“Rebuilding our community”: Hearing silenced voices on Aboriginal youth suicide

Introduction

Suicidal behaviors are among the most significant mental health-related problems among youth (Reynolds & Mazza, 1994), and are even more pronounced among North American Indigenous youth, including the youngest generations of First Nations communities across Canada. As part of a report by the Advisory Group on Suicide Prevention (2002), summary statistics on suicide within Canada revealed rates 5 to 6 times higher among First Nations youth compared to the non-Aboriginal population, with evidence of growing rates in some communities. While these alarming trends suggest that suicide is a problem for many First Nations, it is important to note the differences in suicide rates and risk factors across cultural groups. There are over 1 million self-identified Aboriginals (including First Nations, Métis, and Inuit) in Canada, and over 600 First Nations bands alone (Statistics Canada, 2008), with variability in histories, contemporary community characteristics, levels of enculturation, and traditional practices both within and across groups, thus underscoring the need for careful conceptualizations of “culture” (Waldram, 2009) and due attention to Aboriginal diversity.

The purpose of this paper is to share the voices of adult community members from a single cultural group across three separate central Canadian First Nations reserves who participated in focus group discussions about the devastating loss of their young people to suicide. Our research team views qualitative methods as essential to a culturally relevant understanding of community needs and strengths. Unfortunately, as Cutcliffe (2005) asserts, “the ‘voices’ of First-Nation people are noticeably ‘silent’ from the suicide related literature; without these voices—the narrative and phenomenological accounts, we are unable to account for the particular developmental-existential suicide perspectives of these people” (p. 144). This paper is one step in the efforts to break that silence within the academic literature.

Multilevel conceptualization of stressors

Much of the existing research on correlates of suicide is framed within a “risk-protective factor” approach in which those constructs thought to increase suicidal behaviors are labeled “risks,” while measures negatively associated with suicidality are viewed as “protective.” In this study, our approach is to conceptualize risks as exposure to stressors such as traumas and negative life events. The stress exposure framework affords an opportunity to investigate etiological factors found within the social environment that may be modifiable and/or preventable (Aneshensel, 2009), and therefore useful to efforts aimed at reducing suicidal behaviors. A multilevel examination of stressors related to Aboriginal suicidality broadens our focus to include not only the individual and interpersonal characteristics often identified as pathological (e.g., substance use: Kirmayer, 1994; Olson & Wahab, 2006; distress and mental disorder: LeMaster, Beals, Novins, & Manson, 2004; and prior victimization: Bohn, 2003; Shaughnessy, Doshi, & Jones, 2004), but also community- and societal-level determinants of health and health behaviors. Prior research has indicated that even broad contextual variables like community socioeconomic disadvantage are related to poorer mental health and problem behaviors (Aneshensel & Sucoff, 1996; Beautrais, 2003; Brooks-Gunn, Duncan, Kato Klebanov, & Sealand, 1993; Wight, Botticello, & Aneshensel, 2006). Macro- and meso-level explanations for differential suicide rates date at least as far back as Durkheim’s classic piece, Le Suicide (1897; Suicide: A Study in Sociology, 1951). Likewise, Bronfenbrenner’s (1979) well-known ecological systems theory delineates multiple levels of contextual and multidirectional influence on child development in particular. Thus, casting a wider etiological net that captures a range of ecological risks is imperative.

We employ Wheaton’s (1994, 1999) conceptualization of stressors and Evans-Campbell’s (2008) multilevel approach to historical trauma as theoretical and analytic guides to organizing and understanding the complex set of factors influencing suicidality among young Aboriginal community members. Wheaton provides a categorization of stress across three distinct levels: (a) macro or ecological stressors are those systemic in nature and found above the individual level, including macroeconomic problems like unemployment; (b) micro stressors, which occur on an individual or interpersonal level; and (c) meso stressors that represent an intermediary classification of stress between macro and micro levels to include neighborhood, community, and work/school conditions, for example. Of course, these categories are not necessarily clear-cut in all cases and do not fully illustrate the possible conjunction of stressors across levels. For example, exposure to individual or interpersonal stressors may well be contingent upon contextual stressors occurring at a much more macro-level (Wheaton, 1999).

A multilevel approach to historical trauma

European colonization of North America began with initial contact between Indigenous groups and immigrants and has continued over the years in many forms, including attempted assimilation of communities, the creation of reservations/reserves, relocation policies, and underfunded, inadequate health and educational services (Kirmayer, Tait, & Simpson, 2009; Roubideaux, 2005). Walters and Simoni’s (2002) Indigenist stress-coping model “acknowledges the colonized or fourth world position of Natives … and advocates for their empowerment and sovereignty” (p. 520). Their framework is consistent with an important contribution of the stress process literature to highlight the differential exposure and cumulative impact of stressors on underprivileged groups (Pearlin, 1989; Pearlin, Aneshensel, & LeBlanc, 1997; Turner & Lloyd, 1995). For the Aboriginal peoples of North America, a unique and traumatic history of colonization contributes to intergenerational exposures to stressors and contemporary chronic strains.

