Explore the vast range of titles available.

Indigenous communities have significantly higher rates of suicide than non-Native communities in North America. Prevention and intervention efforts have failed to redress this disparity. One explanation is that these efforts are culturally incongruent for Native communities. Four prevalent assumptions that underpin professional suicide prevention may conflict with local indigenous understandings about suicide. Our experiences in indigenous communities led us to question assumptions that are routinely endorsed and promoted in suicide prevention programs and interventions. By raising questions about the universal relevance of these assumptions, we hope to stimulate exchange and inquiry into the character of this devastating public health challenge and to aid the development of culturally appropriate interventions in cross-cultural contexts.

The broad goals of the community-based participatory research (CBPR) include community engagement, capacity building, developing practical solutions for community concerns and knowledge building. This article describes the data generation and sharing process as it relates to the goals of CBPR and health promotion in an American Indian/Alaska Native communities. The project described herein, “Investigating Inupiaq Cultural Resilience: A Pilot Study, “ achieved these goals in a tribal context by fostering intergenerational dialogue through data collection. The intergenerational exchange served to collect data for a community-based participatory study and provide an opportunity for communication between Elders, adults and youth. By providing an arena for intergenerational sharing, the format encouraged cross-age connections and in doing so, supported, in a broad sense, the transmission of cultural knowledge. The article describes the process and articulates the ways it supports the CBPR goals of engagement, practical relevance, knowledge generation and health promotion.

Background Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15–24), who experience suicide rates significantly higher than the general U.S. youth population. In under-served, remote AN communities, building on existing local and cultural resources can increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention by family members, workers and community members, which can be important for preventing suicide in places where mental health services are sparce. This study expands the variables we hypothesize as important for reducing suicide risk and supporting mental wellness. These variables are: (1) perceived suicide prevention self-efficacy, (2) perceived wellness self-efficacy, and (3) developing a ‘community of practice’ (CoP) for prevention/wellness work. Method With a convenience sample ( N  = 398) of participants (ages 15+) in five remote AN communities, this study characterizes respondents’ social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents’ wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone (3), reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community. Results Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with “working together” behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction. Conclusions The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles (2), developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.

Indigenous people living in the Circumpolar North rely, to varying degrees, on the natural environment and the resources it provides for their lifestyle and livelihoods. As a consequence, these Northern Indigenous peoples may be more sensitive to global climate change, which has implications for food security, cultural practices, and health and well-being. To date, most research on the human dimensions of climate change in the Circumpolar North has focused on biophysical issues and their consequences, such as changing sea ice regimes affecting travel to hunting grounds or the effects of melting permafrost on built infrastructure. Less is known about how these changes in the environment affect mental health and well-being. In this paper, we build upon existing research, combined with our community-based research and professional mental health practices, to outline some pathways and mechanisms through which climate change may adversely impact mental health and well-being in the Circumpolar North. Our analysis indicates that mental health may be affected by climate change due to changes to land, ice, snow, weather, and sense of place; impacts to physical health; damage to infrastructure; indirect impacts via media, research, and policy; and through the compounding of existing stress and distress. We argue that climate change is likely an emerging mental health challenge for Circumpolar Indigenous populations and efforts to respond through research, policy, and mental health programming should be a priority. We conclude by identifying next steps in research, outlining points for policy, and calling for additional mental health resources that are locally responsive and culturally relevant.

Youth suicide is a significant health disparity in circumpolar indigenous communities, with devastating impacts at individual, family, and community levels. This study draws on structured interviews and ethnographic work with health professionals in the Alaskan Arctic to examine the meanings assigned to Alaska Native youth suicide, as well as the health systems that shape clinicians’ practices of care. By defining suicide as psychogenic on the one hand, and as an index of social suffering on the other, its solutions are brought into focus and circumscribed in particular and patterned ways. We contrast psychiatric and social explanatory models, bureaucratic and relational forms of care, and biomedical and biosocial models for care delivery. Within the broader context of global mental health, this study suggests steps for linking caregiving to the health and social equity agenda of social medicine and for operationalizing commitments to health as a human right.

The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.

