Suicide Among Young Alaska Native Men: Community Risk Factors and Alcohol Control

Indigenous residents of Alaska (Alaska Natives) die by suicide at a rate nearly 4 times the US average and the average for all American Indians and Alaska Natives (AI/ANs).1---3 An astonishing 7% of Alaska respondents to a 2003 international household survey of Arctic Indigenous people indicated that they had seriously contemplated suicide within the past year.4 Studies have shown that alcohol is directly or indirectly involved in most of these deaths.5---9 Although Alaska Natives have encountered alcohol for well over a century, the high suicide risk is an entrenched but comparatively recent phenomenon affecting only the past 2 generations.9,10 Figure 1 shows that crude suicide rates for this group rose rapidly in the decade after Alaska achieved statehood in 1959. The 3-year moving average rate peaked at more than 50 per 100 000 in the early 1980s, before declining to a level of about 40 per 100 000 during the past decade. The dip in suicide rates in the late 1970s likely represents faulty data rather than a real departure from the secular trend.11 An emerging new pattern of risk drove the increase in suicide rates in the 1960s. Higher suicide rates among young men led the rise in suicide as a whole.9,12,13 More recently, another important pattern of differential risk emerged as more Alaska Natives moved to the state’s growing urban areas in search of jobs. Suicide rates among Alaska Native residents remaining in small rural communities are more than twice as high as those among Native residents of urban areas and vary greatly among communities even in the same region (Alaska Bureau of Vital Statistics, unpublished data).13 In fact, suicide rates may have declined since the peak in the 1980s (Figure 1) only because the lower risk population of urbandwelling Alaska Natives has grown relative to the more vulnerable rural population. The large disparities among populations with similar ethnicity and histories suggest that the elevated suicide risk is not simply an unfortunate side effect of rapid social change but may be influenced directly by contemporary living conditions. The associationYe