“Grieved Out”: How Suicide Affects US Indigenous Communities

by John Whitehead



NOTE: This post discusses suicide and sexual and intimate partner violence.


Suicide is a leading cause of death in the United States; an estimated 47,646 suicides occurred in 2021. Although suicide affects the general US population — the national suicide rate has been on an upward trend for roughly 20 years — indigenous communities are affected most severely. Native American and Alaska Native communities have suicide rates dramatically higher than that of the general population. This situation requires special attention.


The national US suicide rate, adjusted for age, has hovered around 14 per 100,000 people in recent years. In contrast, non-Hispanic Native Americans and Alaska Natives had a suicide rate of 23.9 per 100,000 in 2020. Among racial/ethnic groups, these indigenous communities have a noticeably higher suicide rate than both non-Hispanic white Americans, who have the next highest rate (16.9), and any other peoples of color in the United States.


Beyond being more frequent, suicide patterns among these indigenous communities have other notable characteristics. Like suicides in the general US population, suicides among Native Americans and Alaska Natives skew heavily male. The suicide rate for men in these communities was 36.4 in 2020 versus 11.7 for women.


Younger Native Americans and Alaska Natives tend to have higher suicide rates, whereas rates diminish among older members of these communities. This pattern contrasts with that among white Americans, where the suicide rate tends to be higher among older cohorts. A comparative study by the Centers for Disease Control and Prevention measuring suicides among Native Americans and white Americans over a 12-year period found that 35.7% of indigenous suicides were among people 10-24 years old, while only 11.1% of suicides by white individuals were from this age group.


When these patterns are considered together, young Native American and Alaska Native men have a horrifyingly high suicide rate. For men ages 15-24 in these communities, the suicide rate in 2019-2020 was 59.7, roughly four times the national rate. For men ages 25-34 in these communities, the suicide rate in 2019-2020 was 71.1, roughly five times the national rate.


Different factors may account for suicide’s disproportionate toll on these indigenous communities. The comparative study of suicides in indigenous versus white populations found that roughly 70% of the indigenous people who had died by suicide lived in rural or other nonmetropolitan areas. Rural areas generally have higher suicide rates. American Indian and Alaska Native communities also have the highest poverty rate of any racial/ethnic group in the United States: 25.9%, roughly double the national rate.


A combination of geographic isolation and high poverty likely leads to a lack of healthcare, including mental health services. The CDC’s comparative study found that American Indians and Alaska Natives who had died from suicide were less likely than whites who had died from suicide to have received mental health care or a mental health diagnosis before their deaths. Underfunding of the federal Indian Health Service department, which provides healthcare for millions of indigenous people, is a related problem.


Trauma may also play a role. Although suicide disproportionately affects indigenous men, American Indian and Alaska Native women have the highest suicide rates of any racial/ethnic group among women. Women from these communities are also more likely to be targets of violence: almost 84% experience violence in their lifetimes, according to one estimate, including sexual and intimate partner violence. Such experiences may increase suicide risk.


The prevalence of suicide among certain indigenous communities may also contribute to further suicide, a pattern known as “suicide contagion.” The CDC also found that indigenous people who died from suicide were more than twice as likely as white people to be affected by the suicide of a relative or friend. R. Dale Walker, a psychiatrist of Cherokee heritage, worked with a Native American community that had experienced 17 suicides in eight months and reported hearing the sobering phrase “grieved out.”


This pattern of violent death disproportionately affecting some of the most marginalized people in the United States requires a response. Native American and Alaska Native communities need the resources and opportunities necessary to reduce poverty and improve healthcare. More specifically, they need adequate, well-funded, and culturally appropriate mental health resources.


Given the high suicide risk among young people, mental health programs in schools or other youth-focused settings could be especially valuable. Providing support to those who have lost loved ones can help prevent suicide contagion. Giving Native American communities the power to prosecute non-Native Americans for crimes committed on reservations may help reduce domestic violence.


Karen Hearod, a member of the Choctaw Nation of Oklahoma who works as an administrator at the Substance Abuse and Mental Health Services Administration, commented that, “Despite all of the things that tribes have endured, we're still here…There is strength and resilience we can find in that.” Members of indigenous communities deserve support in their struggle against suicide and other threats to their lives.


Those interested in mental health resources for Native American and Alaska Native communities may wish to consult the One Sky Center (http://www.oneskycenter.org/). Those in need of immediate assistance can call or text the Suicide & Crisis Lifeline at 988.

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