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Objectives: Suicide is a leading cause of death worldwide, and disproportionately affects Indigenous populations. Seasonal suicide patterns are variable in the literature, and could offer novel approaches to the timing and focus of prevention efforts if better understood. With a suicide surveillance system in place since 1989, this study offers an unprecedented opportunity to explore seasonal variations in both fatal and non-fatal suicide behavior in an Indigenous Arctic region. Study design: Cross-sectional. Methods: In this descriptive study, we analyzed data collected from 1990 to 2009 in the rural northwest region of Alaska, both graphically and using the chi-squared test for multinomials. Results: We found a significant monthly variation for suicide attempts, with a peak in suicide behavior observed between April and August (P = 0.0002). Monthly variation was more pronounced among individuals ≤29 years of age, and was present in both males and females, although the seasonal pattern differed by sex. Conclusions: Our findings of a significant seasonal pattern in suicide behavior, with monthly variation (summer peak) in non-fatal suicide behavior among younger age groups, and among both males and females can assist planners in targeting subpopulations for prevention at different times of the year. [ABSTRACT FROM AUTHOR]

Chandler and Lalonde broadened the scope of inquiry in suicide research by providing theoretical grounding and empirical support for the role of community, culture, and history in understanding Indigenous youth suicide and reimagining its prevention. Their work pushed the field to consider the intersectional process of individual and collective meaning-making in prevention of Indigenous suicide, together with the central role culture plays in bringing coherence to this process over time. Their innovation shifted the research focus to include the shared histories, contexts, and structures of meaning that shape individual lives and behaviors. We describe here a new generation of research extending their pathbreaking line of inquiry. Recent work aims to identify complex associations between community-level structures and suicidal behavior by collaborating with Alaska Native people from rural communities to describe how community protective factors function as preventative resources in their daily lives. Community engagement and knowledge co-production created a measure of community protection from suicide. Structured interviews with rural Alaska Native community members allowed use of this measure to produce relevant, accessible, and actionable knowledge. Ongoing investigations next seek to describe their mechanisms in shaping young people's lives through a multilevel, mixed-methods community-based study linking community-level protection to protection and well-being of individual youth. These efforts to understand the multiple culture-specific and culturally mediated pathways by which communities build on their strengths, resources, and practices to support Indigenous young people's development and reduce suicide risk are inspired by and expand on Chandler and Lalonde's remarkable legacy.

This paper presents how a community mobilization program to prevent suicide was adapted to an online format to accommodate the impossibility of in-person delivery in Alaska Native communities during the COVID-19 pandemic. The intervention, Promoting Community Conversations About Research to End Suicide (PC CARES), was created collaboratively by researchers and Alaska Native communities with the goal of bringing community members together to create research-informed and community-led suicide prevention activities in their communities. To continue our work during the COVID-19 pandemic and restrictions, we adapted the PC CARES model to a synchronous remote delivery format. This shift included moving from predominantly Alaska Native participants to one of a mainly non-Native school staff audience. This required a pivot from Alaska Native self-determination toward cultural humility and community collaboration for school-based staff, with multilevel youth suicide prevention remaining the primary aim. This reorientation can offer important insight into how to build more responsive programs for those who are not from the communities they serve. Here, we provide a narrative overview of our collaborative adaptation process, illustrated by data collected during synchronous remote facilitation of the program, and reflect on how the shift in format and audience impacted program delivery and content. The adaptation process strove to maintain the core animating features of self-determination for Alaska Native communities and people as well as the translation of scientific knowledge to practice for greater impact.

Suicide is a significant health disparity among Alaska Native youth, which is linked to cultural disruptions brought about by colonialism and historical trauma. Many Indigenous suicide prevention efforts center on revitalizing and connecting youth to their culture to promote mental health and resilience. A common cultural approach to improve psychosocial outcomes is youth culture camps, but there has been little evaluation research to test this association. Here, we conduct a pilot evaluation of a 5-day culture camp developed in two remote regions of Alaska. The camps bring together Alaska Native youth from villages in these regions to take part in subsistence activities, develop new relationships, develop life skills, and learn traditional knowledge and values. This pilot evaluation of the culture camps uses a quantitative pre/post design to examine the outcomes of self-esteem, emotional states, belongingness, mattering to others, and coping skills among participants. Results indicate that culture camps can significantly increase positive mood, feelings of belongingness, and perceived coping of participants. Culture camps are a common suicide prevention effort in Indigenous circumpolar communities, and although limited in scope and design, this pilot evaluation offers some evidence to support culture camps as a health promotion intervention that can reduce suicide risk.

