other age groups. Suicide rates were lower among the older age groups. They were significantly higher among First Nations people than non-Indigenous people in most age groups under 45 years of age, but the disparities were widest among those under 15 years ( RR = 8.9) and 15 to 24 years ( RR = 6.3) (data not shown). This was particularly apparent among females between 15 and 24 years of age ( RR = 12.0; Table A.1 in appendix).

The suicide rate was nearly twice as high among First Nations people living on reserve than among First Nations people living off reserve (non age-standardized rate of 34.1 versus 19.5, respectively). Among on-reserve First Nations people, suicide rates were highest for males aged 15 to 24 years (78.8) (Chart 1). Rates were lower in the older age groups among both males and females on reserve (Table A.2 in appendix). Disparities were particularly elevated among 15 to 24-year-old First Nations females living on reserve ( RR = 15.8) in comparison to non-Indigenous females across Canada. Disparities were smaller in the older age groups, but continued to be seen until age 55 for females and age 45 for males. For those aged 55 and older, suicide rates were not statistically different between on-reserve First Nations and non-Indigenous people. A similar comparison to rates among First Nations people living off reserve was not done since most age-specific estimates were not published due to low cell counts or precision (table A.2 in appendix).

No significant differences were seen in the suicide rates among First Nations people (on and off reserve combined) by province and territory. However, in every province, the suicide rate among First Nations people was higher than the non-Indigenous rate (Atlantic provinces were grouped together to increase sample size; suicide rates were not reportable for the non-Indigenous population in Yukon, Northwest Territories and Nunavut). And, the rate ratios were notably higher in the Prairie provinces. It was 4.6, 4.5 and 3.5 in Manitoba, Saskatchewan and Alberta, respectively. In other provinces, it ranged from 1.9 to 2.6. Suicide rates did not differ significantly by type of population centre. It was 28.8 among First Nations people in rural areas, 22.9 Note E: Use with caution among those in small population centres and 18.8 Note E: Use with caution among those in large population centres. The suicide rate among First Nations people in each of these areas was significantly higher compared with non-Indigenous rates (9.3 for rural areas, 9.0 for small population centres and 7.2 for large population centres).

These national and provincial level estimates, while useful, underestimate the variability in the suicide rates among individual First Nations communities. Suicide rates were estimated at the band level using a geographic approach (for more details, please refer to the methods section). Of the just over 600 First Nations bands in Canada, 555 were associated with reserves that were enumerated in the 2011 NHS and with individuals in the CanCHEC cohort. Just over 60% of First Nations bands had experienced no suicides between 2011 and 2016. The proportion of bands without suicides, when examined in the context of the overall on-reserve suicide rate among First Nations people (34.1) highlights the obscuring of variability in the national level estimate. This proportion of bands with zero suicide rate varied by province and territory. A larger proportion of bands in the Atlantic provinces (55%), Ontario (71%), Saskatchewan (53%), British Columbia (78%), Yukon (80%) and Northwest Territories (74%) had zero suicide rates. In the other provinces, the proportion ranged from 39% to 44%. It should be noted that 31 reserves were incompletely enumerated in the 2011 Census many of which were in Ontario and Québec (a brief description of these reserves can be found in the methods section), and were not included in this analysis. Also, band members who did not live on their band's reserve at the time of the Census were not included in the analysis.

Socioeconomic factors have previously been shown to be associated with suicide among Indigenous people in North America. To examine if similar patterns were evident in the 2011 CanCHEC cohort, the role of individual socioeconomic factors such as household income, labour force status, level of education, marital status and geographic factors such as living on or off reserve on risk of death by suicide were examined for First Nations people aged 25 years or older. After adjusting for age and sex, the risk of suicide among First Nations adults was twice as high as that among non-Indigenous adults (hazard ratio [HR] = 2.0; Table A.4 in appendix). Adjusting for household income resulted in a decrease in risk by 35%. After further adjusting for labour force status, level of education and marital status, First Nations adults were still at a higher risk of suicide than non-Indigenous adults ( HR = 1.4). Together, these factors accounted for 66% of the excess suicide risk. Further adjusting for living on and off reserve resulted in a HR of 1.2, which was not significantly different from 1.0. Together, all these factors accounted for 78% of the excess suicide risk among First Nations adults.

Suicide among Métis in Canada

Based on the current analysis, of the 452,985 self-identifying Métis (based on population estimates using the 2011 CanCHEC and its weights) who lived in private households in 2011, approximately 415 individuals died by suicide in the 2011 to 2016 period. As a result, the suicide rate was 14.7 Note E: Use with caution deaths per 100,000 person-years at risk (Table 2), which was nearly twice as high as the rate among non-Indigenous people (8.0). The rate among Métis males (22.6 Note E: Use with caution ) was more than three times higher than the rate among Métis females (7.2 Note E: Use with caution ). The suicide rate was nearly twice as high among Métis (22.6 Note E: Use with caution ) as non-Indigenous males (12.3). However, the suicide rates for Métis (7.2 Note E: Use with caution ) and non-Indigenous females (3.9) were not significantly different from each other.

﻿

Among the provinces and territories, because of low counts when broken down, suicide rates for Métis could only be generated for Ontario, Manitoba, Saskatchewan, Alberta and British Columbia combined (Ontario and west). In these provinces, the rate among Métis (13.4 Note E: Use with caution ) were higher than that among non-Indigenous people (7.6). Suicide rates among Métis in rural (16.5 Note E: Use with caution ), small (12.8 Note E: Use with caution ) and large population centres (15.5 Note E: Use with caution ) were not significantly different. The rate among Métis in large population centres was higher than the rate among non-Indigenous people (7.2; marginally significant). Suicide rates could not be published for medium population centres due to low cell counts.

Among Métis adults over 25, after adjusting for age and sex, the risk of suicide was twice as high as that among non-Indigenous adults (hazard ratio = 1.9; Table A.4 in appendix). Adjusting for household income, labour force status, population centre type of place of residence, level of education and marital status accounted for 37% of excess suicide risk. The risk of suicide was 1.6 times higher among Métis than non-Indigenous people after adjusting for these factors.

Suicide among Inuit in Canada

There were approximately 59,220 Inuit in Canada in 2011 who lived in private households (based on population estimates using the 2011 CanCHEC and its weights). Among them, there were an estimated 250 deaths by suicide between 2011 and 2016. This lead to a suicide rate of 72.3 deaths per 100,000 person-years at risk (Table 3). This was nine times higher ( RR = 9.0) than the suicide rate among non-Indigenous people (8.0). The suicide rate was three times higher among Inuit males than Inuit females (109.3 versus 35.4 Note E: Use with caution , respectively).

﻿

Suicide rates among Inuit were highest in youth; the highest suicide rate was seen among Inuit males between 15 and 24 years of age (363.2; non age-standardized) living in Inuit Nunangat (Chart 2). Publishable estimates could only be produced for Inuit females between the ages of 15 and 24 and 25 to 34. Suicide rate among females 15 to 24 years of age was 108.9 Note E: Use with caution , which was 33 times higher than non-Indigenous females of that age (Table A.3 in appendix).

Rates among Inuit were also compared by Inuit Nunangat region. Rates were significantly higher among Inuit in Nunatsiavut (188.2 Note E: Use with caution ; non age-standardized) than those in Nunavik (98.1) and Nunavut (94.0). Rates among Inuit in Inuvialuit region could not be published due to low reliability of estimates.

The national, Inuit Nunangat and Inuit regional level estimates underestimate the variation in rates among individual Inuit communities. Among the 50 Inuit communities, 11 communities had a suicide rate of zero. However, for most communities (66%), estimates were too unreliable to be published. It should be noted that some deaths may not have linked to the NHS and others may not have been in Vital Statistics at the time of data integration. The latter shortcoming has previously been reported by Jack Hicks. These exclusions may have biased the estimate of number of communities without suicides.

In multivariate analyses, among Inuit adults 25 years and older, the risk of death by suicide was 4.8 times higher than the risk among non-Indigenous adults, after accounting for age and sex (Table A.4 in appendix). After further adjusting for household income, labour force status, level of education and marital status, the hazard ratio decreased to 3.4 suggesting that these factors accounted for 37% of the excess risk of death by suicide among Inuit. After adjusting for size of community (population centre type), Inuit adults were still at 3.3 times higher risk of suicide than non-Indigenous adults ( HR = 3.3). All combined, these factors accounted for 40% of the excess risk of suicide among Inuit adults.

Discussion

The report is the first to examine suicide rates among all three Indigenous peoples, including First Nations people, Métis and Inuit, of different age groups and living in different geographies using one methodology. However, gaps in knowledge remain. Further research is needed to assess long-term trends and estimate the role of other risk and protective factors of suicide among Indigenous peoples, which should be done in consultation with First Nations people, Métis and Inuit, as recommended by the Truth and Reconciliation Commission of Canada.

In the current analysis, the suicide rates among First Nations people, Métis and Inuit were many times higher than the non-Indigenous rate during the 2011 to 2016 time period. The rates were highest among Inuit and, specifically, adolescents and young adults. The suicide rate among First Nations people living on reserve was higher than that among those living off reserve, and among males than females. The higher suicide rate among males has been attributed to their tendency to use more lethal methods and to the differential effect of specific stressors in the two sexes. However, greater disparities were observed among First Nations females, where higher suicide rates were seen when compared with non-Indigenous females. These patterns are similar to what has been previously reported.

Of particular concern is the high rate of suicide among Indigenous children under 15. The suicide rate among First Nations boys, nationally, was four times higher than among non-Indigenous boys. It was ten times higher among First Nations boys living on reserve. As with other national trends, this rate may obscure regional differences. Previously reports have suggested that in some remote First Nations communities in Ontario, under-15 suicide rates were nearly 50 times higher than non-Indigenous rates. And, among Inuit communities of Nunatsiavut, the age-specific disparity was largest among 10 to 19-year-olds relative to their non-Indigenous counterparts outside Inuit Nunangat ( RR = 15.8). Also, rate of death by suicide among Inuit children 10 to 14 years of age appears to be increasing since 1989 although significant fluctuations are seen across time. In line with these rates among children, suicidal ideation among grade 5 to 8 school children in Saskatoon was nearly twice as high among Indigenous children as non-Indigenous children after accounting for mental health, cognitive abilities and bullying experiences. While risk factors for suicide among children are numerous and complex, a recent report suggests that Inuit children and youth in Nunavut experience a lack of mental health services that are specific to them, culturally relevant and of adequate quality.

And, while time trends were not examined here, suicide attempts among First Nations people in British Columbia have been reported elsewhere to be declining. Risk of self-inflicted injury hospitalization among Registered Indians, and disparity between them and their non-Indigenous counterparts decreased between 1991 to 2010. However, this is in contrast to trends in remote First Nations communities in Ontario. There, Indigenous youth suicide was previously reported to be on the rise because of the emergence of suicide among communities that previously did not experience it, exposure to suicide or suicide attempts among family members and peers, and increase in clusters of suicides.

Methods

Data

The 2011 Canadian Census Health and Environment Cohort (CanCHEC) used here is a population-based integrated dataset that follows the non-institutional (household) population enumerated in the 2011 National Household Survey (NHS) for different health outcomes such as mortality, cancer, and hospitalizations. Briefly, record integration for the 2011 CanCHEC was carried out using Statistics Canada's Social Data Linkage Environment (SDLE). The SDLE helps create linked population data files for social analysis through integration to the Derived Record Depository (DRD), a dynamic relational database containing only basic personal identifiers. Survey and administrative data are linked to the DRD using a generalized record integration software that supports deterministic and probabilistic integration.

The NHS is a voluntary survey, conducted in May 2011, of approximately 4.5 million (30%) private dwellings randomly selected from the 2011 Census of Population. The NHS covers all persons who usually live in Canada, including permanent and non-permanent residents, and individuals living on First Nations reserves, Métis settlements or Inuit communities. There were 36 incompletely enumerated First Nations reserves in the 2011 NHS. In 13 of these communities, enumeration was delayed because of forest fires in Northern Ontario and occurred at a later date. The NHS excludes residents of institutions (for example, hospitals, nursing homes, penitentiaries) and collective dwellings (for example, work camps, hotels, shelters).

Records for approximately 6.7 million NHS respondents were eligible for integration; 97% linked to the DRD using a probabilistic approach based on telephone number, surnames, given names, birthdate, and place of residence. No differences in integration rates were found by collection mode, province, sex, or birth decade. To ensure representativeness of the linked cohort, weights were calculated to adjust for non-integration.

To protect the confidentiality of Census respondents, data made available for analysis did not contain personal identifiers such as name, and address. In addition, estimates based on small cell counts (fewer than five deaths or fewer than 10 total individuals) were suppressed.

Variables

Self-reported Indigenous identity, age, sex, household income, labour force status, highest level of education, marital status and province of residence variables were available in the 2011 NHS dissemination dataset. Variables for the Inuit Nunangat regions were generated using Standard Geographical Classification (SGC) codes. Similarly, a variable for on and off-reserve areas of residence was generated using SGC. A binary suicide variable was created using ICD-10 codes in the "Underlying cause of death" variable in the CVSD. Generation of suicide and person-years at risk variables are described in the following section.