The pervasive effects of history on Indigenous life have been conceptualized as historical trauma, or the persistent, intergenerational exposure and response to multiple traumatic events within communities (Brave Heart, 1999; Brave Heart & DeBruyn, 1998). Traumas of this sort are considered “historical” insofar as they began in the past; however, the oppressive, restrictive policies and practices of colonization continue in many ways to the present day. Evans-Campbell (2008) has referenced the broad array of contemporary outcomes of historical trauma as multilevel in nature, affecting individuals, families, and communities.

At the individual level, research with Indigenous communities has found that perceptions of historical cultural losses are associated with sadness, anxiety, mistrust of White people, anger, distress, and other negative outcomes (Whitbeck, Adams, Hoyt, & Chen, 2004; Whitbeck, Walls, Johnson, Morrisseau, & McDougall, 2009). The work of Brave Heart (1999; Brave Heart & Debruyn, 1998) identifies historical trauma as a source of grief, ruminating thoughts, anger, distress, and guilt among Indigenous adults and parents. Evans-Campbell (2008) further notes the potential for historical traumas to increase stress vulnerability, a phenomenon documented among Jewish Holocaust survivors (see Solomon, Kother, & Mikulincer, 1988; Yehuda, 1999).

The family-level outcomes of historical trauma include contemporary attention to ancestral traumas and associated guilt. Moreover, the widespread enrollment of Indigenous children in government- and church-based boarding/residential schools represents a critical interruption of healthy, culturally rooted caretaker socialization. Numerous sources chronicle the abuses endured by many of the children residing in boarding schools (e.g., Adams, 1995; Ahern, 1994; Milloy, 1999). As a result, some Indigenous adults have struggled and felt overwhelmed in their role as parents (Brave Heart, 1999), thus affecting subsequent generations’ development.

The last unit of classification in Evans-Campbell’s (2008) approach emphasizes community-level responses to historical trauma; she asserts that this level of impact has received little attention in the academic literature. Beyond attacks on Tribal sovereignty and, for some communities, a lack of basic, well-functioning agencies and institutions (e.g., education and health care systems; Roubideaux, 2005), historical traumatic events and policies have the potential for community-wide perceptions of loss and grief. Especially germane to this study are historical community losses of Aboriginal children to boarding schools, adoptions outside the reserve, and foster care. Disproportionate youth suicide rates represent one additional community trauma response (Duran & Duran, 1995).

Methods

The focus group methodology employed for this study was built upon on an already established longitudinal survey research project created in partnership with a United States university and several U.S. reservations and Canadian First Nations. This smaller, qualitative component of the study was facilitated by the community networks, advisory boards, and Tribal research workers already implemented and maintained through the survey project.

Focus groups were led by the first author at three separate First Nations reserve locations across central Canada in the summer of 2005. Throughout the planning and recruitment process for these focus groups, an on-site project coordinator facilitated communication and planning between university-based staff and the reserve community members. All project methodologies and questions were developed in partnership with and approved by an advisory board comprised of Tribal members from each participating reserve.

Advisory members from each reserve agreed to recruit participants for two separate focus group sessions at each community: the first groups included Elders, and the second was comprised of service providers who worked within the community as mental health workers/counselors, crisis response team members, youth and family welfare/child safety employees, youth educators, substance use or chemical dependency counselors, and so forth. Elders were invited to these discussions because of their cultural status as wisdom-keepers, storytellers, and respected caregivers. Service providers were included because of their proximity to and experience dealing with crisis situations like suicide within the communities. In this case, all of the service providers were in fact Aboriginal community members themselves and thus maintained kinship roles (including the role of Elder in some cases) in addition to their professional duties. A total of six focus groups were planned and completed. Upon recruitment, participants were provided with a brochure containing project information, the goals of the focus groups, and the basic content of our planned discussions. Our recruitment goals included 10 Elders and 12 service providers per site, with an even split by gender; this goal was generally met at each site, with the exception of one or two recruited members being replaced, not being able to attend, or, in some cases, including additional interested community members. This flexibility was an important part of our focus group process and helped in our goal of creating a welcoming and trusting atmosphere for community members (see also Krueger & Casey, 2000). For all focus groups, the first author (a member of the cultural group included in this study) was accompanied by project coordinator Allan Morrisseau for guidance, advice, and practical considerations (e.g., driving directions in remote reserve areas). In addition, a project consultant and Aboriginal Elder and translator, Calvin Bombay, accompanied us to half of the focus groups.

