Protective and risk factors of suicide in Native American youth: cross-sectional findings from a mixed-methods study.

Background: Native American (American Indian/Alaska Native) youth have the highest rates of suicide and suicide clusters in the United States, and appropriate responses are lacking. This study examined protective and risk factors for suicide in a remote Northern Plains reservation with a recent cluster. Methods: A mixed-methods study was conducted on the Fort Belknap Indian Reservation, Montana, in 2022 using a community-engaged approach. Quantitative results from the 251-item questionnaire are presented, which were derived from a culturally adapted socio-ecological model. Aaniiih and Nakoda youth 14-24 years of age, living on/near Fort Belknap were recruited. Findings: In total, 197 youth completed the questionnaire; average age was 16.6 years (SD = 2.60). One hundred (51%) youth were female and 90 (46%) male; 6.1% of data points were missing. Positive family relationships, communal mastery, benevolent childhood experiences, and emotional intelligence were protective, decreasing odds of suicide ideation. Childhood and family risk factors correlated with increased odds of suicidal ideation, including verbal abuse, low community support, sexual abuse, and witnessing community violence. Utilizing multivariable modeling, emotional intelligence (protective factor), and early initiation of substance use, verbal abuse, PTSD, and historical losses (risk factors) were significant factors for suicide ideation, when controlling for all other factors. Interpretation: Adverse childhood experiences, early initiation of substance use, and PTSD increase suicide ideation and attempts. When youth experience positive and supportive family relationships, odds of suicide ideation are lower, which highlight pivotal areas for intervention and response. Funding: William T. Grant and Doris Duke Family Foundations.