Rationale: This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise., Method: Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses., Results: Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention., Conclusion: PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The Arctic Council, a collaborative forum among governments and Arctic communities, has highlighted the problem of suicide and potential solutions. The mental health initiative during the United States chairmanship, Reducing the Incidence of Suicide in Indigenous Groups: Strengths United Through Networks (RISING SUN), used a Delphi methodology complemented by face-to-face stakeholder discussions to identify outcomes to evaluate suicide prevention interventions. RISING SUN underscored that multilevel suicide prevention initiatives require mobilizing resources and enacting policies that promote the capacity for wellness, for example, by reducing adverse childhood experiences, increasing social equity, and mitigating the effects of colonization and poverty.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert-driven approaches to emphasize local control through processes that utilize research evidence, but privilege self- determined action based on local and personal contexts, meanings, and frameworks for action. "Promoting Community Conversations About Research to End Suicide" is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health-promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing., (© 2018 Society for Community Research and Action.)

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people's access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes--at its heart--decolonization, while also utilizing the "best practices" from research to effectively address the issue from multiple levels. This article describes such an approach: Promoting Community Conversations About Research to End Suicide (PC CARES). PC CARES uses popular education strategies to build a "community of practice" among local and regional service providers, friends, and families that fosters personal and collective learning about suicide prevention in order to spur practical action on multiple levels to prevent suicide and promote health. This article will discuss the theoretical underpinnings of the community intervention and describe the form that PC CARES takes to structure ongoing dialogue, learning, solidarity, and multilevel mobilization for suicide prevention., (© The Author(s) 2016.)

As part of the National Action Alliance for Suicide Prevention's American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance's prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond.

Indigenous circumpolar youth are experiencing challenges of growing up in a context much different from that of their parents and their grandparents due to rapid and imposed social change. Our study is interested in community resilience: the meaning systems, resources, and relationships that structure how youth go about overcoming difficulties. The research reflects an understanding that social and cultural ecologies influence people's available and meaningful options. The in-depth, qualitative study of 20 youth from the same Arctic community shows Inupiat (Alaska Native) youth are navigating challenges. Findings from this research suggest that Inupiat youth reflect more flexible patterns of resilience when they are culturally grounded. This cultural foundation involves kinship networks that mediate young people's access to cultural and material assets. Our participants emphasized the importance of taking care of others and "giving back to the community." Being "in the country" linked youth to traditional ontology that profoundly shifted how youth felt in relation to themselves, to others, and the world. The vast majority of participants' "fulfillment narratives" centered on doing subsistence and/or cultural activities. In relation to this, young people were more likely to demonstrate versatility in their resilience strategies when deploying coherent self-narratives that reflected novel yet culturally resonant styles. Young women were more likely to demonstrate this by reconfiguring notions of culture and gender identity in ways that helped them meet challenges in their lives. Lastly, generational differences in understandings signal particular ways that young people's historical and political positioning influences their access to cultural resources., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Arctic peoples today find themselves on the front line of rapid environmental change brought about by globalizing forces, shifting climates, and destabilizing physical conditions. The weather is not the only thing undergoing rapid change here. Social climates are intrinsically connected to physical climates, and changes within each have profound effects on the daily life, health, and well-being of circumpolar indigenous peoples. This paper describes a collaborative effort between university researchers and community members from five indigenous communities in the circumpolar north aimed at comparing the experiences of indigenous Arctic youth in order to come up with a shared model of indigenous youth resilience. The discussion introduces a sliding scale model that emerged from the comparative data analysis. It illustrates how a "sliding scale" of resilience captures the inherent dynamism of youth strategies for "doing well" and what forces represent positive and negative influences that slide towards either personal and communal resilience or vulnerability. The model of the sliding scale is designed to reflect the contingency and interdependence of resilience and vulnerability and their fluctuations between lowest and highest points based on timing, local situation, larger context, and meaning., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Research has established connection between indigenous culture--often described in terms of cultural identity, enculturation, and participation in traditional activities--and resilience, the process by which people overcome acute and ongoing challenges. Despite correlations between culture and resilience, research has seldom described the ways these concepts are linked in indigenous people's narratives. Furthermore, little attention has been paid to the affect of historical trauma on different generations' understanding and deployment of "culture" in the context of hardship. This project, conducted in the summer of 2008 in an indigenous Arctic community, focuses on narratives from three generations who have experienced different degrees of cultural suppression in their lifetimes. From this starting point, the study explores how individuals make meaning and take strength from particular notions of culture, and illuminates the ways each generation accesses and deploys their cultural understandings in the face of hardship. By identifying the similarities and differences in both the challenges and sources of strength for each generation, the paper highlights how understandings of culture are shaped by historical experiences and modified through time. The differing ways that culture fosters strength, purpose, and fortitude (or does not) in indigenous young people's, adults' and Elders' life stories provide clues for enhancing indigenous youth resilience. Findings suggest that "culture" can galvanize Inupiaq people's sense of identity, feeling of commitment, and purpose, all of which are protective. However, young people need support in developing particular ideas around cultural identity and group membership that can contribute to resilience.