Estimation of weighted suicide rates

For suicide rate estimates, each person's time at risk of death by suicide was split into single years of follow-up, and within each year of follow-up, into durations before and after birth date. In the process, each person was aged on his or her birthday. This allows for the appropriate categorization into age groups for computing suicide rates. Weighted age-standardized suicide rates (ASMRs) (see figure 1 for a brief description of this measure) and their 95% confidence intervals were estimated. Those under the age of one were excluded from the analysis due to under-representation of this group in the integrated dataset. Briefly, ASMRs were computed by dividing the count of cohort members who died by suicide in the follow-up period by the total person-years at risk. Age standardization was done with age-specific mortality rates in 5-year age groups using the 2011 total Indigenous population as the reference population. Weighted age-specific suicide rates generated without age standardization were used for comparisons between age groups within an Indigenous group or between an Indigenous group and the non-Indigenous population. These rates were also used to compare suicide rates in the on and off-reserve First Nations populations since their age structures were somewhat similar in 2011 (median age: 23.9 and 27.1 years, respectively). Suicides were identified using the following International Statistical Classification of Diseases and Related Health Problems 10th Revisions ( ICD-10) codes: X60-X84, Y87.0. For each member of the cohort, person-years of follow-up were calculated as the number of days from the beginning of the study period to the date of death or end of study divided by 365.25. Variance was calculated using 500 bootstrap weights.

Description for Figure 1
﻿

Figure 1 is a schematic showing the method used to estimate the suicide rate using number of deaths as the numerator and person-years as the denominator. The schematic illustrates a hypothetical example with seven individuals who were "followed" from May 10, 2011 (Census day) to December 31, 2016 (end of follow-up period) to see if they had died. In this example, three of the seven individuals died during follow-up. Person 1, 4 and 7, who died during the follow-up period, each contributed 3.0, 1.5 and 4.2 person-years at risk, respectively, to the denominator. The others, who were alive as of December 31, 2016, each contributed 5.6 person-years to the denominator. In all, the seven individuals contributed 31.1 person-years to the denominator. The crude mortality rate is calculated by dividing the number of deaths by the total person-years contributed by the seven individuals, and multiplied by 100,000. In this hypothetical example, the crude suicide-related mortality rate is 9,646.3 deaths per 100,000 person-years of follow-up.

Age-standardized and age-specific suicide rates, expressed as the number of deaths by suicide per 100,000 person-years at risk, were generated by sex, Indigenous identity and select geographic areas. Indigenous identity, as self-reported in the 2011 NHS Survey, included: First Nations, Métis, Inuit, Multiple Indigenous identity, Indigenous identity responses not indicated elsewhere and non-Indigenous. However, in this paper, only estimates for single identity groups are presented. Geographic areas studied include: province/territory; on or off-reserve; rural areas or small, medium and large population centres, and for Inuit, inside/outside Inuit Nunangat and by the four regions of Inuit Nunangat (Nunatsiavut, Nunavik, Nunavut, and the Inuvialuit region), as well as outside Inuit Nunangat. Rate ratios, or the ratio of suicide rate among First Nations people, Métis or Inuit over suicide rate among non-Indigenous people were computed to examine the magnitude of disparity in the Indigenous group compared to the non-Indigenous population. To estimate variance of the rate ratios, variance and covariance of the mortality rates in the Indigenous group of interest and non-Indigenous population were estimated using PROC RATIO in SAS-callable SUDAAN. Variance of the rate ratios was then computed using Taylor linearization and the variance and covariance estimates from PROC RATIO, and used in generating 95% confidence intervals.

Hypothesis testing was done to identify suicide rates that were significantly different from one another using p<0.05. The weighted number of suicides and suicide rates were not published if (1) the unweighted number of suicides in a cell was less than five, (2) the weighted population count in the cell were less than 10, or (3) coefficient of variance (CV) was greater than 33.3% (40% for those under 15 years). Weighted numbers of suicides were also randomly rounded to base five. ASMRs with CV greater than 16.6% and less than or equal to 33.3% are presented with an "E" to indicate that these should be used with caution.

Estimation of suicide rate by First Nations band

For estimating suicide rates by First Nations band, reserve CSDs associated with each band were grouped. Reserves that were shared by multiple bands were grouped separately. This was done for seven reserves. Three of these had a population of 10 or less. And, one was incompletely enumerated in the 2011 NHS. This grouping resulted in about 600 First Nations bands. Of these, 561 included individuals that were in the 2011 CanCHEC. Others were associated with reserves that were incompletely enumerated in the 2011 NHS or had participated in the 2011 Census and not the NHS. In the end, 555 bands were included in the analysis. Suicide rates were computed by First Nations band, from which the number and percentage of bands with a reportable zero suicide rate were identified. The percentage of bands with a zero suicide rate were calculated with and without the reserves that were associated with multiple bands and were found to be similar.

Multivariate analysis

To examine the role of socioeconomic and geographic factors in the excess risk of suicide among Indigenous people relative to non-Indigenous people, Cox proportional hazards modelling was performed. Analyses were restricted to those 25 years and older to allow for the use of labour force status, level of education and marital status as covariates. For this analysis, age at baseline on Census day, was used since other covariates also had the same reference period. Hazard ratios for suicide were estimated among First Nations people, Métis and Inuit (with non-Indigenous people as the reference group). Covariates were entered sequentially into the model in this order: age group together with sex, household income quintile (based on after-tax income adjusted for economic family size), labour force status (employed, unemployed and not in the labour force), highest level of education (less than high school, high school, post-secondary education below Bachelor's level and university degree), marital status (never legally married or single, legally married and not separated, separated but still legally married, divorced or widowed) and living on or off reserve (for First Nations people) or in population centres or rural areas (for Métis and Inuit). Household income quintiles were generated for each province and territory separately to account for regional differences. In secondary analysis, household income was used as a continuous variable or household income quintiles were generated at the national level and used in place of the original income quintile variable to examine the robustness of the influence of this predictor on the relative risk of death by suicide among First Nations people, Métis and Inuit. Covariates were chosen based on previous literature on the relationship between socioeconomic factors and suicide. and the availability of related variables in the 2011 NHS data.

From the hazard ratios (age and sex-adjusted and additionally adjusted for socioeconomic factors), the percent of excess risk of suicide among First Nations, Métis and Inuit people accounted for by household income, labour force status, highest level of education, marital status and geography was computed. The proportion of excess mortality explained was calculated as the difference between the age and sex-adjusted and the final hazard ratios, divided by the former minus 1. Analyses were not carried out separately by sex due to sample size limitations.

Assessing validity of suicide rates

Suicide rates based on the linked 2011 CanCHEC cohort were compared with previously generated estimates using different methodologies to assess validity.

The non age-standardized suicide rate for the total population of Canada between 2009 and 2013 was previously estimated to be 11.4 deaths per 100,000 people; in comparison, in the CanCHEC cohort, the overall suicide rate was 10.5 deaths per 100,000 person years between 2011 and 2016. While there are no published rates of suicide for First Nations people, Métis and Inuit for the 2011 to 2016 period, suicide rates for all individuals in Inuit Nunangat, which is home to 73% of Inuit in Canada, was previously estimated to be 83.5 deaths per 100,000 people. In the 2011 CanCHEC cohort, the rate was 83.5 deaths per 100,000 person years at risk. However, the estimates by Inuit Nunangat region between 2011 and 2016 (167.3 Note E: Use with caution in Nunatsiavut, 87.5 in Nunavik and 83.1 in Nunavut) were somewhat different in comparison to previous estimates from the 2009 to 2013 period (185.4, 98.3, 79.0, respectively). While, the estimates are similar, there are several potential reasons for this discrepancy between the two sets of estimates. While there is some overlap in time periods for the two estimates (2009 to 2013 for previous estimates and 2011 to 2016 for the estimates in this report), they are not identical. There is some year-to-year fluctuation in suicides rates. For example, in Nunavut, previous estimates suggest that the rate ranged from 58.2 to 108.5 deaths per 100,000 people. Some deaths that occurred between 2011 and 2016 were not linked to the 2011 NHS. Also, the CanCHEC cohort excludes institutional population (e.g., nursing homes, jails), and those living in collective dwellings (e.g., motels, hotels, rooming houses) at the time of census collection and those that were not enumerated by the 2011 NHS. The denominators used in the two studies are also different; in the previously published tables, the suicide rates are per 100,000 people; in the current study, the rates are per 100,000 person years.

Limitations

Several limitations of the analysis should be noted. Suicide rates presented in this article may underestimate the true rates because of (1) exclusion of the institutional population and population living in collective dwelling, (2) exclusion of persons not enumerated by the 2011 NHS including the homeless among whom Indigenous people are overrepresented, (3) non-integration of some deaths between 2011 and 2016 to the 2011 NHS, (4) potential integration error, (5) potential misclassification of suicides in the CVSD to avoid stigmatization or as a result of misclassification as an accident, or inability in ascribing a cause, etc., and (6) potentially missing deaths, due to processing delays, in Vital Statistics at the time of data integration. Furthermore, Indigenous identity in the Census is self-reported, which may have led to underestimation or overestimation of suicide rates in some Indigenous groups. Also, 36 Indian reserves and Indian settlements were incompletely enumerated in the 2011 NHS, which could have resulted in under or over-estimation of suicide rates. Most (29) of these reserves were in Québec and Ontario, with the rest in Saskatchewan, Alberta and British Columbia. Among the ones in Québec and Ontario, some are proximal to Census Metropolitan Areas (CMA) while others were rural or remote. The former includes Kahnawake, Kanesatake and Wendake. Mortality rates for small areas and small subgroups of the population may experience substantial year-to-year random fluctuations since death is a relatively rare event, particularly death by suicide. Finally, baseline socioeconomic and demographic factors used in the multivariate analysis may not reflect conditions at the time of death. This may have led to some biases in the findings.

Appendix

﻿ ﻿ ﻿ ﻿ ﻿ ﻿

# data[].attributes.attachment_link.title
Suicide among First Nations people, Métis and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC)

# data[].attributes.attachment_link.description
The article presents suicide rates for the 2011-2016 time period among self-identifying First Nations, Métis, Inuit, and non-Indigenous people in private dwellings in Canada. It also explores the influence of socioeconomic factors in the disparity in risk of suicide between First Nations people, Métis, Inuit and non-Indigenous people in Canada.

# data[].attributes.attachment_link.readable_text
Note: This content may be emotionally difficult. The Hope For Wellness help line is 1-855-242-3310 or via online chat, Additional supports are available through We Matter.

A new report on Indigenous suicide in Canada has generated the most comprehensive picture of the crisis to date, despite health authorities continuing not to collect data about the problem.

Released at the end of June, the Statistics Canada report titled " Suicide among First Nations people, Métis and Inuit (2011-2016)" found that, overall, Indigenous people in Canada die by suicide at a rate three times as high as non-Indigenous Canadians.

While comprehensive, the report acknowledges there are limitations to the findings that likely result in underestimations of the actual rates. The report's analysis includes a number of socio-economic factors, as well as comparative differences based on age, sex and location - on or off reserve.

The lead researcher of the report, Mohan Kumar, said he wants readers to remember that for each of the numbers in the report "there is a person behind them, and their deaths meant an incredible loss to family, friends, community and the society at large."

He also contextualizes the findings in light of existing research that shows how aspects of colonization contribute to the Indigenous suicide crisis. So that the high rates, he says, shouldn't be taken as indicative of personal, community or cultural failings.

Canada doesn't track suicides specifically by Indigenous identity, and the process that Kumar and co-researcher Michael Tjepkema used to overcome this is important to look at, as are the limitations inherent to these findings. The findings are estimations not full counts, as they're based on only a sample portion of the full population, and there are some population groups not surveyed.

But as Indigenous researchers Roland Chrisjohn and Shaunessy McKay wrote in Dying To Please You: Indigenous Suicide in Contemporary Canada, their 2017 book on the suicide crisis, discourse about the problem and solutions is often unhelpful and not evidence-based: "It sounds like drumbeats of a PR bandwagon, like Native people are being recruited to a mainstream viewpoint rather than being convinced with real data; with all parties repeating a mantra over and over again until they parrot it without any real understanding."

Thus, the Statistics Canada report's contributions in terms of new, fuller data analysis are important.

The report's central finding - that First Nations people die by suicide at three times the rate of non-Indigenous Canadians, Inuit at nine times the rate, and Métis at two times - illustrates a crisis but is not likely to surprise those familiar with previous statistics. For those unfamiliar, it puts Inuit among the people with the highest rates of suicide anywhere in the world.

The report examines each of the three groups separately, and is based on 2011 populations, when the census had 851,560 people self-identify as First Nations, 59,445 as Inuit and 451,795 as Métis .

The report estimates that there were 1,845 total deaths by suicide of the Indigenous population in Canada from May 10, 2011, through Dec. 31, 2016. This total consists of 1,180 First Nations people, 250 Inuit and 415 Métis.

Looking at it side by side with murder data can help contextualize the scale of the problem.

For the five years since StatCan started tracking homicides by Indigenous identity, there have been 710 recorded Indigenous victims of homicide. The number of estimated suicides from the StatCan report is approximately two and a half times larger, though it applies to a slightly longer period.

The public interest in addressing the problem of missing and murdered Indigenous women and girls (MMIWG) in Canada illustrates the scale of the energy that could be mustered in service of a similar reckoning with the suicide crisis.

A Statistics Canada report found that Indigenous people die by suicide at a rate three times as high as non-Indigenous Canadians. But the report acknowledges there are limitations to the findings that likely result in underestimations of actual rates

Younger Indigenous people suffer higher rates of suicide

When comparing overall populations of the identity groups, the report uses age-standardized suicide rates to account for the groups' different age distributions - the 2011 census shows median age was 26 for First Nations, 23 for Inuit, 31 for Métis and 41 for non-Indigenous. Kumar said the approach ensured that the findings were in the form of "the rate that would be expected if the age structures of the populations were the same."

