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

Chapter 1the suicide. Alcohol and drug abuse were included as psychiatric illness because of theirassociation with suicide in young people (Aldridge and St. John, 1991:433).This procedure revealed that fully 58 per cent of suicides were not reported initially. While this type ofcareful reassessment gives a more accurate estimate of suicide prevalence rates, it also introduces bias intostudies of the causes of suicide, since psychiatric morbidity and substance abuse become criteria for defininga death as suicide. In effect, it combines suicidal and parasuicidal behaviours that may have occurred withoutsuicidal intent.In most populations, suicide rates show great variation with age, gender, and other socio-demographiccharacteristics. Comparisons across regions and groups—or between groups and the general population—must adjust the crude suicide rate to account for differences in the demographic composition of thepopulation. Alternatively, comparisons among groups must be made for specific age and gender subgroups.Further, breakdown of group comparisons by type of suicide may also be important where there areclinical or public health reasons for identifying the role of specific risk factors or the effectiveness ofspecific interventions (Tousignant and Mishara, 1981).A general problem with cross-sectional epidemiological research is that correlations between variablesat one point in time cannot establish whether one factor is the cause of another. In fact, studies thatsimply report correlations between specific risk factors and suicide rates may be useful in developingindices of prediction, they may also be misleading when one attempts to determine the causes of suicide.There may be nothing specific in the factors that are identified as associated with suicide; similar factorsmay be associated with other co-existing or antecedent problems, like substance abuse or interpersonalconflict. In the case of attempted suicide, longitudinal studies permit greater confidence in identifyingantecedents and consequences of factors presumed to contribute to suicide. Ultimately, however,determining causality depends on developing causal models of the pathways and processes from causeto effect. These causal models are usually derived from social or psychological theory, clinical experience,and detailed knowledge or case studies of communities.Ethnographic ResearchEthnographic studies use anthropological techniques of participant observation, in-depth interviewsand qualitative data analysis to explore the meaning of events and actions to the individuals, groups,or communities involved. They examine actions as situated—that is, the meaning of actions dependson a specific social context. In the case of suicide, ethnographic studies do not assume that suicide hasa universal meaning, but focus instead on the specific meanings of suicidal behaviour within a givencommunity. While older anthropological approaches were concerned with belief systems, contemporarypsychiatric anthropology focuses on the local construction of meaning through action. A cultural systemdoes not affect everyone identically—it emerges from processes of invention, transmission, negotiation, andcontestation of shared beliefs and practices. People of different ages, gender, background, and personalityfind different possibilities and positions within any given community or social world. Understandingbehaviour and experience at this level may resolve some of the inconsistencies across studies of suicideand mental health based on communities with different histories, cultural practices, and current social,political, and economic situations.