Because of imposed rapid social change, Alaska Native youth are growing up in a context different from their elders and suffering far worse health and behavioral outcomes. This research seeks to understand (a) their everyday struggles and life challenges, (b) the practices and resources they rely on to get through challenges, and (c) the meaning they make from these experiences. Data were generated from interviews with 20 Alaska Native youth between the ages of 11 and 18 years, balanced by gender and age-group (early and late adolescence). Purposive sampling identified participants with a broad range of experiences. Following a semistructured guide, youth participated in face-to-face, audio-recorded interviews, transcribed verbatim. A codebook was developed using an iterative process and transcripts were coded using ATLAS.ti. The most commonly identified stressors were relationship loss, "not being there for me," nonsupportive/hostile experiences, transitioning into adulthood, and boredom. Resilience strategies included developing and maintaining relationships with others, being responsible, creating systems of reciprocity, practicing subsistence living, and giving back to family and the community. These opportunities allowed youth to gain a sense of competence and mastery. When difficult experiences align with opportunities for being responsible and competent, youth are most likely to exhibit resilience.

This qualitative study of youth resilience takes place in an Alaska Native community, which has undergone rapid, imposed social change over the last three generations. Elders, and successive generations have grown up in strikingly different social, economic and political contexts. Youth narratives of relationships in the context of adolescent growth and development offer insights to better understand culturally-patterned experience, continuity and change. Local youth and adults shaped the design, implementation and analysis phases of this participatory study. Multiple interviews, totaling 20 older (ages 15-18) and younger (11-14) boys and girls provide accounts of everyday lives and life histories. Although losing close relationships was the most common stressor, many of the participants' resilience strategies centered on their connections to others. Participants cultivated 'relatedness', nurturing relationships that took on kinship qualities. Within these relationships, youth participants acted more responsibly and/or developed a sense of competency and self-worth because of others' reliance on them.

Using a positive youth development framework, this article describes how a 3-year digital storytelling project and the 566 digital stories produced from it in Northwest Alaska promote protective factors in the lives of Alaska Native youth and serve as digital "hope kits," a suicide prevention approach that emphasizes young people's reasons for living. Digital stories are short, participant-produced videos that combine photos, music, and voice. We present process data that indicate the ways that digital stories serve as a platform for youth to reflect on and represent their lives, important relationships and achievements. In so doing, youth use the digital storytelling process to identify and highlight encouraging aspects of their lives, and develop more certain and positive identity formations. These processes are correlated with positive youth health outcomes. In addition, the digital stories themselves serve as reminders of the young people's personal assets--their reasons for living--after the workshop ends. Young people in this project often showed their digital stories to those who were featured positively within as a way to strengthen these interpersonal relationships. Evaluation data from the project show that digital storytelling workshops and outputs are a promising positive youth development approach. The project and the qualitative data demonstrate the need for further studies focusing on outcomes related to suicide prevention.

Suicide rates among American Indian and Alaska Native (AI/AN) young people are significantly higher than other ethnic groups in the United States. Not only are there great differences when comparing AI/AN rates and those of other Americans, some tribal groups have very low rates of suicide while other Native communities have much higher rates. Despite this obvious variability, there is little research to help understand the factors associated with these differences. The current study considers the correlates of suicidal behavior in one rural Alaska Native region that suffers disproportionately from suicide. The analysis describes suicide behavior between the years 2001-2009, and considers the characteristics associated with both suicide deaths and nonfatal suicidal behavior. In multivariate analyses we identified gender, method of suicide and history of previous attempt as significant predictors of fatal suicide behavior, similar to results obtained from analyses on the same community's data from the previous decade. This descriptive study can offer some insights to shape prevention efforts in this and other rural, tribal 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.

Alaska Native youth suffer disproportionately from suicide. Some researchers explain this by pointing to social disintegration brought on by rapid social change, but few make the connection to an ongoing colonialism explicit. This paper articulates some of the ways that colonial discourses affect Inupiat young people's self-conceptions, perceived choices, and, consequently, their behavioral health. Inupiat youth narratives will illustrate these connections and, in so doing, offer new ways to understand youth suicide in Native communities.

Factors correlated with suicidal behavior in a predominately Alaska Native region of Alaska are described, and the correlates relating to fatal and nonfatal suicide behaviors in this indigenous population are distinguished. Suicide data from the region (1990-2001) were aggregated and compared to 2000 U.S. Census Data using chi-squared tests. Multivariable logistic regression was used to identify predictors of suicide behaviors. Suicidal behaviors were significantly more common among single, unemployed Alaska Natives who had not completed high school. In multivariable analysis, male sex, age > or = 25 years, firearms, and substance abuse history were each associated with suicide death.

In 2003 the age-adjusted suicide rate in Alaska (20.2 per 100,000) was the second highest in the country and nearly twice that of the U.S. all races population. The suicide rate among Alaska's Native population (35.1 per 100,000) was 1.7 times greater than the rate among all Alaskans and 3.3 times greater than the U.S. all races rate. This retrospective case-control study examined suicide among Alaska Native males living in a northern Alaska region, in an attempt to identify the frequency and nature of contact with medical staff during the 12 months preceding the cases' suicides. Results show that during the last year of life, cases were 2.75 times as likely to have any contact with medical staff, they were 3.29 times as likely to be treated for an injury, and were 22.18 times as likely to be treated for an alcohol-related event than were the matched controls.