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

Chapter 1A central problem for cross-cultural research concerns the meaningful translation of concepts, categories,and questionnaires (Canino, Lewis-Fernandez, and Bravo, 1997; Kirmayer, 1989). Generally, this has beendealt with by having bilingual or bicultural people translate questionnaires, which are then checked by“blind” back-translation (i.e. by a person who has not seen the original) to identify and resolve discrepanciesin meaning (Brislin, 1986; Westermeyer and Janca, 1997). The properties of the resulting questionnaires areconfirmed by the statistical methods of psychometrics (more recently with latent variable methods like itemanalysis). However, this approach may still be insufficient. Ethnographic work to explore the local meaningsof symptoms and modes of expressing distress may be essential to develop adequate research measures.Questionnaires must employ items that are culturally meaningful in that they utilize familiar language andtap cultural “idioms of distress”—local ways of expressing and understanding problems (Manson, Shore,and Blum, 1985; O’Nell, 1996). Without this modification of instruments, it is possible to conclude thatsymptoms or disorders similar to those found in other cultural contexts exist while nevertheless missinga whole range of concerns that are expressed in culturally distinctive ways—a problem that medicalanthropologist Arthur Kleinman has referred to as “category fallacy” (Kleinman, 1987).The most valid methods of determining the prevalence, nature, and correlates of suicidal behaviourrequire integrating epidemiological and ethnographic methods. To date, this comprehensive approachhas been used in only a few studies of Native American groups (Manson et al., 1985; O’Nell, 1989). Ithas not yet been applied to the problem of suicide among Aboriginal people in Canada. Systematic workof this type is essential because, without it, one must rely on impressions that may be subject to manyforms of observer bias (Dion, Gotowiec, and Beiser, 1998). Many individuals have convictions aboutwhat the most important contributors are to suicide and what needs to be done for prevention; but,without careful study, it is difficult to choose among competing alternatives and to determine whetherexplanations and solutions that fit one situation can be applied more broadly.Outline of This ReportIn Chapter 2, basic epidemiological data on suicide among Aboriginal people compared to the generalpopulation in North America are presented. Variations in the prevalence of suicide and attemptedsuicide by age, gender, socio-economic status, and other demographic factors are summarized. Particularattention is given to the marked changes in rates of suicide that have occurred in recent times, as well asto the wide variations across geographical regions and communities.Suicide is never the result of a single cause, but arises from a complex web of interacting personal and socialcircumstances. Chapter 3 summarizes what is known about the causes of suicide at the individual level. From theperspective of prevention, the contributors to suicide can be thought of in terms of risk factors that increase thelikelihood of suicidal behaviour, and protective factors that reduce it. These risk and protective factors include:the physical and social environments; individual constitution, temperament, or developmental experiences;interpersonal relationships; alcohol and substance abuse; suicidal ideation and previous suicide attempts;and co-existing psychiatric disorders. The individual factors that affect suicide in Aboriginal people are nodifferent than those found in other populations and communities, but the prevalence and interrelationshipsamong these factors differ for Aboriginal communities due to their history of colonization, and subsequentinteractions with the social and political institutions of Canadian society.What is most distinctive about suicide among Aboriginal people in Canada is the pattern in whichlarge numbers of young people in some communities have been affected. This suggests that variations