Suicide Among Aboriginal People in Canada - Institut universitaire ...

Chapter 1is depressed, the individual recalls similar periods of depression and despair in his or her life, but whena person is feeling better, memory for such times may be vague and the person may forget even seriousepisodes. This selective recall serves adaptive functions in that it allows people to put painful experiencesbehind them to some extent, but it hampers accurate assessment of individual histories. People may alsobe reluctant to divulge behaviour and experience they feel is shameful, embarrassing, or puts them in abad light. These factors set limits on the reliability of psychiatric surveys.This is illustrated by recent epidemiological studies on two American Indian reservation populations (Bealset al., 2005a; 2005b; 2005c). The survey involved 3,084 people in two closely situated Northern Plainstribes and a large southwestern tribe. Depression was assessed with the Composite International DiagnosticInterview (CIDI), a structured diagnostic interview widely used in international and cross-cultural research.Lifetime rates of depression varied from 3.8 to 7.9 per cent; 12-month rates varied from 2.1 to 4.9 per cent.Contrary to the researchers’ expectations, these rates were about 30 per cent lower than those found in thegeneral population with similar methods. Participants in the study found it difficult to answer the CIDIquestion that asks which symptoms of depression co-occurred during the same time period as feelingsof sadness or depression. As a result, the diagnostic module did not appear to function as designed. Theauthors produced alternative estimates based on less stringent criteria that did not require the symptomsof depression to co-occur. This yielded much higher rates that varied from 7.2 to 14.3 per cent for lifetimeprevalence and from 3.9 to 8.8 per cent for 12-month prevalence. Even these rates remain lower than thosefound in the general population and the validity of these alternative criteria remains unclear.Self-report questionnaires of symptoms, which the person can fill out privately, can also be used toidentify suicidal behaviour and associated mental health problems. The quality of the informationobtained depends on how well the questionnaire is constructed and on the level of trust and confidencein the people who are conducting the survey. There is evidence that young people are more likely to reportsuicide attempts when questionnaires are anonymous and when the wording asks about “ending yourlife” rather than “attempted suicide” (Safer, 1997; Evans, Hawton, and Rodham, 2005a). When surveyquestionnaires have not been culturally adapted and validated, and when individuals are unsure abouthow the data collected will be used, the accuracy of the information collected may be compromised.Studies of deaths by suicide require special methods to retrospectively reconstruct the suicide victim’spersonality, psychopathology, recent life events, and living circumstances by interviewing family, friends,and others who knew the deceased. This reconstruction of past events is called a “follow-back study”or, sometimes, a “psychological autopsy” (Brent et al., 1988). Usually, retrospective studies are designedas case-control studies in which suicide victims are compared with a group of peers or age-mates whodid not die by suicide (Cavanagh et al., 2003). Without this “control group” for comparison, it may betempting to relate the suicide to any aspect of the individual’s personal history that appears distinctiveor distressing. Only careful comparison with others in similar circumstances using statistical analysescan clarify which factors are actually associated with suicide and which are simply common forms ofadversity with no particular contribution to suicidality.All retrospective studies have limitations due to the lack of complete and accurate information in medicalcharts, family or informant recollection, official records, and so on. For example, many studies have foundlow correlations between parents’ reports of their children’s distress and children’s self-reports. Whileparents are often aware of symptoms of emotional distress in adolescent suicide attempters, parentstend to be unaware of—or may deny or refuse to report—their adolescent’s suicidal ideation and even