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Suicide among Aboriginals

There is no question that suicide among Aboriginal peoples is a big and dramatic health issue in Canada as well as in other countries. This series of 3 articles will try to shed some light on a complex and pressing public health problem that we, as health professionals, must address. The Truth and Reconciliation Commission of Canada recently released a report focusing on all aspects of the status of First Nations peoples, including health status. This report identified suicide (rates) as an indicator of the progress in closing the gap between Aboriginal and non-Aboriginal communities. Suicide rates are quite high, and it is well known that suicide rates among Aboriginal populations are at least double that found in the general population. Kirmayer noted that among Aboriginals, there is an increase in suicide rates, and this author also stressed the fact that suicides often occur in clusters, a marked distinctive characteristic of Aboriginal suicides. Culture and language play an important but unclear role in the rise of suicide and mental health problems, in general. It seems that there is definitely a link between language, a major expression of culture, and suicide rates. For example, Chandler and Lalond found lower suicide rates among British Columbia Aboriginal communities where the native language was still spoken. Hallet et al. stipulated that many Aboriginal languages are in danger of disappearing and consequently contributing to the disappearance of cultural identities. These identities, which Aboriginal languages mediate, are definitely in threat. Hallet et al. added that failure to achieve any viable sense of self or cultural continuity is strongly linked with self-destructive and suicidal behaviors. Suicide is in fact the ‘coal miner’s canary’ of cultural distress, as Hallet et al. wrote. We still know very little about the intersection of culture, suicide, depression, and history, according to Waldram. One has to develop an integrated explanation of why some communities have much lower suicide rates than others and why some individuals suffer so much more distress than others. These 3 articles try to give some interpretations on a complex phenomenon such as suicide among Aboriginal people; they also propose some solutions about how to address and respond to this complex problem. The first article addresses similarities and differences in suicide prevention between the Māori in New Zealand and indigenous peoples of Canada. Hatcher stresses the fact that the problem of indigenous suicide is linked to coping with losses secondary to colonization in both former colonies such as New Zealand and Canada. Of major importance is the assessment of the identity in all clinical encounters as a cultural evaluation should be part of a psychiatric interview with any patient, as Hatcher proposes. Both countries share an ancient colonial model where ‘thwarted belongingness’ refers to a combination of loneliness and an absence of relationships marked by reciprocal care, as Hatcher stipulates. In clinical practice, this means that, for example, clinicians who see Māori, the Aboriginal people of New Zealand, are expected to say something about themselves as part of the initial ‘ritual of encounter’—a form of a ‘cultural handshake’. This stresses a trivial means of establishing rapport with a patient, but to me, it goes further than breaking the ice and divulging our own values or culture, watching to be culturally sensitive and respectful. We know as health professionals that we might be different, but we are ready to overcome our differences. The second article, by Kral, focuses on suicide among the Inuit or the indigenous peoples of the Arctic. There are reasons why we put the focus on the Inuit as they have the highest suicide rates in the world; between 1999 and 2003, rates averaged 135 per 100,000, more than 10 times the general Canadian population rates. Recent original research based on psychological autopsies of Inuit-completed suicides showed that risk factors are childhood abuse, family histories of depressive disorders, substance abuse, and