The highest rates of Indigenous suicide are seen in youth and young adults, between the ages of 15 and 24, Kumar told National Observer. For First Nations people, the rate for these ages is 6.2 times higher than for non-Indigenous population in the same age range; for Inuit people, the rate is 23.9 times higher. (There wasn't enough data to generate accurate rates for Métis by age range.)

Not all communities are equally affected by the suicide crisis

For the First Nations population, the suicide rate was two times as high for those living on-reserve as those living off-reserve.

While a critique of much of the general discourse around Indigenous issues is that it is negative or problem-focused, this report did aim to "to look at it from the perspective of resiliency (instead) of having a deficiency-based estimate," according to Kumar.

In conversation, he highlighted that the report's findings show that of "close to 600 bands ... 60% of those FN bands had not experienced suicides (of any people in the sampled population), so they have a zero suicide rate."

For Inuit Nunangat, "11 out of 50 Inuit communites had a zero suicide rate."

These numbers do need qualifying, as these zero suicide rates don't necessarily mean there were no deaths by suicide from these bands and Inuit communities over the roughly five-and-a-half-year period covered by the report. This is due to the methodology.

How to count Indigenous suicides when the government doesn't track Indigenous suicides

This research is based on the 2011 National Household Survey (NHS), which replaced the long-form census, and was based on voluntary responses. These responses accounted for a total of just over six million of the Canadian population, including what was then approximately a third (466,000) of self-identified Indigenous people in the country.

For the First Nations communities that participated in the NHS (over 90 per cent of the over 600 in Canada), all households on reserve received the survey while First Nations people living off-reserve were, like those in the general population, selected to receive the survey at random. All Métis living in households in surveyed areas, including the Métis Settlements of Alberta, received the survey while Métis living outside of survey areas were part of the random selection process to receive the survey.

For Inuit, every household in Inuit Nunangat (spanning parts of Northwest Territories, Quebec, and Labrador as well as all of Nunavut) received the survey, but individuals outside of the territory were selected for the NHS at random as part of the general population.

The NHS was used as a way to determine who among the suicide deaths were Indigenous, because the Canadian government doesn't track that in its records of health statistics.

"In the Canadian Vital Statistics Database (CVSD), there are no Indigenous identifiers, so you can't say if a death that occurred is of a First Nations person or a Métis or Inuit," Kumar explained.

"So the only way we can do that is we link the mortality records (from the CVSD) to the National Household Survey records, and in the NHS people self-identified as either a First Nations person, Inuit or Métis, or they didn't identify as Indigenous and so they would be considered non-Indigenous."

He noted a small percentage identify as belonging to more than one of the three Indigenous groups, about 0.8 per cent of the 2011 Indigenous population, though there is no separate analysis of their data in this report.

The report uses the deaths by suicide recorded in the CVSD starting from the day the NHS was collected, May 10, 2011, through the end of December 2016 - the period of 5.6 years.

Who - and what - was and wasn't counted

The NHS is a survey of private dwellings that omits people living in institutions (jails, medical facilities, etc.), collective dwellings (group homes, hostels, etc.), and many of those who are homeless.

These unmeasured groups may have higher rates of death by suicide compared with those who were surveyed; also, a higher proportion of the Indigenous population may be in those unmeasured groups than of the non-Indigenous population. It is for these reasons, and other less specific factors relating to the counting of deaths by suicide, that the report states "suicide rates presented (here) may underestimate the true rates."

The NHS also doesn't include data on gender or sexual identity, so there are no specific suicide rates in this report for two-spirit people or by sexual orientation or trans and non-binary gender identities - though these individuals are part of the overall statistics, except for those who are part of the unmeasured groups.

Kumar said the government is looking at having gender identity and sexual orientation identification included for the 2021 long-form census in consultation with Indigenous organizations.

"There are so many other factors that are behind the suicide rate we couldn't look into because we were restricted to what was collected in the NHS," Kumar said. The report itself identified some of these factors: "historical and intergenerational trauma, community distress, cultural continuity, family strength and mental wellness were not explored here."

Socio-economic factors

The report was able to do an analysis based on five socio-economic factors contained in the NHS: household income, level of education, labour force status, marital status, and, for First Nations, on- or off-reserve, while for Métis and Inuit, the size of the community in which they lived.

This itself, may be a unique contribution to the knowledge base of research on Indigenous suicide, especially with the large population range covered in this research.

But there were limitations to this too: only individuals 25 and older could be included to accurately analyze the roles of education, labour and marital status. This is a problem, because suicide rates for Indigenous youths and young adults are disproportionately high, and they are not reflected in this part of the report's analysis.

Adjusting for these socio-economic factors found that for the applicable age groups, 78 per cent of the difference in suicide rates disappears when the five factors are controlled for between First Nations and non-Indigenous; for Métis, 37 per cent of the difference disappears; and for Inuit, 40 per cent disappears (and closer to 50 per cent when household income was factored with the northern higher costs of living).

To illustrate what this adjustment means (in statistical terms, 'controlling for' these variables), is that First Nations median income in 2011 was $15,615 compared to $28,239 for non-Indigenous, but this part of the analysis compared the rates of suicide for First Nations and non-Indigenous who have similar incomes (and similarly adjusts for the other four factors), and found rates that were only 22% different. This also implies that for the non-Indigenous population in and of itself, suicide rates are not uniform, but vary corresponding with these socio-economic factors.

Kumar commented on the differing percentages of difference (i.e. the 78, 37, and 40 per cents, respectively) that disappeared for First Nations, Métis, or Inuit: "There are so many other things that are going on ... probably the better answer is that we don't quite understand why there is a difference."

It's also important to note the difference between causation and correlation: this analysis doesn't necessarily mean these factors are the cause of the different suicide rates, but that they are occurring together, which may be indicative of what is behind the problem.

Where to go from here

This analysis indicates that widespread societal imbalances between Indigenous and non-Indigenous populations are a large aspect of the Indigenous suicide crisis. Thus, individual-focused suicide-prevention programs are not a full solution.

That idea is parallel to how the Calls For Justice from the MMIWG inquiry final report do not solely focus on directly stopping murderers or murders, nor say that the murders and disappearances are the genocide itself, but look more to changing the current conditions that result from the continuity of genocidal practices and that cause Indigenous victimization.

Three of the five socio-economic factors - the areas of education, employment and poverty - are included in parts of the MMIWG inquiry Calls For Justice ( pages 170-221), as well as in the " Master List of Report Recommendations" that the inquiry compiled from 100 previous reports they reviewed during their process.

The need for repair, to create equitable conditions and treatment, was also recognized recently when the Canadian government was ordered by the Canadian Human Rights Tribunal to pay $40,000 each to all individual First Nations children and some parents/grandparents who were affected by the government's discriminatory practices in child welfare and service provision, including in the area of suicide-prevention services, as part of an ongoing tribunal case to end discriminatory policies.

The Statistics Canada report findings may help shape future research on Indigenous suicide, "There are lots of questions that probably come up (based on this report), which need to be addressed in future research," Kumar said. "I think it's up to other researchers to come up with questions or what sort of direction other research should go."

Kumar, who previously worked at the National Aboriginal Health Organization, also noted the importance of the involvement of national Indigenous organizations, including Inuit Tapiriit Kanatami, the Métis National Council, and the National Association of Friendship Centres, and their contributions to the research process: it's important that Indigenous peoples do have a leading role in such knowledge production, and in developing approaches to these problems.

​​What people, communities, organizations, and governments do about the continuing suicide crises is crucial. It is a long-term problem that hasn't been adequately addressed, often only appearing in the general public consciousness when a specific community is forced to declare a state of emergency - as God's Lake First Nation, about 1,000 kilometres northwest of Winnipeg, did at the end of August.

International Suicide Awareness Day was marked on Sept. 10, with the annual Celebrate Life event hosted by Inuit at Canada's Parliament Hill and other events across the country. The report's findings will add to these discussions, as well as those at the bi-annual World International Suicide Prevention Conference, being held next Aug. 25-27 in Winnipeg, an opportunity for all working on this problem.

But perhaps the most important part of the report may be its affirmation, with the best quantitative evidence currently available, that there continues to be a crisis and that the approaches used to address it have not been sufficient.

# data[].attributes.attachment_link.title
Canada's Indigenous suicide crisis is worse than we thought

# data[].attributes.attachment_link.description
A Statistics Canada report's central finding - that First Nations people die by suicide at three times the rate of non-Indigenous Canadians, Inuit at nine times the rate, and Métis at two times - illustrates a crisis but is not likely to surprise those familiar with previous statistics.

# data[].attributes.attachment_link.readable_text
The suicide rate among First Nations people was three times higher than in non-Indigenous populations between 2011 and 2016 in Canada, according to Statistics Canada.

The agency reported Friday on the rates of death by suicide for self-identifying First Nations people, Metis and Inuit from 2011 to 2016, compared to non-Indigenous people.

The suicide rate among First Nations people was 24.3 deaths per 100,000 person-years at risk, which StatsCan says is "roughly understood as number of deaths per persons per year." That is compared to eight deaths per 100,000 person-years at risk for non-Indigenous people.

The suicide rate for First Nations people living on a reserve was twice as high than those living off reserve, according to the agency.

Story continues below advertisement
WATCH: Indigenous leader says he's waiting for a national strategy around issue of suicides
Indigenous leader says he's waiting for a national strategy around issue of suicides

For those who self-identify as Metis, their suicide rate was around twice as high as the rate of non-Indigenous people, at 14.7 deaths per 100,000 person-years at risk.

For Inuit, the rate was around nine times higher than non-Indigenous, at 72.3 deaths per 100,000 person-years at risk.

Suicide rates were highest for youth and young adults aged 15 to 24 years old among First Nations men and Inuit men and women.

However, StatsCan did point out that there is a high level of variability for suicide rates "at the community level" for Indigenous people.

Story continues below advertisement

"When examined by First Nations band, just over 60 per cent of bands had a suicide rate of zero," the agency reported.

Statistics Canada says the higher risk of suicide for Indigenous people compared to non-Indigenous is due to "socioeconomic characteristics," such as household income, labour force status, level of education, marital status, as well as whether they live on or off a reserve and the community size.
WATCH: Cape Breton's Eskasoni First Nation experiencing mental health crisis
Cape Breton's Eskasoni First Nation experiencing mental health crisis

"Among First Nations people, 78 per cent of the higher risk of death by suicide was accounted for by these characteristics, while it was 37 per cent among Metis and 40 per cent among Inuit adults aged 25 years and older," the report stated.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help. The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.

# data[].attributes.attachment_link.title
First Nations suicide rate 3 times higher than for non-Indigenous people: StatsCan | Globalnews.ca

# data[].attributes.attachment_link.description
The suicide rate among First Nations people was three times higher than in non-Indigenous populations between 2011 and 2016 in Canada, according to Statistics Canada. The agency reported Friday on the rates of death by suicide for self-identifying First Nations people, Metis and Inuit from 2011 to 2016, compared to non-Indigenous people.

# data[].attributes.attachment_link.readable_text
Research article

Open Access

Published:

BMC Medicine 16, Article number: 145 (2018) Cite this article

14k Accesses

30 Citations

35 Altmetric

Metrics

Abstract

Background

Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.

Methods

We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.

Results

The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.

Conclusions

This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

Peer Review reports

Background

Globally, suicide accounts for approximately 800,000 deaths annually [ 1] and is the second leading cause of mortality among adolescents [ 2]. According to the World Health Organization (WHO), low- and middle-income countries and high-income countries have similar annual age-standardized suicide rates at 11.2 and 12.7 per 100,000 respectively; however, low- and middle-income countries account for 75% of suicide deaths worldwide [ 1]. National suicide rates range from less than one to 44 per 100,000 population, though there is often a disproportionate burden among specific subgroups within countries, such as Indigenous peoples [ 1]. Studies from high-income countries including Australia [ 3, 4], New Zealand [ 5], the USA [ 6, 7], Canada [ 8, 9, 10], and other Arctic nations [ 11, 12, 13, 14] consistently find elevated suicide rates among Indigenous populations, with substantial rate disparities compared to non-Indigenous populations. Several studies have shown that regional suicide rates vary greatly among Indigenous peoples, and that some Indigenous populations have low rates or no incidence of suicide [ 15, 16].

Indigenous peoples and nations differ vastly in culture, language, political autonomy, and relative wealth, yet many face similar social disadvantages and health disparities as a result of colonization [ 17, 18, 19]. Colonial governments have used discriminatory legislation and policies to deny rights and economic opportunities, and have attempted to acculturate Indigenous people into non-Indigenous societies [ 17, 19, 20]. Structural violence meted out by governments has taken many forms including dispossessing Indigenous peoples from traditional and sovereign lands, forced settlement and relocation, and outlawing cultural practices and languages [ 17, 18, 19, 20, 21]. This violence is grossly evident in the twentieth century assimilationist policies of former British colonies such as Canada and Australia. Indigenous children were systematically removed from their communities and placed in non-Indigenous institutions or families with the policy mandate to "weaken family ties and cultural linkages, and to indoctrinate children into a new culture" ([ 20], p. v). The contemporary legacy of this type of social engineering manifests in differential exposures to health threats and in inequitable outcomes that show up across generations [ 20, 22]. Intergenerational trauma from institutionalized abuse and racism experienced by Indigenous peoples has been linked to persistent social and mental health problems in some communities [ 19, 20, 23].

