Research Profile – Culturally Based Interventions

Adapting suicide prevention programs in partnership with Aboriginal communities.

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Programs intended to prevent and reduce suicide among Canada's Aboriginal youth have not met with much success, largely because they have not been properly evaluated for effectiveness and have not been adapted to local culture.

But researchers are now developing programs in partnership with Aboriginal communities that hopefully will be more successful, according to Dr. Jitender Sareen, professor of psychiatry at the University of Manitoba.

He is part of the Swampy Cree Suicide Prevention Team research group, which consists of university-based researchers, health care providers and community members from the Swampy Cree Tribal Council.

The Swampy Cree Nation consists of eight Cree communities in northern Manitoba with a total population of about 11,000. Communities range in size from about 300 to 3,500 people.

According to Dr. Sareen, suicide rates among adolescents and teens in First Nations, Inuit and Metis communities are five times higher than in the general population in Canada. Reasons for this include loss of cultural identity, high rates of poverty and unemployment, and violence.

Research from Dr. Sareen’s research team shows that with adolescents, additional factors which contribute to risk of suicide include boredom, lack of supervision, lack of connection with the elders of the community, and personally knowing other youth who commit suicide.

"Knowing other youth who have committed suicide, especially if they were people they had looked up to, seems to give validation of that as a way out, rather than seeking help," says Dr. Sareen. A single suicide in a small community can generate widespread grief, affecting everyone.

“Traditional ways of helping prevent suicide has been to go into communities, identify people who are depressed or otherwise at risk of suicide, and helping these at-risk people individually,” he says.

There are even standardized suicide prevention programs, but it is unclear how effective they are. One such program is Applied Suicide Intervention Skills Training (ASIST), in which select people in communities are trained to identify those at risk and intervene.

However a pilot study recently published by Dr. Sareen and his team shows that ASIST was not helpful in improving suicide intervention skills in the Cree communities.

“We’re finding that working with families and youth at an earlier age will have more of an impact than working with just individuals who are at risk,” says Dr. Sareen.

The Swampy Cree Team is evaluating two programs which take this approach and incorporate traditions and ideas from the Cree culture.

One is a family-based program that targets all families with children aged 10 to 12 and brings in siblings, parents, grandparents, and sometimes even aunts and uncles. It is a universal prevention program that targets known suicide risk factors in individuals, families and communities and addresses these issues with families at an early stage of development. Essentially, it helps identify at-risk participants and involves the whole family in the management of the issue.

The program includes 14 sessions and covers parenting skills (for all the adults raising the children), learning about community and traditions through story-telling and other activities, communication, and more.

The “group” approach is designed to address the lack of connection between youth and elders, a factor that community leaders identified as a problem.

The second program, called Sources of Strength, teaches young adults and peers how to and identify and assist at-risk youth. Often, adolescents don’t listen to adults, but respond better to people close to their own age, according to Dr. Sareen.

So far, reaction from participants to both programs has been very positive, and participation rates are high. But it will take time to see how effective they are long-term.

"We’re finding that working with families and youth at an earlier age will have more of an impact than working with just individuals who are at risk."
– Dr. Jitender Sareen, University of Manitoba