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

Chapter 3people in Canada. The challenge is to explain why most young people do not succumb to suicide even incommunities with very high rates. Identifying the relevant crucial risk and protective factors can providea starting point for understanding vulnerability and resilience, as well as potential directions for suicideprevention. This chapter will address the influence on suicide of psychiatric disorders, previous suicideattempts, suicide ideation, alcohol and substance abuse, factors influencing development in childhood,cognitive factors, reasoning, and sexual orientation. This chapter will then conclude with a discussion ofresilience factors as well as the interaction between risk and protective factors.Psychiatric DisordersAlthough there is no single cause of suicide, the most important factor in the general population is themental health of the individual. Many studies concur that the majority of people who die by suicide sufferedfrom a psychiatric disorder that contributed to their death (Evans, Hawton, and Rodham, 2004; Fleischmanet al., 2005; Gould et al., 1998a; 1998b; Lesage et al., 1994). In particular, both major depression and drugand alcohol abuse are strongly correlated with both suicide and suicide attempts. In the 2002 RegionalLongitudinal Health Survey, First Nation individuals who had experienced feeling sad or depressed forat least two weeks in a row in the previous year were more than twice as likely as others to report suicidalideation or a suicide attempt (First Nations Centre, 2005). Unfortunately, few studies on Aboriginalpopulations in Canada have used current psychiatric diagnostic methods to determine the prevalence ofcommon mental disorders, including major depression. As a result, it is not yet possible to know the relativecontribution of different psychiatric disorders, and discussion must rely on extrapolations from studiesin other populations. Recent studies in Canada and the United States have produced new data on theprevalence of depression that will address these questions in the next few years.Follow-back studies in several countries using methods of reconstructing histories through familyinterviews and medical records have identified mental disorders in 70 to 95 per cent of youth suicides(Cavanagh et al., 2003; Houston, Hawton, and Sheppard, 2001; Runeson and Rich, 1992). Acrossstudies, the most common diagnoses are mood disorders (42%; especially major depression), substancerelateddisorders (41%), and disruptive behaviour disorders (21%; including conduct disorder, attentiondeficit disorder, oppositional disorder, and identity disorder). About 18 per cent of youth who die bysuicide have no evidence of psychiatric disorder (Fleischmann et al., 2005). This may reflect limitationsin retrospective diagnosis or milder clinical or social problems. Some of these youth may have a historyof excessive performance anxiety and perfectionism, along with a poor response to stress and dislocation(Hawton, 1986). These individuals may make a suicide attempt when faced with a significant failure orsetback at school or in other activities.Retrospective studies of deaths by suicide in adolescents and young adults find high rates of specificdisorders with ranges from 43 to 79 per cent for affective disorders (major depression and bipolardisorder with depression), from 26 to 66 per cent for alcohol and drug abuse, from 3 to 61 per cent forconduct problems or personality disorder (usually borderline or antisocial personality disorder), and lesscommonly, (0–17%) schizophrenic disorders (Ryland and Kruesi, 1992; Cavanagh et al., 2003; Brent etal., 1994). The wide range in rates reflects differences in diagnostic methods and criteria as well as thelimitations of making diagnoses with retrospective data. A case-control psychological autopsy study of75 young men (aged 18–35) in Quebec who died by suicide found that 88 per cent had a psychiatricdiagnosis and 38.7 per cent had major depression (compared to 5.3% of controls) (Lesage et al., 1994).34