Although evidence has shown a disproportionate burden of suicide among Indigenous populations in national and regional studies, a global and systematic investigation of this topic has not been undertaken to date. Previous reviews of suicide epidemiology among Indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth [ 24, 25], high-income countries [ 9, 26], or regions such as Oceania [ 27] or the Arctic [ 24, 28]. Given that approximately 80% of the world's more than 300 million Indigenous people live in Asia, Latin America, and Africa [ 17, 18], a comprehensive study of global suicide rates that includes low- and middle-income countries is needed. Our aim was to examine the published findings on the incidence of suicide among Indigenous peoples worldwide, and to compare rates with non-Indigenous or general populations to assess relative disparities.

Methods

Search strategy

We systematically reviewed findings on the incidence of suicide in Indigenous populations worldwide. We searched for studies that analyzed population-based data on suicide deaths, and included papers that reported crude or standardized mortality rates. Health science librarians were consulted about the design of the search strategy with the aim to capture all peer-reviewed literature. The search combined terms related to three concept areas: population (Indigenous), outcome (suicide mortality rates), and study design (observational). Term selection was based on previous systematic reviews and combined key terms adapted for each database and also Medical Subject Headings (MeSH) as applicable. The study protocol is available in Additional file 1: Supplement 1. Additional details about the methods are reported in Additional file 1: Supplement 2, including citations for previous reviews, a list of included terms, a description of the procedures used for study selection and eligibility criteria, and a complete list of databases and hand-searched review articles.

One author (NJP) performed online text word and MeSH searches for articles indexed in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SCiELO). A second author (KN) replicated the search in PubMed and obtained the same number of articles as the first author. We searched for studies in any language, indexed from database inception until June 1, 2017. We conducted a secondary search with a comprehensive list of terms for specific tribal groups, nations, and populations identified in previous reviews. As no additional studies were identified, this approach validated the primary search. We also searched the WHO's regional medical literature indexes, Indigenous-specific online research portals, and journals focused on Indigenous health. We hand-searched the reference lists of included articles and previous reviews to identify other eligible studies. Additional file 1: Supplement 2 includes a list of all databases and hand-searched sources.

One author (NJP) imported the results into a reference management program and removed duplicates. Two authors (NJP and KN) read the abstracts and screened in papers if they (1) reported a population-based crude and/or standardized suicide rate, or count and population data; (2) reported a rate for an Indigenous population; and (3) used an observational design. We excluded articles that did not include an Indigenous population, focused only on a specific age, gender, clinical subgroup, or deaths from a specific cause (for example, firearms), or were not peer-reviewed. Articles were also excluded if they were iterations, program evaluations or experimental studies, not primary studies, from the gray literature, or used identical data sources as prior studies.

Although there is no international consensus on the definition of Indigenous, we used the United Nation's working definition to assess study population eligibility [ 17, 18]. The UN's conceptualization of Indigenous involves self and group identification; a special attachment to and use of traditional land, distinct knowledge, language, and culture; distinct social, economic, and political systems; common ancestry with original territorial occupants; participation in maintenance and reproduction of distinct ethnic identity; and a non-dominant socio-political status [ 17, 18]. A paper was eligible based on this criterion if it reported an outcome for an Indigenous population, tribe, community, nation, or group, including papers that used the geographic proxy method. For the proxy method, census data is used to detect areas where Indigenous people are a majority population [ 29, 30]. We considered an area to be a proxy identifier if 80% or more of the population self-identified as Indigenous.

Two authors reviewed the full text of each paper and assessed eligibility based on inclusion criteria. At this stage, we excluded papers that did not report rates for the majority of the population (aged 15-65 years), did not conduct the primary data analysis, or provided rates in figures only and did not report count and population data. If two eligible articles used the same data source with a period of overlap, we included the article with the longer study period. During screening, full text review, and data extraction, we resolved disagreements through discussion or consultation with a third author. Translators helped assess non-English language articles and assisted with data extraction for four included studies. The following data was independently extracted by two authors (AL and NJP), then compared: citation, study design, country and region/community, Indigenous population, data source, standard population, number of suicide deaths, population count, crude and standardized suicide rates (overall and by gender and age group), comparative rates for a non-Indigenous or general population, and the measure of relative effect (incidence rate ratio).

Data analysis

We summarized all included studies in a table and reported counts, population, crude and standardized suicide mortality rates, and rate ratios. We calculated crude suicide mortality incidence rates for articles that reported only count and population data, and we estimated rate ratios when not otherwise reported by dividing the Indigenous population rate by the comparison population rate. To identify global patterns, we presented rates and rate ratios in tables and figures grouped by WHO region, country, population, and gender; we did not pool the data due to heterogeneity. We also reported on trends in suicide mortality over time and by age group; reported time trends reflect results from included studies, not pooled and recalculated rates. We modified the Newcastle-Ottawa Scale and used it to assess the quality of included articles. Additional file 1: Supplement 2 includes a description of the quality assessment procedures and scoring, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist is provided in Additional file 1: Supplement 4 [ 31].

Results

The search identified 13,736 papers; after removing duplicates, screening abstracts, and full text review, we included 99 in our analysis (Fig. 1). Included studies examined suicide rates in Indigenous populations in 30 countries and territories across six decades (Table 1), though the majority focused on those in high-income countries such as American Indian and Alaska Natives in the USA ( n = 35) and Inuit and First Nations in Canada ( n = 14). Studies in low- and middle-income countries ( n = 22) were mostly from Brazil ( n = 4), China and Taiwan ( n = 6), and Fiji ( n = 5). Coverage included circumpolar Indigenous peoples such as Sámi ( n = 3) and Nenets ( n = 1), and populations from the Western Pacific region including Aboriginal and Torres Strait Islanders in Australia ( n = 6) and Māori and other Pacific peoples ( n = 16). Four studies were transnational comparisons [ 32, 33, 34, 35], though numerous papers included multiple Indigenous groups within a single country. Studies were mostly of moderate quality (mean 2.79 on a 4-point scale) based on our assessment of study characteristics, as reported in Additional file 1: Supplement 3, Tables S1 and S2.

Flow diagram of study selection

Table 1 Overview of included studies

Incidence

We extracted population-based suicide mortality rates from 93 papers (Table 2) and included gender-specific incidence data from six additional studies [ 5, 10, 36, 37, 38, 39]. Overall, suicide rates among Indigenous peoples varied at all levels of aggregation in both high-income and low- and middle-income countries, and spanned from zero to 187.5 deaths per 100,000 person-years (PY; Table 2). In high-income countries, national and provincial suicide rates among Indigenous peoples ranged from 1.7 per 100,000 in Brunei Darussalam [ 40] to 50.4 per 100,000 among Aboriginal and Torres Strait Islanders in Northern Territory, Australia [ 41]. Rates in high-income countries were highest among rural Indigenous populations and in sparsely populated regions such as the Arctic. Among low- and middle-income countries, Palawan communities in the Philippines had the highest crude suicide rates (134 per 100,000) [ 42], while Indigenous peoples in Malaysia [ 43] and some Pacific small island states such as Fiji had crude rates under 7 per 100,000 population. The number of suicide deaths used for rate calculations ranged from zero to 4219 (Table 2).

Table 2 Suicide mortality rates among Indigenous populations by WHO region and country

Measure of relative effect

Incidence rate ratios were reported or calculated for 102 Indigenous populations in 69 studies. The results showed rate disparities in the majority of studies (Fig. 2), though 22 reported rate ratios below one. The rate ratios ranged from 0.04 in China [ 44] to more than 20 in Brazil [ 45] and Canada [ 30] (Additional file 1: Supplement 3, Table S4). Most Indigenous populations had higher suicide rates than comparison groups; disparities were widest in studies with small populations. One study reported a suicide rate of zero for an urban Indigenous population in Brazil compared the general population rate of 4.8 per 100,000 in the same city [ 46].

Global suicide mortality incidence rate ratios among Indigenous and comparison populations. a Western Pacific Region (Oceania and Australia). b Western Pacific Region (East Asia). c European Region. d Region of the Americas (Canada and Brazil). e Region of the Americas (USA, National). f Region of the Americas (USA, Alaska). g Region of the Americas (Lower 48 states and Hawaii). NWT Northwest Territories, IHSA Indian Health Services Area. The dotted line indicates a rate ratio of one (RR = 1). This means that there is rate parity (no difference) between the incidence of suicide in Indigenous and comparative populations. Rate ratios to the left of the dotted line (RR < 1) indicate that rates are comparatively higher in the non-Indigenous population. Conversely, rate ratios to the right of the dotted line (RR > 1) show that the Indigenous population has a comparatively higher rate. Citations for each study are reported in Additional file 1: Supplement 3, Table S4

Time trends

Suicide rates appeared to increase over time, especially in the latter half of the twentieth century, though reports were limited. Among studies with reported time series ( n = 24), most (83%, n = 20) had fewer than 10 data points and covered an average of 19 years. A study in Greenland was the exception; it reported longitudinal data that showed a steady suicide rate increase among Inuit that began with the near absence of suicide in the early part of the twentieth century (2.4 per 100,000) and climbed exponentially to a rate of 110.4 per 100,000 in 2010-2011; the average number of suicides per year changed from less than one to 55 during this period [ 12]. Aboriginal and Torres Strait Islanders in Northern Territory, Australia experienced similar rate accelerations (6.1 per 100,000 in 1981 to 50.4 per 100,000 in 2002) [ 41], while incidence among Alaska Natives was relatively stable, though high, from the 1980s to the early 2000s [ 47, 48]. Indigenous peoples in the Micronesian islands experienced a sixfold increase in suicide rates between the 1960s and the late 1980s (from 4.3 to 25.8 per 100,000) [ 35], and one study reported slight rate declines for both Māori and non-Māori in New Zealand from 1996 to 2002 [ 5]. Annual rates tended to fluctuate in studies with small populations.

Age differences

Age-specific rates were reported in 39 studies; various age categories were used, and rates were often only available for select strata. Youth less than 30 years old, especially those aged 15-24 years old, had the highest suicide rates of any age group in 89% of studies ( n  = 34) that reported age-specific rates. In the larger studies (> 100 total suicides) with age-specific incidence, youth suicide rates ranged from 15.9 to 108 per 100,000 population. Very few studies reported deaths or rate estimates for adults more than 60 years old.

Gender differences

Men accounted for the majority of suicide deaths in all but four studies; only two of these four studies reported a greater number of suicide deaths among women [ 49, 50]. Studies with gender-specific crude and age-standardized rates ( n = 35) ranged from zero to 75.5 per 100,000 among Indigenous women (Additional file 1: Supplement 3, Table S3). Suicide rates were higher among Indigenous men compared to Indigenous women, though rate differences were marginal among some Pacific populations [ 33, 51]. Suicide rates were also higher among Indigenous men than for men in comparison populations in all countries except Israel and Fiji. Outside of the relatively low rates among Indigenous men in these countries, estimates ranged from 19.5 among Sámi [ 13] to 248.7 per 100,000 among Inuit [ 30].

Discussion

This study showed that the rate of suicide is elevated in many Indigenous populations globally, but that rate variation is common (Fig. 1). The evidence of substantial rate disparities for Indigenous peoples in Australia, Brazil, Taiwan, and circumpolar countries is notable. Equally important, we found that disparities were marginal or non-existent in some US territories and Pacific nations; we also identified 21 studies in which Indigenous populations had lower suicide rates than non-Indigenous populations. These results demonstrate that the high incidence of suicide and large rate disparities are not universal among Indigenous peoples. This confirms and extends findings from prior research that reported variation in localized estimates in the USA [ 52] and Canada [ 16].

Worldwide variation in the incidence of suicide among Indigenous peoples has complex and place-based social origins. These origins are traceable to regional differences in the impact of colonization, which is widely recognized as a major determinant of Indigenous health [ 17, 18, 19, 53]. Colonial governments have historically threatened the well-being of Indigenous peoples through chronic and often state-sanctioned discrimination and human rights abuses, and continue to do so in many countries [ 18, 20, 23]. Until 2016, several high-income countries had not ratified the United Nations Declaration on the Rights of Indigenous Peoples, and therefore legislative reforms to recognize Indigenous self-determination lagged. As a result, many Indigenous nations have yet to attain political sovereignty over lands and natural resources, education, or health care.

Globally, Indigenous peoples commonly experience social and economic marginalization and, as a consequence, some of the most disparate health outcomes [ 17, 18, 53]. In this context, the extent and the persistence of high suicide rates and rate disparities reveal a striking deficit in the global effort to prevent suicide and achieve social and health equity. This is further challenged by overlapping barriers to accessing health care and community supports, especially in rural areas and low- and middle-income countries. Barriers include fragmented care networks, lack of access to services due to geography, discriminatory attitudes from health care providers, and services that are not culturally safe or provided in the necessary language [ 18, 54, 55]. In resource-limited and conflict settings in particular, mental health services are inadequate in scope and quality, chronically under-funded, and in some places non-existent [ 18, 54].

