Unique patterns of suicide completions and attempts among the White Mountain Apache tribal youth

Background: Suicide is a leading disparity among American Indian and Alaska Native (AI/AN) youth. Rates of suicidal behavior vary markedly across tribes. In January 2001, the White Mountain Apache Tribe became the first population in the U.S. to mandate community-wide reporting of suicide completions, attempts and ideation. Methods: A common suicide registry form is used by tribal agencies to report suicidal events to a Suicide Prevention Coalition. Data are entered weekly into an electronic database. Patterns in age, gender, methods, and potential triggers have been analyzed for 2001-2006 with assistance from Johns Hopkins Center for American Indian Health. Results: From 2001 to 2006, 40 suicide completions were reported among a reservation-based population of ~15,000. The majority (24 of 40, or 60%) were youth (<25 years of age). In 2005, 159 (68%) of the 235 reported cases of attempted suicide (AS) were <25 years. In 2006, 103 (64%) of the 160 AS cases were <25 years. Annual average completion rates among 15-24 year olds were approximately 118/100,000. Male youth completions exceeded female completions by 5:1. Male-to-female youth attempts were ~1:1. Hanging was the primary method (88%) of completion (21/24 youth). Conflict with partners, family members and/or loss of loved one were the triggers most often noted by AS youth cases. Conclusions: Several suicide characteristics and patterns found among the White Mountain Apache contrast with those of the U.S. population. These findings may shed light on cultural or social underpinnings of suicidality and inform prevention strategies in this and other high-risk populations.