Results

Discussion

The purpose of this paper was to bring forward the voices of adult First Nations community members who gathered in a focus group setting to discuss the problem of youth suicide. We attempted to integrate the stress classification system proposed by Wheaton (1994, 1999) with Evans-Campbell’s (2008) multilevel approach to historical trauma as a way to thematically analyze qualitative feedback. Table 1 provides a summary of key findings, organized by level of impact. Four broad levels of “risk” were identified in the data aligning with the multilevel typology: (a) micro, (b) family, (c) community, and (d) macro. The first of these corresponds to both Wheaton’s micro- (individual and interpersonal) and Evans-Campbell’s individual-level classifications. The second and third components correspond to Evans-Campbell’s family and community categorization. Both family and community could be conceptually subsumed by Wheaton’s meso-level description of stressors, but the data better reflected distinct family and community factors. The fourth level corresponds to Wheaton’s macro or ecological description. Finally, historical traumas via colonization were identified as a unifying theme and fundamental cause of First Nations youth suicide for the participants of these groups.

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Table 1.

Multilevel classification of community identified risks for Aboriginal youth suicidality

Micro (Interpersonal)	Suicide clusters Communication Relationships/early dating
Meso	Family	Alcohol and substance abuse Gambling Parenting skills
	Community	Service integration/coordination Community accountability
Macro	Government influence Economics Environment

Our attempt to organize risk factors by various levels of impact illuminates the wide range of social, historical, and cultural influences on suicidality within these Aboriginal communities. We found it difficult to categorize several of the often overlapping themes into distinctly unique levels of influence. For example, widespread substance use and gambling problems (both individual behaviors) were discussed as community-level issues, but seemed to impact youths from within extended family networks. Thus, we urge readers to interpret these findings with due consideration of the interdependence of themes.

A careful review of results reveals a complex web of intersecting stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Corroborating the “Indigenist” stress-coping paradigm presented by Walters and colleagues (Walters & Simoni, 2002; Walters, Simoni, & Evans-Campbell, 2002), our multilevel coding approach revealed that suicidal behavior—a phenomenon often conceptualized as individual pathology—was in fact described by community members largely as a problem with deep historical and contemporary structural roots. Our findings likewise echo Inupiat views of youth suicide as presented by Wexler (2006), in which historical perspectives of community strengths contrasted with ongoing cultural losses and contemporary manifestations of colonial assaults in terms of abuse, neglect, and substance abuse.

We were somewhat surprised to find that almost none of the focus group participants highlighted individual mental health problems as critical foundations for suicidal behaviors, in spite of direct questioning regarding why youth commit suicide (see Appendix) and a great deal of literature devoted to this issue both in majority population (e.g., World Health Organization, 2002) and Aboriginal/Indigenous-specific studies (Freedenthal & Stiffman, 2004; LeMaster et al., 2004). Despite widespread public awareness and popularity surrounding medical models of mental disorder in which individual pathology and associated behavior is understood as a “disease” caused mainly by physiological or inherited dysfunctions, the participants of these groups understood suicide from a broader, sociohistorical point of view. Structural and systemic (meso- and macro-level) problems were afforded the bulk of the blame, perhaps reflecting the keen sense of endured oppression felt and expressed by Aboriginal participants. It is also likely that a de-emphasis of individual “risk” is the result of the traditionally collectivist nature of the particular Indigenous culture included in this study. This is not to say that individualized risk factors should be altogether ignored; rather, it illustrates how adult participants in these Aboriginal communities viewed an individual behavioral construct as something inseparable from its structural and historical roots. For example, individual adolescent behaviors like alcohol abuse and emotions/cognitive states such as hopelessness were discussed, though always in the context of interpersonal relationships and/or elaboration of them as outcomes of colonization. This conceptualization was summed up nicely by one service provider (quoted earlier) and is worth restating here:

These problems we have are just symptoms of our main problems, [emphasis added] I think … like we try to solve alcohol problems, sniffing, and the fighting families, you know … those are just symptoms to me. (Emphasis added)