Challenges in accessing mental health care are compounded by the limited relevance and generalizability of some "best practice" interventions in Indigenous contexts [ 56, 57]. Recent clinical trials with gatekeeper training [ 57], hospital-based interventions [ 58], and mobile self-help applications [ 59] reported adverse and limited effects on suicide-related outcomes for Indigenous peoples. Overall, intervention studies with Indigenous populations are rare, and community-based programs are often not evaluated or have weak study designs [ 60, 61, 62, 63]. These challenges point to a need to expand efforts to generate Indigenous-specific evidence [ 23, 56, 60]. Indeed, many communities have developed contextualized and complex approaches to suicide prevention that respond to local priorities. There is emergent evidence that such programs increase protective factors and reduce suicide-related behavior [ 63, 64, 65]. However, knowledge about programs' effectiveness, implementation, and capacity to scale up is limited, and many programs are not sustainably funded [ 56, 60, 61, 62].

Indigenous organizations and governments in New Zealand, Canada, and several Arctic states have moved beyond programmatic approaches and designed Indigenous-specific suicide prevention strategies [ 23, 55, 66]. These strategies integrate evidence-based public health and clinical interventions with Indigenous knowledge about the consequences of colonization, institutionalized violence and racism, and the value of culture. They also recognize that social conditions have an important role in shaping mental health, especially during the early years of life, and that improving these conditions can have a positive impact on population mental health and suicide-related outcomes. The path to lowering the incidence of suicide among Indigenous peoples and achieving health equity requires broader social transformation both within states and globally. This transformation must be collaborative, with Indigenous organizations and communities as leaders and rights-holders in knowledge production and decision-making [ 23, 29, 53, 56, 66, 67]. Public health systems can also enhance capacity for Indigenous suicide prevention with efforts to increase the visibility of community-level differences in health status and by accurately tracking changes in suicide mortality over time.

Limitations

This study is a comprehensive synthesis of the published evidence on the global epidemiology of suicide among Indigenous peoples. Although it is the first review of this scale, our study has several important limitations. First, included studies varied their methods of identifying Indigenous populations. Self-identification is the gold standard in administrative and registry data [ 67]. However, this is a recent benchmark. Its uptake has varied internationally, and some countries do not identify Indigenous populations in health data at all [ 53, 67]. The majority of included studies relied on linkages with census or registry data, geographic proxies, or observer-determined assessments. These procedures are useful approximations, but they use varied definitions and tend to under-count Indigenous people, especially groups without legal recognition [ 29, 53, 67]. This can lead to ascertainment bias and underestimation of inequities [ 53, 67]. A second and related limitation is the under-representation of studies from low- and middle-income countries. In our review, we may have missed studies, particularly from the Global South, due to the conceptualization of Indigenous and the search terms used, which do not necessarily apply in all contexts. We attempted to limit this bias by searching databases focused on low- and middle-income countries and including non-English language papers.

The third limitation was that it was difficult to compare suicide rates between countries. Included studies were heterogeneous in population size, number of cases, aggregation, data source and outcome assessment, method of identifying Indigenous peoples, and coverage period. Many papers provided crude estimates only and did not report numerator and denominator data by age group, gender, or ethnicity. For studies with adjusted rates, different standard populations were used, and confidence intervals were rarely reported. Differences in analytic and reporting practices made it challenging to directly and reliably compare suicide rates across studies. To address this, we examined rate ratios to assess relative differences between Indigenous and non-Indigenous/general populations. This allowed us to estimate rate disparities, which were compared globally.

The fourth limitation was that studies reporting low suicide rates may be under-represented, which is a potential publication bias. It is unclear whether the lack of low incidence populations is related to the common finding of elevated rates of suicide among Indigenous peoples compared to non-Indigenous populations or, as we suspect is more likely, to the possibility that suicide rates are rarely studied when they are low. Additional low incidence reports may exist outside of peer-reviewed studies; however, these were not identified because we did not search the gray literature. The primary reason for excluding gray literature reports was the extensive volume of sources with variable quality and also the risk of over-including data from high-income nations where public reporting of mortality data is common and vital statistics infrastructure is of high quality. Nonetheless, we identified 23 papers that reported rate parity or had a rate ratio below one, but these tended to use older data. A related problem is that case studies tended to examine suicide clusters in small populations [ 42, 68]. The advantage of using localized data is the ability to contextualize a complex health issue. The disadvantage is that the potential to compare health status between multiple groups, across regions, and over time is reduced.

Strengthening surveillance in Indigenous suicide prevention

Our results substantiate previous work [ 16, 52] to demonstrate that elevated suicide rates are not universal among Indigenous people and debunk notions that Indigeneity increases risk for suicide. Our results also point to several gaps in knowledge about the epidemiology of suicide in Indigenous populations globally. The lack of published suicide data on Indigenous populations in low- and middle-income countries is a glaring absence. Previous studies noted a scarcity of Indigenous-specific data in the Global South overall [ 18, 53]. Poor infrastructure for death registration is a key limitation [ 1]. In the context of suicide, this is especially problematic, because countries in Asia, Africa, and Latin and South America are the homelands for the majority of the world's Indigenous populations [ 18] and, at a national level, account for more than three quarters of all suicide deaths [ 1]. Suicide data in high-income countries tends to be of better quality than that in low- and middle-income countries; however, many governments do not include Indigenous or other ethnic identifiers in administrative health data, and do not routinely link census or Indigenous registries with national health datasets such as vital statistics. In Canada for example, the federal government does not know how many Indigenous people die by suicide in a given year. Globally, there is a critical need to strengthen capacity for surveillance in Indigenous suicide prevention.

National governments can take several steps to improve suicide surveillance in Indigenous populations. Actions should include efforts to enhance suicide data quality and standardized classification by improving vital registration infrastructure, especially in low- and middle-income countries, and integrating mortality data with monitoring of suicide attempts [ 1]. Countries should adopt an equity-based approach to data collection that includes Indigenous identifiers derived from self-reported sources and linked to registries or census data to address gaps in identification, and align Indigenous identification procedures with recommendations from the International Group for Indigenous Health Measurement, adapted for each national context [ 1, 53, 56, 67, 69]. Building inclusive, Indigenous-centered models of data governance in suicide prevention will be a critical element of strengthened surveillance. To achieve this will require national statistical agencies to not only consult Indigenous communities, organizations, and leaders about priorities, but to respect Indigenous rights to determine the parameters of data ownership, custodianship, access, and use [ 29, 32, 67].

Future research and global suicide surveillance efforts will be further strengthened with longitudinal and up-to-date national and state-level datasets that allow disaggregation and comparisons of outcomes in small areas and subpopulations by ethnicity [ 1, 17, 53, 56]. Overall, these actions will help maintain robust public health surveillance systems in order to monitor health status, increase knowledge about the social determinants of suicide, target interventions, and evaluate strategies aimed at reducing the incidence of suicide among Indigenous peoples worldwide [ 1, 56]. Increasing the visibility of populations that bear the greatest burden from suicide can help drive efforts to achieve the WHO and Sustainable Development Goals of reducing national suicide rates by up to 30% [ 1, 69].

Conclusions

Suicide among Indigenous peoples is not a universal or intractable problem. Our study showed substantial global rate variation, with striking disparities in some countries. Efforts to understand these differences and to continue to build the knowledge base for effective interventions will require sustained political and financial investments in Indigenous communities, health systems, and governments. Across sectors and countries, Indigenous peoples have called for suicide prevention strategies that are community-led, strengths-based, and trauma-informed, and that redress intersecting forms of structural discrimination, social inequity, and their downstream consequences. Global efforts to reduce suicide rates among Indigenous peoples must include actions focused on communities that experience the most profound disparities, while also seeking to promote population mental health and improve health equity.

Abbreviations

CI:

Confidence interval

CSIR:

Crude suicide incidence rate

FSM:

Federated States of Micronesia

IHSA:

Indian Health Services Area (USA)

NWT:

Northwest Territories (Canada)

SSIR:

Standardized suicide incidence rate

UN:

United Nations

USA:

United States of America

WHO:

World Health Organization

Acknowledgements

Work on this study was conducted while the authors resided in communities in Newfoundland and Labrador, Canada situated on the homelands of the Innu, Inuit, Mi'kmaq, and Beothuk peoples, and in communities in Ontario, Canada situated on the traditional and unceded territory of the Algonquin Nation. We respectfully acknowledge their ancestral and continued ties to the lands and waters.

We wish to thank the health science librarians who contributed their expertise to the design of this study: Janice Linton, University of Manitoba; Lindsay Alcock, Memorial University; and Lindsey Sikora, University of Ottawa. Thank you as well to our colleagues who assisted with translation, data extraction, and article access, and provided feedback on previous versions of this manuscript: Dr. Marina Sokolova, University of Ottawa; Dr. Albert Formanek, Laval University; Dr. Joseph Murray, University of Pelotas; Dr. Peter Bjerregaard, University of Southern Denmark; Dr. Yanqing Yi, Memorial University; Christopher Penney, Indigenous and Northern Affairs Canada, Government of Canada; Dr. Joyce Law, Labrador-Grenfell Health; Michele Wood, Department of Health and Social Development, Nunatsiavut Government; and Morgon Mills, Labrador Institute, Memorial University. We also recognize and are grateful for ongoing partnerships and research collaborations with the Nunatsiavut Government, Innu Nation, NunatuKavut Community Council, and Labrador-Grenfell Regional Health Authority, and for administrative support from the Labrador Institute and Faculty of Medicine at Memorial University, and the University of Ottawa.

Funding

NJP was supported by doctoral scholarships from the Canadian Institutes of Health Research and is a research associate at the Labrador Institute of Memorial University with salary funding from the Government of Canada's Atlantic Canada Opportunities Agency. KN was supported by a studentship from the Ontario Mental Health Foundation. IC is an associate professor at the University of Ottawa and received salary support through the Canada Research Chairs program. SM is a professor in the Faculty of Medicine at Memorial University. There was no direct funding source for this study. All authors had full access to all the data in the study, take responsibility for the integrity and accuracy of the data, and had the final responsibility for the decision to submit for publication.

Availability of data and materials

All data relevant to this study has been reported in the manuscript or included in the additional file.

Author information

Affiliations

1. Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada

Nathaniel J. Pollock & Shree Mulay

2. Labrador Institute of Memorial University, P.O. Box 490, Stn. B, 219 Hamilton River Road, Happy Valley-Goose Bay, ,Newfoundland and Labrador, A0P 1E0, Canada

Nathaniel J. Pollock

3. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada

Kiyuri Naicker, Alex Loro & Ian Colman

Contributions

NJP, KN, AL, SM, and IC met the International Committee of Medical Journal Editors criteria for authorship, and no individual who met these criteria was excluded. NJP, IC, KN, SM, and AL conceived and designed the review; NJP and KN conducted the searches and screened titles and abstracts; NJP, IC, KN, and SM reviewed full text articles; AL, NJP, and KN extracted and cleaned the data; NP and IC analyzed the data; and NJP and IC planned and drafted the manuscript. All authors interpreted the results, revised the manuscript, and approved the final version of the article. NJP is the guarantor.

Corresponding author

Correspondence to Nathaniel J. Pollock.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional file

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Reprints and Permissions

About this article

Cite this article

Pollock, N.J., Naicker, K., Loro, A. et al. Global incidence of suicide among Indigenous peoples: a systematic review. BMC Med 16, 145 (2018). https://doi.org/10.1186/s12916-018-1115-6
Download citation
Keywords

Indigenous

First peoples

Inuit

Health disparities

Suicide

Mortality

Surveillance

Epidemiology

# data[].attributes.attachment_link.title
Global incidence of suicide among Indigenous peoples: a systematic review

# data[].attributes.attachment_link.description
Background Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available.

# data[].attributes.attachment_link.readable_text
People

Suicide was unknown to Aboriginal people prior to invasion. Appalling living conditions and past traumas have led to a suicide rate that by far exceeds that of non-Aboriginal people.

Wishing you knew more about Aboriginal culture? Search no more.

Get key foundational knowledge about Aboriginal culture in a fun and engaging way.

This is no ordinary resource: It includes a fictional story, quizzes, crosswords and even a treasure hunt.
Stop feeling bad about not knowing. Make it fun to know better.
Sold! Show me how No, thank you

Selected statistics

Number of Aboriginal suicides in Australia in 2018; in 2017: 165; in 2014: 140; in 2012: 120; for the years 2001 to 2010: 100 (reported average).

Suicides per 100,000 people in 2014 in the Kimberley; overall national rate in 2018: 24; world's highest overall national rate (Guyana, South America): 44.

Percentage of Aboriginal deaths which are from suicide in 2014; in 2012: 4.5% ; in 2011: 4.2%. Figure for non-Aboriginal Australians in 2011: 1.5% .

"Death is our life"-Aboriginal suicide is at crisis levels

Almost non-existent in the 1980s, the rate of suicide and self harm amongst Aboriginal people is at crisis levels and has reached "horrific proportions", particularly in remote communities and especially amongst youth.

Aboriginal suicides are rising year-on-year, yet the Australian government does not respond adequately to this epidemic. In 2018, 169 Aboriginal people took their own lives, in 2017 there were 165 suicides, 140 in 2014 and 120 in 2012.

"Death is our life," says South Australian Elder Tauto Sansbury, describing the despair in Aboriginal communities Australia-wide, of mourning and sadness for young lives lost far too often.

Suicide affects 95% of Aboriginal people in Australia, and many are born into families where grief from suicide already exists, sometimes across two or three generations. Suicide is the fifth leading cause of death for Aboriginal and Torres Strait Islander people (second for males and seventh for females).

Research by journalist Gerry Georgatos found "that the prevalence of spates of suicides among Australian Aboriginal youth are the world's highest, and that these spates are becoming more prevalent and settling in to higher medians year in year out."

Suicide numbers are so high among young Aboriginal children that community leaders speak of "horrific narratives" and a "normalisation" of suicide in that age group. More and more children, who are younger and younger, commit suicide.

