Suicide interventions for American Indian and Alaska native populations: A systematic review of outcomes

Abstract Objective A 2018 Center for Disease Control and Prevention report estimated that 22.1 per 100,000 American Indian/Alaska Native (AI/AN) individuals died by suicide, much higher than the overall U.S. rate of 14.2. To understand how to remedy this problem, we performed a systematic review in response to the following question: “What interventions work to prevent AI/AN suicide?” Method We adopted a broad inclusionary stance while searching, screening, and extracting data. Our search strategy yielded 1605 unique citations, and after screening 28 items met the set criteria. Results While participants from each study reported an improvement on at least one targeted measure, particularly along community-driven outcome measures, several methodological modifications arose to meet the ideals of both practice- and evidence-based research. For example, only 11 studies featured assessments that measured changes in direct suicide outcomes. Among these 11 studies, only four featured either a randomized or a non-randomized controlled trial. Furthermore, only one intervention produced consistent outcomes across several studies. Nevertheless, the results from our reviewed corpus were methodologically innovative and suggest an overall benefit to AI/AN communities. Conclusions The case for these interventions could be augmented through a variety of methodological advancements. Thus, we propose that future studies dismantle their interventions into underlying processes, evaluate these processes using direct, standardized measures of suicidal behavior, and incentivize AI/AN recruitment into research trials outside of Indian Country.