This paper introduces a new method for acquiring and interpreting data on cognitive (or perceptual) networks. The proposed method involves the collection of multiple reports on randomly chosen pairs of individuals, and statistical means for aggregating these reports into data of conventional sociometric form. We refer to the method as \"perceptual tomography\" to emphasize that it aggregates multiple 3rd-party data on the perceived presence or absence of individual properties and pairwise relationships. Key features of the method include its low respondent burden, flexible interpretation, as well as its ability to find \"robust intransitive\" ties in the form of perceived non-edges. This latter feature, in turn, allows for the application of conventional balance clustering routines to perceptual tomography data. In what follows, we will describe both the method and an example of the implementation of the method from a recent community study among Alaska Natives. Interview data from 170 community residents is used to ascribe 4446 perceived relationships (2146 perceived edges, 2300 perceived non-edges) among 393 community members, and to assert the perceived presence (or absence) of 16 community-oriented helping behaviors to each individual in the community. Using balance theory-based partitioning of the perceptual network, we show that people in the community perceive distinct helping roles as structural associations among community members. The fact that role classes can be detected in network renderings of \"tomographic\" perceptual information lends support to the suggestion that this method is capable of producing meaningful new kinds of data about perceptual networks.

Alaska Native (AN) youth suicide remains a substantial and recalcitrant health disparity, especially in rural/remote communities. Promoting Community Conversations About Research to End Suicide (PC CARES) is a community health intervention that responds to the need for culturally responsive and evidence-supported prevention practice, using a grassroots approach to spark multilevel and community-based efforts for suicide prevention. This paper describes theoretical and practical considerations of the approach, and assesses the feasibility and preliminary learning and behavioural outcomes of the training-of-trainers model. It details the training of a first cohort of intervention facilitators in Northwest Alaska (NWA). Thirty-two people from 11 NWA village communities completed the PC CARES facilitator training, preparing them to implement the intervention in their home communities. Facilitator pre-post surveys focused on readiness to facilitate, a group quiz assessed participants' understanding of relevant research evidence, and practice facilitation exercises demonstrated competency. Curriculum fidelity and accuracy scores were calculated using audio recordings from learning circles conducted by facilitators in their home communities. Facilitator reflections describe the successes of the model and identify several areas for improvement. As of March 2017, 20 of the 32 trained facilitators in 10 of the 11 participating villages have hosted 54 LCs, with a total of 309 unique community members. Coding of these LCs by 2 independent raters indicate acceptable levels of fidelity and accurate dissemination of research evidence by facilitators. Facilitator reflections were positive overall, suggesting PC CARES is feasible, acceptable and potentially impactful as a way to translate research to practice in under-resourced, rural AN communities. PC CARES represents a practical community education and mobilisation approach to Indigenous youth suicide prevention that displays preliminary success in learning and behavioural outcomes of local facilitators.

Because suicide is deeply connected to local, historical and relational contexts, effective suicide prevention strategies must balance maintaining fidelity of evidence-based practices and adapting for the unique needs of diverse communities. Promoting Community Conversations About Research to End Suicide (PC CARES) builds the capacity of local people in close-knit rural Alaska Native communities to take preventative actions based on existing relationships, roles, and priorities. In a series of learning circles, community members learn about multilevel evidence-based suicide prevention practices, apply the information to personal and cultural contexts, and develop plans for taking action—on their own terms—in their lives. Here, we describe the participatory process used to adapt PC CARES from one region of Alaska to another, aiming to maximize transferability, practicality and relevance in our partner communities. With the shared goal of promoting self-determined, evidence-informed, community-based suicide prevention, the adaptation process included negotiating between comprehensiveness and understandability; subject appeal and utility; predictability and customizability, through consensus-building with researchers and community members. Lessons learned can be helpful to others working to navigate community-specific priorities and evidence-based approaches to develop interventions that can work across many different communities.

Community psychology emphasizes the importance of context in the study of people’s lives, and culture influences this in profound ways. To develop programs that effectively address diverse communities’ problems, it is essential to recognize how Euro-American human service systems are understood and responded to by the many different people being served by them. The article describes how some broadly defined social services—conceptualized and implemented within a Euro-American framework—are ill suited for the everyday realities of Alaska Native villages. The cultural discontinuities are illustrated through ethnographic vignettes. The article concludes with suggestions for developing more culturally-responsive ways to conceive of and do programming for Alaska Native and possibly other Indigenous and minority communities.