"There is a fundamental failure at a community level where kids feel as if the only coping mechanism they have is to end their life," finds Geraldton Mayor Ian Carpenter.

Australia's Aboriginal suicide epidemic

Aboriginal communities in the Kimberley in Western Australia mourned 21 suicide deaths in 2006, compared to only three in the wider community, a rise by 100%. A "suicide epidemic" saw up to 20 young Aboriginal people took their lives within 12 months. In Mowanjum, a 10-minute drive from mining hub Derby in the West Kimberley, there were 6 suicides in as many months. In the seven weeks to Christmas 2014 as many people killed themselves.

And it doesn't stop. Year after year consecutive Aboriginal suicides rock communities, so much so that Australia's most powerful medical organisations are pleading with the federal government to take urgent action to stop the "unspeakable tragedy" of Aboriginal youth suicide.

The young suicide more

For Aboriginal children aged 14 years and less, suicide is the second leading cause of death - and they are up to 8 times more likely to die by suicide than their non-Aboriginal peers.

In 2018, suicide was the leading cause of death for 5- to 17-year-olds (26.5%), and in 2015 it was the leading cause of death for young Aboriginal people aged 15 to 35 years (30%).

Suicide rates in that age group are three to four times higher than those of the general population. But even the age group of 35-44 years still has almost twice the rate. This can partly be explained by the higher number of young people in the Aboriginal population.

Analysis of 102 suicides in the Kimberley between 2005 and 2014 found that 71% of individuals were male, 68% were less than 30 years old, and 27% were less than 20 years old. Hanging was the method of suicide in 93% of the cases.

Male suicide rates

In a 2009 report the Australian Institute of Health and Welfare compared suicide rates of 15 to 34-year-old males:

The table shows that the most vulnerable age-specific category are the 25 to 29-year-old Aboriginal males - 91 suicides per 100,000, nine times the overall national rate of 11 suicides per 100,000.

Suicide has become the 2nd leading cause of death for Aboriginal men in the NT after cardiovascular disease. Since the majority of Aboriginal suicides occur before 35 years of age, it has devastating psychological and social impacts on families.

States and territories

Western Australia leads the Aboriginal suicide rates, with 35.8 per 100,000 Aboriginal population.

The Northern Territory has a similar suicide rate - 35.2 suicides per 100,000 people. These rates are three times the suicide rate of Aboriginal people in NSW, and twice the Queensland rate.

In Queensland the suicide rate for the period 1990 to 1995 was 14.5 per 100,000, with the Aboriginal rate being 23.6.

The number of "completed" Aboriginal suicides in 2011 exceeded the number of Australian Defence Force fatalities in Afghanistan.

The independent and not-for-profit Telethon Kids Institute also researches Aboriginal suicides. It has published maps showing Aboriginal suicide rates and numbers across Australia like the one below using data from the National Coronial Information System which provides the best available picture of suicide in Australian states and territories, although some data needs to be used with caution (see the disclaimer on their website).

On 8 July 2021 the Australian government established a Royal Commission Into Defence and Veteran Suicides to investigate the veteran's suicide rate of about 25 suicides a year (between 2001 and 2017).

No Royal Commission has been called for to examine Aboriginal suicides which averages 149 per year (2012 to 2018) - six times the veterans' rate.

There are probably more suicides

Precise data on the number of suicides is difficult and most likely too low because some cases are not recorded as suicides (death occurred due to "external causes" or "accidental threats to breathing") and delays in publishing figures. In remote areas it's difficult to access health care services which leads to under-reporting.

Because of these uncertainties, some researchers estimate that rather than one in 18 deaths the official suicide rate is closer to one in 10.

Video: Personal suicide stories

Watch a documentary with personal stories from Aboriginal people, developed to be an early intervention tool to bring awareness to the growing suicide crisis.

On the Tiwi Islands, north of Darwin in the Northern Territory, steel spikes on power poles try to stop young people from hanging or electrocuting themselves. From 2000 to 2005 the islands were known as the "suicide capital" of the world.

Why do Aboriginal people kill themselves?

Aboriginal suicides are similar but also different to non-Aboriginal suicides--people kill themselves at the end of a long period of suppressed rage (and not grief as commonly thought), but also because of trauma passed on from previous generations, and social marginalisation.

Aboriginal people

Non-Aboriginal people

Main driver

Disempowerment

Risk factors

Examples

Mental illness, substance abuses, sexual abuse trauma, loss of land and culture, trans-generational trauma, grief and loss, racism, social exclusion.

Psychiatric disorders (e.g. depression), stressful life events, substance abuse.

Environment

Removed from their biological parents, incarceration, acute poverty, denied rights, third-world conditions, missing access to the benefits of education and hard work.

High levels of social disadvantage ranging from unemployment, to homelessness, incarceration and family problems.

Historical experiences

High influence, transgenerational trauma of massacres, war and genocide.

Not very influential.

Rage is what overwhelms us in unbearable situations that we can neither fight nor flee. It is compounded if such situations repeat over a long period of time and the sufferer is powerless to avenge. Rage or violence is the "prime mover" of suicide, and a person who self-harms has endured physical violence, emotional or sexual abuse as a child or young adult. All these factors are prevalent in Aboriginal communities. Aboriginal violence is not only a result of invasion but also of tribal history.

Aboriginal male suicides play an important part in explaining elevated suicide rates with many suicides concentrated in the 15 to 24 and 25 to 34 age brackets, often through hanging and while incarcerated.

Any event can trigger suicide: becoming unemployed or relationship stress, but also more banal triggers such as not handing over a mobile phone, being refused the car keys or being locked out.

Unbearable (and intergenerational) trauma. Many Aboriginal people have been traumatised when they were abused as children in Aboriginal missions and by foster parents, when their children were stolen, their families massacred, they lost their homelands or experienced institutional racism. The pain haunts them through their adult life and if they don't receive help some just cannot cope any more. Many bear multiple traumas that are composite, aggressive and complex. Trauma is passed on through the generations (transgenerational or collective trauma).
"There were all these funerals, these preventable deaths, that were happening and people were reaching a sense of hopelessness. They felt that they couldn't address their issues, and that death was the only answer," says Aboriginal woman June Oscar, chief executive of Fitzroy Crossing's women's centre.

Invasion. Invasion and decolonisation has a significant impact on the rates of suicide among indigenous peoples worldwide, as have policies that dominate and change the Aboriginal way of life, such as under the Northern Territory intervention. Decolonisation causes governmental and mission-structured administrations to disappear overnight, leaving a vacuum that causes communities to "implode" and become disordered societies.

Poverty. The major factor is the extreme poverty that many are marginalised and racialised within. Research found that wherever there is extreme poverty in the Kimberley there are spates of suicide and self-harm incidents . Aboriginal people who live above the poverty line suicide at a lower rate than non-Aboriginal Australians.

Racism. Ongoing racism is a big driver to suicide, even for Aboriginal youth who are doing well at school . Walmajarri and Bunaba Kimberley mother, Lena Andrews, who lost her 18-year-old daughter to suicide, says: "Our people are smashed by it, hurt by it, tortured by it. This is a nation of two peoples. The First Peoples and the Australian peoples and unless First Peoples do as they're told then they are punished by every means imaginable." Some cannot show the "inexhaustible resilience" required to deal with racism.

Abuse of alcohol and drugs. Many deaths are highly correlated to the abuse of alcohol, ice and cannabis. Some propose a self-imposed ban on drugs to 'suicide-proof' communities. The time has come to take matters into their own hands and address "how we've neglected each other and made up excuses."

Poor living conditions. The appalling living conditions play their part: Fetal alcohol syndrome, poor levels of education, few jobs, 'disgraceful' public housing, overcrowded homes. Increasing government spending is a way to improve community life and avoid Aboriginal suicides. But it is seriously flawed, because "no organisation or individual monitors the performance of [government] agencies and no-one is held responsible for achieving improved outcomes for Aboriginal people".

Being locked up in prison. Prisons are one of the places where Aboriginal suicide emerged. It's a place where Aboriginal Australians continue to be vastly over-represented. With extensive media coverage of the Royal Commission into Aboriginal Deaths in Custody, awareness of Aboriginal suicide found its way into communities in the 1990s, and in the decades that followed rates have soared.

Young people's crisis. Young Aboriginal people often commit suicide as a result of sustained and ongoing drug abuse, problems with psychosis and a lack of self-esteem. The only empowerment they have, it seems to them, is over their bodies and lives.

Theory of Interculture

Sue Hanson, a linguist with the Noongar Boodja Language Cultural Aboriginal Corporation in Bunbury, WA, says Aboriginal suicide statistics can be attributed to cultural friction.

"There is a theory called the theory of interculture which describes three cultural areas, non-Indigenous, Indigenous and the intercultural space between where the two interact," she explains. "When we interact in our community [with people of another culture] we do so in the intercultural space, when we go home we enter the non-Indigenous area, and for Aboriginals they enter the Indigenous area."

"The problem for a lot of Indigenous youth is - because of their loss of culture - they remain in the intercultural space permanently and that's where issues surrounding drug use, crime and suicide begin to arise."

Contagion effect. Counsellors often refer to a contagion effect with suicide, with one death sparking another. In 2013-14 contagion was identified as a potential factor for seven of the 23 children who suicided in Queensland. Also, during traditional funeral ceremonies which can go on for days, children see that the most attention the deceased ever gets is during the funeral period. This attracts other young people to take their own lives.

Domestic violence. Some cannot see other ways of escaping domestic and family violence than ending their lives.

Video

Following is a special ABC report about the youth suicide crisis levels among the Aboriginal population.

Suicide risk factors

The following 'risk factors' have been identified by community leaders, Elders and those working closely with Aboriginal communities in Australia.

Effects of suicide

Heather Umbagai used to be a proud and perceptive woman. After she lost her son to suicide a big sadness and depression followed. Her health declined and renal failure set in.

Suicide affects a community in many ways.

Mental health problems as a result of trauma and grief.

Copycats are triggered when witnessing suicide deaths.

Normalisation of suicide as children witness it at a young age and grow up learning that suicide is a valid option to "solve" even little problems.

Loss of leaders. Communities are losing the next generation of leaders to suicide.

Family and community breakdown. Self-destructive and suicidal behaviours lead to familial breakdowns and of community distresses.

A young man in the Mowanjum Aboriginal community is called " the hangman" because of the scars around his neck from an attempted suicide.

Many Aboriginal funeral insurance plans have clauses that limit the money paid out if a person commits suicide. In one case a plan worth $64,000 only paid $1,600.

Overcoming the suicide crisis

Aboriginal people crying out for help are often met what they believe is "chronic official indifference" to their plight. Despite the deaths, no effective suicide prevention strategy has been put in place.

Work done overseas in Canada has shown that there is a direct correlation between declining suicide rates and increases in resources allocated to allow for self-government and community-based services.

Often listening is all that is required as the following story shows.

Story: In his bag he had rope to hang himself

Gerry Georgatos is tirelessly working to help raise awareness for Aboriginal suicide. He tells the following story:

"One of the volunteers, a gentleman walked up to me, embraced me. I do my bit with an elevated risk group to suicide - the homeless. The last time we met, he had been sitting in a park where many of Perth's homeless congregate.

"He was on his own, tearful. I put my hand on his shoulder and said something [comforting] to him... He looked up at me forlorn, in a tumult of unbearable pain but with eyes screaming 'help'.

I sat next to him and for a couple of hours I listened. We talked but mostly I listened. In his bag he had rope to hang himself."

How to reduce Aboriginal suicides

There are some factors that can improve the well-being of Aboriginal people and reduce the risk of suicide:

Listen to the people. Despite suicide being a crisis the topic has been absent from politics. But people who are losing their loved ones are crying out to be heard. Experts like Gerry Georgatos demand a national inquiry or royal commission into (not only) Aboriginal suicides.

Revive the connection to land. For example by living on, or maintaining relationship with, traditional lands. Taking young people onto country so they can reconnect with who they are as the basis for building self-belief, self-confidence and self-respect.

Join youth with Elders. Bridging the divide between youth and Elders and bringing back respect for Elders and culture.

Empower community. Empowering communities to handle affairs themselves is important for true self determination. When an Aboriginal community with a high suicide rate was given a grant to send a few people to a big suicide prevention conference in Alice Springs they used the money instead to hire a bus for 12-15 people to go all the way to Alice Springs, stopping at other communities along the way to exchange stories about suicide with them.

Recognise Aboriginal law and customs. Recognise customary law and discipline and offer culturally appropriate ways to address and overcome the crisis. Apply justice reinvestment rather than punitive justice.

Practice 'two-way' education. Schools need to also teach Aboriginal culture.

Focus on the young. Engaging activities for youth in communities help them socialise and discover alternatives. The award-winning Yirimam Project in the Kimberley, initiated by Aboriginal elders in 1997, takes young people into the bush to help them develop a sense of their cultural heritage, which builds self-esteem and identity and prevents suicides.

Offer jobs. Culturally-appropriate job pathways and work opportunities give meaning to their lives.

Heal the trauma. Elder-driven on-country healing programs for youth help them become stronger and think differently about themselves. (The Healing Foundation is a national Aboriginal organisation that partners with communities to address the ongoing trauma.) Support Elders to maintain and pass on their cultural knowledge to young people. Help those who have suffered child sexual abuse. Strengthen social and emotional wellbeing and cultural identity. Equine Assisted Learning has shown success in Western Australia.

