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

Chapter 1suicide attempts (Marttunen, Aro, and Lönnqvist, 1992; Velez and Cohen, 1988). A study of youthwho had made serious suicide attempts found that the parents tended to be aware of the adolescents’substance use and disruptive behaviour, but were less likely to recognize major depression and alcoholabuse (Velting et al., 1998). Depression is often associated with social withdrawal and decreasedinteraction or communication that may go unnoticed by others preoccupied with their own concerns.Thus, psychological autopsy studies may tend to underestimate the relative importance of depressionand alcohol abuse or other factors that family and friends are unaware of or reluctant to talk about.Retrospective case studies of deaths by suicide that involve intensive interviews with bereaved familymembers also raise special practical and ethical issues (Beskow, Runeson, and Åsgåard, 1991). Interviewsmay be stressful for family and friends, and it is crucial to insure that such interviews are conducted bymental health professionals equipped to recognize and deal with intense responses to loss. Properlyconducted, such research can provide bereaved families with an opportunity to work through their lossand reach a better understanding of the events. Indeed, as will be discussed in a later chapter, currentrecommendations for suicide postvention (aimed at preventing recurrent suicide or suicide clusters andreducing the long-term consequences for others) emphasize giving the bereaved family and friendsopportunities to talk about their feelings and make sense of the suicide.Many deaths recorded as “accidents” are really suicides. This error in classification or record-keeping isdue both to the difficulty of determining intent retrospectively and to a general reluctance to acknowledgesuicide because of its social stigma. The issue of suicide masquerading as accidental, violent, or drugrelateddeath is particularly important in assessing the extent of the suicide problem in Aboriginalcommunities where rates of accidental death and injury are up to 4 times that of the general population(Medical Services Branch Steering Committee on Native Mental Health, 1991a). The film Between TwoWorlds (National Film Board of Canada, 1990), recounting the life of Joseph Idlout, provides a strikingillustration of this problem. After his life as a hunter is dismantled by the forces of colonization, Idloutdies in a skidoo accident that his son, Peter Paniloo, insists could only have been a suicide. Although it isnot possible to make firm estimates, a Medical Services Branch report (1991b) suggests that as many as25 per cent of accidental deaths among Aboriginal people represent suicide.A partial solution for this problem of distinguishing between accidental death and suicide involvesreassessing the official cause of death by standardized criteria (Cheifetz et al., 1987). Such criteria canbe applied in other settings to allow comparisons that are not distorted by local variations in coroners’judgments and reporting practices. For example, it was claimed that Newfoundland had a very lowsuicide rate. Aldridge and St. John (1991) suggested that this might simply be due to high rates of underreporting.They produced a more thorough count of the total number of suicides by supplementing officialsuicides with a systematic reassessment of records of accidental deaths, death certificates not transmittedto archives, and records of pathologists’ examinations not sent to the chief forensic pathologist.Cases were included as suicide if death had been caused by firearms, hanging, jumpingin front of a speeding vehicle or jumping from high places. Deaths by other less lethalself-destructive methods such as recreational or prescription drug overdose, asphyxiaor drowning were considered to be suicide if one or more of the following were foundin the record: a suicide note or record of a note having been found; record of a previoussuicide attempt; evidence of previous psychiatric hospitalization or psychiatric treatment;statements that the person had suffered from a psychiatric illness before or at the time of