During a recent trip to Kotzebue (an Iñupiat town of about 3,200 in Alaska’s Northwest Arctic), I took a walk one evening and passed a house where a man was screaming at a young child. The little girl must have been about four or five, and she was sweeping the floor of their storm shed with a small broom. An adult male (presumably her father) emerged from inside the house and as he passed her, he yelled, “Stop sweeping the fucking floor, you’re making a fucking mess!” The little girl put the broom down and went back inside the house as the man sat down outside and lit up a cigarette. I wondered if that negative experience and others would leave an imprint on the girl’s brain as she grew up. I wondered if the man had had similar experiences as a child, and I hoped that what I had witnessed was an isolated incident rather than a glimpse of much worse.
In an earlier post, I shared some of my thoughts on the elevated suicide rates experienced by Alaska Natives. I talked about how suicide prevention efforts could benefit from understanding the role of traumatic experiences like sexual assault, child sexual abuse, and other risk factors in suicidal behavior. Since this information is not readily available from the Alaska Native regions with the highest suicide rates, we’re dealing with an incomplete picture when developing strategies to prevent suicide. Yet new research from Nunavut, Canada looking at some of the life experiences of Inuit who have died by suicide gives us clues about the situation in Alaska.
The Nunavut Suicide Follow-Back Study 2005-2010 published in June 2013 examines the lives of 120 Nunavut Inuit who died by suicide between January 1, 2003 and December 31, 2006. (You can find a news article summarizing the study here.) More than 400 interviews were conducted with the family and friends of the deceased, as well as with 120 individuals who made up a comparison group of living individuals whose backgrounds closely matched those of the deceased. The purpose of interviewing living individuals was to identify risk and protective factors associated with suicide. In other words, to attempt to understand why individuals with similar backgrounds to those who died by suicide are still alive today.
As might be expected, individuals in the comparison group of living individuals were more likely to be married or in a common-law relationship, employed or in school, and to have more formal education than the 120 people who died by suicide.
Significantly more individuals in the suicide group had experienced child abuse than the comparison group, including physical and sexual abuse.
- 21.6% of the suicide group had experienced physical abuse during childhood compared to 13.3% of the comparison group.
- 15.8% of the suicide group had experienced sexual abuse in childhood compared to 6.7% of the comparison group.
Diagnosed psychiatric illness, personality disorders and addictions were also higher among the suicide group.
The report “indicates that the risk factors of unemployment, child maltreatment, sexual abuse, impulsiveness, aggression, current and lifetime diagnoses of major depressive disorder, alcohol abuse or dependence and current or past cannabis abuse or dependence are risk factors for Inuit suicide in Nunavut.”
The report concludes that inter-generational trauma and its results as well as elevated mental disorders are the main drivers of Nunavut’s high suicide rates. It stresses the need for greater mental health care, counseling and substance abuse services for Inuit in Nunavut.
Yet the study does not discuss the connections between adverse child experiences (experiencing or witnessing physical or sexual abuse, etc.) and lifelong outcomes such as mental disorders. This is interesting to me because it seems somewhat reactionary — a call to deal with the symptoms of trauma rather than to directly address and prevent some of the causes of trauma.
It is pretty well documented that the foundation for sound mental health begins in early childhood in an environment of relationships (with parents, extended family members, community, etc.) In other words, traumatic experiences like witnessing or experiencing violence or sexual abuse during childhood can place people at greater risk for experiencing mental health issues and other “risk factors” later in life.
It is no coincidence that many of the Inuit in Nunavut who died by suicide experienced physical and sexual abuse in childhood, just as it is no coincidence that the same is true for people in the broader U.S. population who have attempted suicide.
The Adverse Childhood Experiences Study (ACES) carried out between 1995 and 1997 used a questionnaire to compare the current health status of more than 17,000 people in the U.S. to information participants shared about adverse experiences during childhood. The categories of adverse child experiences looked at included:
- abuse (psychological, physical, sexual)
- household dysfunction (substance abuse, mental illness, mother treated violently)
- criminal behavior in household
Those who had experienced four or more of these categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt. Of the respondents who reported having attempted suicide in their lifetime, those who had experienced four or more of these adverse childhood experiences were at the greatest risk: of those who had attempted suicide at some point in their life, 18.3% had experienced 4 or more categories of childhood exposure.
The Nunavut study apparently only looked at two kinds of adverse experiences (physical and sexual abuse), which makes me wonder what other forms of childhood adversity people who died by suicide may have experienced, and how they would compare to the comparison group.
Implications for moving forward
Understanding the prevalence of childhood exposure to adverse experiences among Alaska Natives, and then implementing interventions that prevent exposure to things like household violence and child sexual abuse will be an important step toward implementing more effective suicide prevention measures. We continue to experience elevated suicide rates in Alaska in part because this research has not been carried out, with the result that people who work on this issue are dealing with an incomplete picture of the challenge. This is not to say that the inspiring advocates, service providers and many Alaska Native people who work in this area are not aware of this aspect of suicide. But until the taboo around publicly addressing some of these challenges begins to erode – opening the door to interventions that focus on preventing adverse experiences – we will continue to play catch up.
However, as I pointed out in my last post about this challenge, public dialogue about some of these issues is becoming more common in the Alaska Native community, and this is promising. For example, the MISS Movement was started by two young women in Kotzebue to raise awareness about rape culture and violence against women in Northwest Alaska. And friends of mine who do public health research in Alaska Native communities are in the process of gathering information about adverse childhood experiences that can be used in the future to tackle them head-on. These warriors and others are working to help build a brighter future for our kids.