A network of (Aboriginal) health experts. A network of psychiatrists, nurses and mental health workers - many of them Aboriginal - in Western Australia led to a 120% increase in Aboriginal people accessing mental health services, a 144% increase in face-to-face clinical consultations and a 44% increase in those accessing community health services. Aboriginal community-controlled health services should be the preferred facilitators of suicide prevention activity to their communities.

Aaron Stuart has written The Story of Yudum, a book which illustrates how Aboriginal people dealt with suicide before invasion.

The book is a good resource for anyone teaching about suicide prevention in Aboriginal communities, but also for those interested in the matter.

Homework: What can be done?

South Australian Elder Tauto Sansbury says:

"And yet there is no mention of this continuing [Aboriginal suicide] problem in the media apart from the obituaries, and the Aboriginal community itself reacts to this situation passively as if it is acceptable and just the normal course of things. It is not an issue for discussion or action, at any level of government or in any human rights forum. I tell you it's not the normal course of things."

Questions

Why do you think are Aboriginal people so passive about the suicide epidemic amongst their people?

What should the Australian media change to help prevent future suicides?

Research what the Australian government has done to address Aboriginal suicide. What should it do next?

Every second Tuesday in September is World Suicide Prevention Day.

Story: Uncle Jack Charles' advice

Asked for advice for people who are feeling vulnerable and having suicidal thoughts, Aboriginal actor Uncle Jack Charles responded:

"Don't do anything that puts you in this insidious position. You've got to find a safe spot for yourself. Be truthful. Be honest with yourself. Express yourself clearly. It's difficult. Many of us don't know how to. We've never been able to talk about deep-rooted problems confronting us. And take yourself seriously. We don't know our full potential unless we take ourselves more seriously."

Get help

Help for those affected by suicide

Standby Support
24/7 hotline, phone number depends on your state or area, check here.
Support for support anyone who has been impacted by suicide at any stage in their life, including individuals, families and friends, witnesses, schools, workplaces and community groups, first responders and service providers.
standbysupport.com.au

"Death is our life"-Aboriginal suicide is at crisis levels

Almost non-existent in the 1980s, the rate of suicide and self harm amongst Aboriginal people is at crisis levels and has reached "horrific proportions", particularly in remote communities and especially amongst youth.

Aboriginal suicides are rising year-on-year, yet the Australian government does not respond adequately to this epidemic. In 2018, 169 Aboriginal people took their own lives, in 2017 there were 165 suicides, 140 in 2014 and 120 in 2012.

"Death is our life," says South Australian Elder Tauto Sansbury, describing the despair in Aboriginal communities Australia-wide, of mourning and sadness for young lives lost far too often.

Suicide affects 95% of Aboriginal people in Australia, and many are born into families where grief from suicide already exists, sometimes across two or three generations. Suicide is the fifth leading cause of death for Aboriginal and Torres Strait Islander people (second for males and seventh for females).

Research by journalist Gerry Georgatos found "that the prevalence of spates of suicides among Australian Aboriginal youth are the world's highest, and that these spates are becoming more prevalent and settling in to higher medians year in year out."

Suicide numbers are so high among young Aboriginal children that community leaders speak of "horrific narratives" and a "normalisation" of suicide in that age group. More and more children, who are younger and younger, commit suicide.

"There is a fundamental failure at a community level where kids feel as if the only coping mechanism they have is to end their life," finds Geraldton Mayor Ian Carpenter.

Australia's Aboriginal suicide epidemic

Aboriginal communities in the Kimberley in Western Australia mourned 21 suicide deaths in 2006, compared to only three in the wider community, a rise by 100%. A "suicide epidemic" saw up to 20 young Aboriginal people took their lives within 12 months. In Mowanjum, a 10-minute drive from mining hub Derby in the West Kimberley, there were 6 suicides in as many months. In the seven weeks to Christmas 2014 as many people killed themselves.

And it doesn't stop. Year after year consecutive Aboriginal suicides rock communities, so much so that Australia's most powerful medical organisations are pleading with the federal government to take urgent action to stop the "unspeakable tragedy" of Aboriginal youth suicide.

The young suicide more

For Aboriginal children aged 14 years and less, suicide is the second leading cause of death - and they are up to 8 times more likely to die by suicide than their non-Aboriginal peers.

In 2018, suicide was the leading cause of death for 5- to 17-year-olds (26.5%), and in 2015 it was the leading cause of death for young Aboriginal people aged 15 to 35 years (30%).

Suicide rates in that age group are three to four times higher than those of the general population. But even the age group of 35-44 years still has almost twice the rate. This can partly be explained by the higher number of young people in the Aboriginal population.

Analysis of 102 suicides in the Kimberley between 2005 and 2014 found that 71% of individuals were male, 68% were less than 30 years old, and 27% were less than 20 years old. Hanging was the method of suicide in 93% of the cases.

Male suicide rates

In a 2009 report the Australian Institute of Health and Welfare compared suicide rates of 15 to 34-year-old males:

The table shows that the most vulnerable age-specific category are the 25 to 29-year-old Aboriginal males - 91 suicides per 100,000, nine times the overall national rate of 11 suicides per 100,000.

Suicide has become the 2nd leading cause of death for Aboriginal men in the NT after cardiovascular disease. Since the majority of Aboriginal suicides occur before 35 years of age, it has devastating psychological and social impacts on families.

States and territories

Western Australia leads the Aboriginal suicide rates, with 35.8 per 100,000 Aboriginal population.

The Northern Territory has a similar suicide rate - 35.2 suicides per 100,000 people. These rates are three times the suicide rate of Aboriginal people in NSW, and twice the Queensland rate.

In Queensland the suicide rate for the period 1990 to 1995 was 14.5 per 100,000, with the Aboriginal rate being 23.6.

The number of "completed" Aboriginal suicides in 2011 exceeded the number of Australian Defence Force fatalities in Afghanistan.

The independent and not-for-profit Telethon Kids Institute also researches Aboriginal suicides. It has published maps showing Aboriginal suicide rates and numbers across Australia like the one below using data from the National Coronial Information System which provides the best available picture of suicide in Australian states and territories, although some data needs to be used with caution (see the disclaimer on their website).

On 8 July 2021 the Australian government established a Royal Commission Into Defence and Veteran Suicides to investigate the veteran's suicide rate of about 25 suicides a year (between 2001 and 2017).

No Royal Commission has been called for to examine Aboriginal suicides which averages 149 per year (2012 to 2018) - six times the veterans' rate.

There are probably more suicides

Precise data on the number of suicides is difficult and most likely too low because some cases are not recorded as suicides (death occurred due to "external causes" or "accidental threats to breathing") and delays in publishing figures. In remote areas it's difficult to access health care services which leads to under-reporting.

Because of these uncertainties, some researchers estimate that rather than one in 18 deaths the official suicide rate is closer to one in 10.

Video: Personal suicide stories

Watch a documentary with personal stories from Aboriginal people, developed to be an early intervention tool to bring awareness to the growing suicide crisis.

On the Tiwi Islands, north of Darwin in the Northern Territory, steel spikes on power poles try to stop young people from hanging or electrocuting themselves. From 2000 to 2005 the islands were known as the "suicide capital" of the world.

Why do Aboriginal people kill themselves?

Aboriginal suicides are similar but also different to non-Aboriginal suicides--people kill themselves at the end of a long period of suppressed rage (and not grief as commonly thought), but also because of trauma passed on from previous generations, and social marginalisation.

Aboriginal people

Non-Aboriginal people

Main driver

Disempowerment

Risk factors

Examples

Mental illness, substance abuses, sexual abuse trauma, loss of land and culture, trans-generational trauma, grief and loss, racism, social exclusion.

Psychiatric disorders (e.g. depression), stressful life events, substance abuse.

Environment

Removed from their biological parents, incarceration, acute poverty, denied rights, third-world conditions, missing access to the benefits of education and hard work.

High levels of social disadvantage ranging from unemployment, to homelessness, incarceration and family problems.

Historical experiences

High influence, transgenerational trauma of massacres, war and genocide.

Not very influential.

Rage is what overwhelms us in unbearable situations that we can neither fight nor flee. It is compounded if such situations repeat over a long period of time and the sufferer is powerless to avenge. Rage or violence is the "prime mover" of suicide, and a person who self-harms has endured physical violence, emotional or sexual abuse as a child or young adult. All these factors are prevalent in Aboriginal communities. Aboriginal violence is not only a result of invasion but also of tribal history.

Aboriginal male suicides play an important part in explaining elevated suicide rates with many suicides concentrated in the 15 to 24 and 25 to 34 age brackets, often through hanging and while incarcerated.

Any event can trigger suicide: becoming unemployed or relationship stress, but also more banal triggers such as not handing over a mobile phone, being refused the car keys or being locked out.

Unbearable (and intergenerational) trauma. Many Aboriginal people have been traumatised when they were abused as children in Aboriginal missions and by foster parents, when their children were stolen, their families massacred, they lost their homelands or experienced institutional racism. The pain haunts them through their adult life and if they don't receive help some just cannot cope any more. Many bear multiple traumas that are composite, aggressive and complex. Trauma is passed on through the generations (transgenerational or collective trauma).
"There were all these funerals, these preventable deaths, that were happening and people were reaching a sense of hopelessness. They felt that they couldn't address their issues, and that death was the only answer," says Aboriginal woman June Oscar, chief executive of Fitzroy Crossing's women's centre.

Invasion. Invasion and decolonisation has a significant impact on the rates of suicide among indigenous peoples worldwide, as have policies that dominate and change the Aboriginal way of life, such as under the Northern Territory intervention. Decolonisation causes governmental and mission-structured administrations to disappear overnight, leaving a vacuum that causes communities to "implode" and become disordered societies.

Poverty. The major factor is the extreme poverty that many are marginalised and racialised within. Research found that wherever there is extreme poverty in the Kimberley there are spates of suicide and self-harm incidents . Aboriginal people who live above the poverty line suicide at a lower rate than non-Aboriginal Australians.

Racism. Ongoing racism is a big driver to suicide, even for Aboriginal youth who are doing well at school . Walmajarri and Bunaba Kimberley mother, Lena Andrews, who lost her 18-year-old daughter to suicide, says: "Our people are smashed by it, hurt by it, tortured by it. This is a nation of two peoples. The First Peoples and the Australian peoples and unless First Peoples do as they're told then they are punished by every means imaginable." Some cannot show the "inexhaustible resilience" required to deal with racism.

Abuse of alcohol and drugs. Many deaths are highly correlated to the abuse of alcohol, ice and cannabis. Some propose a self-imposed ban on drugs to 'suicide-proof' communities. The time has come to take matters into their own hands and address "how we've neglected each other and made up excuses."

Poor living conditions. The appalling living conditions play their part: Fetal alcohol syndrome, poor levels of education, few jobs, 'disgraceful' public housing, overcrowded homes. Increasing government spending is a way to improve community life and avoid Aboriginal suicides. But it is seriously flawed, because "no organisation or individual monitors the performance of [government] agencies and no-one is held responsible for achieving improved outcomes for Aboriginal people".

Being locked up in prison. Prisons are one of the places where Aboriginal suicide emerged. It's a place where Aboriginal Australians continue to be vastly over-represented. With extensive media coverage of the Royal Commission into Aboriginal Deaths in Custody, awareness of Aboriginal suicide found its way into communities in the 1990s, and in the decades that followed rates have soared.

Young people's crisis. Young Aboriginal people often commit suicide as a result of sustained and ongoing drug abuse, problems with psychosis and a lack of self-esteem. The only empowerment they have, it seems to them, is over their bodies and lives.

Theory of Interculture

Sue Hanson, a linguist with the Noongar Boodja Language Cultural Aboriginal Corporation in Bunbury, WA, says Aboriginal suicide statistics can be attributed to cultural friction.

"There is a theory called the theory of interculture which describes three cultural areas, non-Indigenous, Indigenous and the intercultural space between where the two interact," she explains. "When we interact in our community [with people of another culture] we do so in the intercultural space, when we go home we enter the non-Indigenous area, and for Aboriginals they enter the Indigenous area."

"The problem for a lot of Indigenous youth is - because of their loss of culture - they remain in the intercultural space permanently and that's where issues surrounding drug use, crime and suicide begin to arise."

Contagion effect. Counsellors often refer to a contagion effect with suicide, with one death sparking another. In 2013-14 contagion was identified as a potential factor for seven of the 23 children who suicided in Queensland. Also, during traditional funeral ceremonies which can go on for days, children see that the most attention the deceased ever gets is during the funeral period. This attracts other young people to take their own lives.

Domestic violence. Some cannot see other ways of escaping domestic and family violence than ending their lives.

Video

Following is a special ABC report about the youth suicide crisis levels among the Aboriginal population.

Suicide risk factors

The following 'risk factors' have been identified by community leaders, Elders and those working closely with Aboriginal communities in Australia.

Effects of suicide

Heather Umbagai used to be a proud and perceptive woman. After she lost her son to suicide a big sadness and depression followed. Her health declined and renal failure set in.

Suicide affects a community in many ways.

Mental health problems as a result of trauma and grief.

Copycats are triggered when witnessing suicide deaths.

Normalisation of suicide as children witness it at a young age and grow up learning that suicide is a valid option to "solve" even little problems.

Loss of leaders. Communities are losing the next generation of leaders to suicide.

Family and community breakdown. Self-destructive and suicidal behaviours lead to familial breakdowns and of community distresses.