Each set of quotations organized here by thematic focus for the sake of analysis and presentation reflects incredibly complicated layers of perspective and interpretation. For instance, throughout the focus group transcripts participants shared deeply emotional lived experiences and perceived intergenerational outcomes of residential school survival. As with Brave Heart’s (1999) findings in the United States, the lack of parental role modeling and missed traditional socialization experiences were seen as causal agents for confusion, guilt, and ineffectiveness as parents. At the same time, we heard numerous instances of adults criticizing themselves for missed opportunities to pass on traditional teachings, and similar criticism of parents as “the ones that are harming our children.” Participants eloquently expressed ways in which colonial trauma impacts individuals, families, and communities, while simultaneously bearing the burden of more proximal causes for youth suicidality. The nuanced and seemingly paradoxical depth of such perceptions may reflect the realities of how cultural loss is manifested in a contemporary state. The adults’ desire to shoulder some blame for local social problems could be viewed as a cultural strength in the form of personal and collective responsibility tied to a sense of efficacy insofar as respondents felt knowledgeable of the actions necessary for change (i.e., returning to a traditional way of life) From another vantage point, however, such self-blame could be viewed as a community’s oppression turned inward (Duran & Duran, 1995), another predicament of postcolonial life that remains in many ways veiled. As Wexler (2009) explains: “By understanding how modern colonialism cloaks Western assumptions and expectations in matter-of-fact language, young people can be helped to see how this process renders people—their people—failures” (p. 17). Without doubt, the suicide problem and its associated “risk” factors must be considered as part of “tensions created and fostered by colonization” (Wexler, 2009, p. 16).

Limitations and future research

Our goal of bringing forth Aboriginal perspectives on suicide deserves consideration of those voices not represented here. First, although important segments of the adult population (parents, aunties, uncles, etc.) were not explicit parameters for focus group membership, many of the service providers served multiple roles both as community professionals and parents, relatives, and in some cases, Elders within the reserves. Second, we did not speak directly with the Aboriginal youth on these reserves due to some community-based apprehension regarding the potential for such discussions to trigger additional suicidal thoughts. It is, of course, imperative that the voices of youth become a key source of knowledge and information when suicide prevention strategies develop within communities. Drawing from the youth-involved works of Wexler (2006, 2009) and Kral Idlout, Minore, Dyck, and Kirmayer (2011), research with younger generations may reveal an even greater degree of postcolonial problems in terms of identity confusion, perceived (limited) choices, and the struggle to “live in two worlds, yet feel … deeply rooted in neither” (Kral et al., 2011, p. 10). After several years of work and a recently funded intervention project, we are happy to report that parent and youth-based discussions are in progress and will become a vital source of information for our collaborative mental health promotion efforts on four reserves, including the three represented by these data.

Conclusion

Across the globe, Indigenous peoples suffer suicide rates of epidemic proportions. Although individual, community, and culture-specific determinants exist, a frequent explanation for these devastating losses centers around the lingering effects of shared colonized histories and genocide (Duran & Duran, 1995; King, Smith, & Gracey, 2009; Wexler, 2006). The Elders and services providers who participated in this study agreed: historical trauma represented the common thread entwined across a range of more proximal stressors and was the overwhelmingly salient and most frequently discussed theme in the data. Furthermore, and coinciding with Evans-Campbell (2008), participants identified outcomes of historically endured traumas across multiple ecological levels.

The results of this study suggest that the most effective suicide prevention and mental health promotion programs would be those that address multiple levels of risk and work to reduce exposure to stressors (Rosich & Hankin, 2010; Wight et al., 2006). Likewise, comprehensive reports on suicide prevention have recommended targeting multiple ecological contexts, including the family, community, and individual (e.g., Kirmayer et al., 2007). Similar sentiment was reflected upon by a participant who felt that the many difficult issues her community faces must be brought to the forefront before suicide can be addressed.

So it’s like cleaning and mopping the floor first before you can have a clean house. You know, you have to clean up all the underlying dirty stuff before you can have a healthy community. (Female service provider)

The potential and widely recognized acute “warning signs” for suicide, such as mood changes, reckless behavior, and hopelessness (Rudd et al., 2006), although important, may in fact serve only as temporary bandages to much deeper wounds brought on in many cases by widespread and cumulative stressors. Culturally safe, competent individualized mental health services serve important functions for secondary prevention (early intervention and treatment) and tertiary or postvention suicide prevention (Kirmayer et al., 2007, p. 93) Unfortunately, an overreliance on individualized mental health care has led to what Gone (2008) has called a “cottage industry devoted to the surveillance and management of the ‘mental health’ problems of North America’s Indigenous peoples” (p. 311). This most frequently Westernized model of behavioral health dominates the industry as another form of Euro-cultural proselytization (Gone, 2008) and pathologizes individuals while ignoring any effects of cultural genocide (Duran & Duran, 1995). And, although countless culturally derived mental health interventions have been developed within Indigenous communities, few have been systematically evaluated for effectiveness and/or sustainability (Gone, 2011; Gone & Calf Looking, 2011; Whitbeck, Walls, & Welch, 2012). Recognizing these bounds, the results of this and other studies (e.g., Commission on Social Determinants of Health [CSDH], 2008; Hankin & Wright, 2010) suggest that contemporary mental health disparities like suicidality would be reduced with due consideration of the multiple levels of social determinants of health/mental health and validation of the ways in which colonial traumas intersect contemporary Indigenous ways of life.