A young man in the Mowanjum Aboriginal community is called " the hangman" because of the scars around his neck from an attempted suicide.

Many Aboriginal funeral insurance plans have clauses that limit the money paid out if a person commits suicide. In one case a plan worth $64,000 only paid $1,600.

Overcoming the suicide crisis

Aboriginal people crying out for help are often met what they believe is "chronic official indifference" to their plight. Despite the deaths, no effective suicide prevention strategy has been put in place.

Work done overseas in Canada has shown that there is a direct correlation between declining suicide rates and increases in resources allocated to allow for self-government and community-based services.

Often listening is all that is required as the following story shows.

Story: In his bag he had rope to hang himself

Gerry Georgatos is tirelessly working to help raise awareness for Aboriginal suicide. He tells the following story:

"One of the volunteers, a gentleman walked up to me, embraced me. I do my bit with an elevated risk group to suicide - the homeless. The last time we met, he had been sitting in a park where many of Perth's homeless congregate.

"He was on his own, tearful. I put my hand on his shoulder and said something [comforting] to him... He looked up at me forlorn, in a tumult of unbearable pain but with eyes screaming 'help'.

I sat next to him and for a couple of hours I listened. We talked but mostly I listened. In his bag he had rope to hang himself."

How to reduce Aboriginal suicides

There are some factors that can improve the well-being of Aboriginal people and reduce the risk of suicide:

Listen to the people. Despite suicide being a crisis the topic has been absent from politics. But people who are losing their loved ones are crying out to be heard. Experts like Gerry Georgatos demand a national inquiry or royal commission into (not only) Aboriginal suicides.

Revive the connection to land. For example by living on, or maintaining relationship with, traditional lands. Taking young people onto country so they can reconnect with who they are as the basis for building self-belief, self-confidence and self-respect.

Join youth with Elders. Bridging the divide between youth and Elders and bringing back respect for Elders and culture.

Empower community. Empowering communities to handle affairs themselves is important for true self determination. When an Aboriginal community with a high suicide rate was given a grant to send a few people to a big suicide prevention conference in Alice Springs they used the money instead to hire a bus for 12-15 people to go all the way to Alice Springs, stopping at other communities along the way to exchange stories about suicide with them.

Recognise Aboriginal law and customs. Recognise customary law and discipline and offer culturally appropriate ways to address and overcome the crisis. Apply justice reinvestment rather than punitive justice.

Practice 'two-way' education. Schools need to also teach Aboriginal culture.

Focus on the young. Engaging activities for youth in communities help them socialise and discover alternatives. The award-winning Yirimam Project in the Kimberley, initiated by Aboriginal elders in 1997, takes young people into the bush to help them develop a sense of their cultural heritage, which builds self-esteem and identity and prevents suicides.

Offer jobs. Culturally-appropriate job pathways and work opportunities give meaning to their lives.

Heal the trauma. Elder-driven on-country healing programs for youth help them become stronger and think differently about themselves. (The Healing Foundation is a national Aboriginal organisation that partners with communities to address the ongoing trauma.) Support Elders to maintain and pass on their cultural knowledge to young people. Help those who have suffered child sexual abuse. Strengthen social and emotional wellbeing and cultural identity. Equine Assisted Learning has shown success in Western Australia.

A network of (Aboriginal) health experts. A network of psychiatrists, nurses and mental health workers - many of them Aboriginal - in Western Australia led to a 120% increase in Aboriginal people accessing mental health services, a 144% increase in face-to-face clinical consultations and a 44% increase in those accessing community health services. Aboriginal community-controlled health services should be the preferred facilitators of suicide prevention activity to their communities.

Aaron Stuart has written The Story of Yudum, a book which illustrates how Aboriginal people dealt with suicide before invasion.

The book is a good resource for anyone teaching about suicide prevention in Aboriginal communities, but also for those interested in the matter.

Homework: What can be done?

South Australian Elder Tauto Sansbury says:

"And yet there is no mention of this continuing [Aboriginal suicide] problem in the media apart from the obituaries, and the Aboriginal community itself reacts to this situation passively as if it is acceptable and just the normal course of things. It is not an issue for discussion or action, at any level of government or in any human rights forum. I tell you it's not the normal course of things."

Questions

Why do you think are Aboriginal people so passive about the suicide epidemic amongst their people?

What should the Australian media change to help prevent future suicides?

Research what the Australian government has done to address Aboriginal suicide. What should it do next?

Every second Tuesday in September is World Suicide Prevention Day.

Story: Uncle Jack Charles' advice

Asked for advice for people who are feeling vulnerable and having suicidal thoughts, Aboriginal actor Uncle Jack Charles responded:

"Don't do anything that puts you in this insidious position. You've got to find a safe spot for yourself. Be truthful. Be honest with yourself. Express yourself clearly. It's difficult. Many of us don't know how to. We've never been able to talk about deep-rooted problems confronting us. And take yourself seriously. We don't know our full potential unless we take ourselves more seriously."

Get help

Help for those affected by suicide

Standby Support
24/7 hotline, phone number depends on your state or area, check here.
Support for support anyone who has been impacted by suicide at any stage in their life, including individuals, families and friends, witnesses, schools, workplaces and community groups, first responders and service providers.
standbysupport.com.au

Books

Aboriginal Suicide is Different

Every Australian's birthright includes the expectation of a healthy and possibly happy life of some longevity, assisted by ...

# data[].attributes.attachment_link.description
People Suicide was unknown to Aboriginal people prior to invasion. Appalling living conditions and past traumas have led to a suicide rate that by far exceeds that of non-Aboriginal people. Get key foundational knowledge about Aboriginal culture in a fun and engaging way.

# data[].attributes.attachment_link.readable_text
In 2018 and 2019, there was a continual increase in suicides amongst Indigenous Peoples, specifically in Australia. Why is this happening at such an alarming rate? What is the cause of these deaths, especially among the youth?

Globally, suicide is the second highest contributor to adolescent deaths. Studies from high-income countries including Australia, New Zealand, the United States, Canada, and Arctic nations consistently find elevated suicide rates among Indigenous populations, with substantial rate disparities compared to non-Indigenous populations. According to the World Health Organization, low- and middle-income countries and high-income countries have similar annual standardized suicide rates. However, low- and middle-income countries account for 75 percent of suicide deaths worldwide, and there is often a disproportionate burden amongst specific subgroups within countries, such as Indigenous Peoples.

In Canada, the highest suicide rates have been reported among First Nations Peoples. According to Canada's Centre for Suicide Prevention, suicide and self-inflicted injuries are the leading causes of death for First Nations youths and adults up to age 44. The suicide rate for First Nations male youths ages 15-24 is 126 per 100,000, compared to 24 per 100,000 for non-Indigenous male youth. For First Nations females, the suicide rate is 35 per 100,000 compared to 5 per 100,000 for non-Indigenous females. Suicide rates for Inuit youth are among the highest in the world, at 11 times the national average.

In Australia, Aboriginal and Torres Strait Islanders between the ages of 15-24 are almost 4 times more likely to commit suicide than non-Indigenous people in the same age bracket. The Australian Bureau of Statistics reported that suicide is the leading cause of death for Indigenous children ages 5-17. From 2014-2018, Aboriginal and Torres Strait Islander children accounted for close to 25 percent of all child suicide deaths.

To better understand the issue of suicide among Indigenous Peoples, Cultural Survival Indigenous Rights Radio Producer, Shaldon Ferris (KhoiSan), recently spoke to Pat Dudgeon (Bardi), director of the Centre of Best Practice in Aboriginal and Torres Strait Islander on Suicide Prevention at the University of Western Australia (UWA). She is a psychologist, professor, Fellow of the Australian Psychological Society, and Poche Research Fellow at the School of Indigenous Studies at UWA in Perth.

Cultural Survival: Is the spike in the Indigenous suicide rate a recent trend, or has it been on the rise for some time?
Pat Dudgeon: Indigenous suicides have always been a big issue. It's probably gained a lot more national media attention in recent times, but it has been a growing concern in the last 40 years. Our Indigenous suicide rate is twice that of the general population, so it's become a big, big issue.

CS: What are some of the leading reasons for Indigenous suicides?
PD: For any suicide there is a whole matrix of different issues and problems. We believe that it's the history of colonization that Indigenous people have lived through. The country was taken over, there was genocide, people were removed from their countries and moved into missions and reserves. We went through a period we call the Stolen Generations, where people were forcibly taken from their families and put into institutions. In contemporary times, as well as having intergenerational trauma that's been passed down, there are a whole lot of social determinants that impact Indigenous people. We have higher rates of poverty and incarceration, and racism is ongoing, so those are factors that contribute to suicide and bad mental health. It's not a simple or clear answer. There's a lot of grief and loss in the community, substance abuse issues, sexual abuse, and so on, but for Indigenous people, having that history of colonization and ongoing racism is certainly a big part of the story.

CS: Is a loss of identity due to the impacts of colonialism a factor?
PD: Absolutely. We've gone out and done workshops and roundtables with community people, and we've done empowerment programs. What amazes me is how people implicitly know that what the mainstream has done-what the State has done to them-is wrong. They've seen their mothers and grandmothers subject to racist acts and treatments. To have it explicitly taught to them, to say, 'yes, this legislation happened and this was the impact,' validates their experience, and people are very conscious to hold on and to strengthen their cultural identity. I think we're in a process of remaking and restrengthening our cultural identity. Lucky for us, colonization has been a relatively short history compared to other countries. It could've been much more damaging. With Stolen Generations, some of those people were moved far away from home, and we have had some big initiatives called Bringing Them Home, which were about helping people come back to rediscover who their family or language group were, and to reconnect. Archie Roach (a local Indigenous singer) has written about the children coming home. That's important for us, to ensure that we strengthen our identity and people build faith so they know who they are and their role in the future.

CS: Are there patterns of similar occurrences happening in other Indigenous communities around the world?
PD: Yes, it's a very similar story. In November 2018, we held the second World Indigenous Suicide Prevention Conference. We ran it in a certain way where we privileged Indigenous presence and voices. When we formed our committees to plan the conference, we ensured there were youth representatives on there, elders, members of our LGBTQIA+ groups. Having the World Indigenous Suicide Prevention Conference was very important because we had people from Canada, New Zealand, the U.S., and so on, present. We looked at the global Indigenous suicide rates; they are very similar, it's a similar story. So I think all Indigenous societies are in a greater or lesser state of recovery from colonization, and one of the markers is a very high suicide rate, much higher than the rest of the population. That was important to us, to come together as world Indigenous people and to share our stories and to share what the solutions could be. We are seeing a global movement happening, and that's very important. I think we join up with our Indigenous brothers and sisters from other countries to talk, to learn from each other, and to share our knowledge and go forward. And, while we claim the right to have leadership in the discussion, there are certainly great nonIndigenous supporters and governments that support us as well.

CS: Do you think we should be talking to our respective governments about solutions, or should this issue be solved by us as Indigenous Peoples?
PD: Definitely from the people. The State has a very important role, and that is to give the resources to the people. It's very important to ensure that resources are sent into the community. Our position is for Aboriginal people themselves. Unless they're in charge of identifying the problem, the issues, and then implementing the solutions, we're going to have very limited effective suicide prevention or any kind of programs. We know that culture, self- determination, and cultural reclamation is important. Both were assumptions on the work done by Professor Michael J. Chandler in Canada, where they did some research with First Nations people and showed that communities with little self-determination and little cultural reclamation had higher suicide rates. We also used the work of the Harvard Project on American Indian Economic Development in the United States, where they've shown that Indigenous communities that are much happier and have higher health rates are ones that are also exercising their self-determination. That's very important for any group of human beings: they need to be there at the table, making decisions, being part of deciding what happens, how, when, and where.

CS: Is enough being done to reduce the Indigenous suicide rate? Do you think there's hope?
PD: I'm optimistic. I think Australia is alarmed at what's happening in its country. I think the government does want change to happen. I think the communities themselves want change to happen, because we had an elders group at our World Indigenous Suicide Prevention conference who were very vocal in what they wanted. They wanted a royal commission to look at the issue, and they were very vocal in what they thought the government should do. I think that all supporters of our society, whether it's governments, whether it's people on the ground, certainly the communities themselves, they want accountability and they want to be part of the discussion. So, I think things will change. I don't think it'll be an overnight solution, because it's taken us years to get to this point. For some sections it might take time to turn this around, but it will be turned around.

CS: What message can we give the Indigenous person who is in a remote area somewhere, contemplating suicide?
PD: Firstly, don't do it. Do not do it. Things will get better, but go and get help. It would be great if we could have a telephone crisis center that's culturally appropriate and knows our values and our issues and can give immediate help. Counselors too, they need to be trained to be more culturally knowledgeable. But there will be people in your family and in your community who can help. In every family and every community there is usually one strong person, or more, who will help the others. We need to nurture those people. They're the people we go to, and we've all got one or two in our lives, so go to those people, talk to them, get help from them.

Top photo: Pat Dudgeon speaks at the 2nd World Indigenous Suicide Prevention Conference. Photo courtesy of Pat Dudgeon.

# data[].attributes.attachment_link.title
Combatting Suicide Amongst Indigenous Peoples: An Interview with Pat Dudgeon

# data[].attributes.attachment_link.description
In 2018 and 2019, there was a continual increase in suicides amongst Indigenous Peoples, specifically in Australia. Why is this happening at such an alarming rate? What is the cause of these deaths, especially among the youth? Globally, suicide is the second highest contributor to adolescent deaths.

# data[].attributes.attachment_link.description
Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.