Aboriginal Peoples Survey, 2012
Lifetime suicidal thoughts among First Nations living off reserve, Métis and Inuit aged 26 to 59: Prevalence and associated characteristics


Release date: January 19, 2016 Correction date: (if required)

Abstract

Suicide rates among Aboriginal peoples in Canada are several times higher than rates among the non-Aboriginal population. Based on data from the 2012 Aboriginal Peoples Survey, this article presents prevalence estimates of suicidal thoughts among First Nations living off reserve, Métis and Inuit aged 26 to 59. It examines associations between suicidal thoughts and mental health, socio-demographic and other characteristics, many of which have been shown to be related to suicidal thoughts in other populations.

In 2012, more than one in five off-reserve First Nations, Métis and Inuit adults reported having ever had suicidal thoughts; only among Métis did a difference emerge between men and women, with women more likely to report such thoughts. Women in all three Aboriginal groups were more likely than non-Aboriginal women to report suicidal thoughts. Compared with non-Aboriginal men, off-reserve First Nations and Inuit men were also more likely to have had suicidal thoughts.

Self-reported, physician-diagnosed mood and/or anxiety disorders; drug use; and lack of high self-worth were associated with suicidal thoughts in all three groups and both sexes. Factors such as heavy, frequent drinking; being widowed, divorced, separated or never married; and not being in excellent or very good health were associated with suicidal thoughts among some, but not all Aboriginal groups and sexes. Personal or familial residential school experience was marginally associated with suicidal thoughts among Métis women when each Aboriginal group and sex was examined separately. When all Aboriginal groups and males and females were combined, residential school experience was significantly associated with suicidal thoughts.

These results could inform further research that can be used to guide suicide prevention programs among First Nations, Métis and Inuit.

Introduction

Suicide is a major cause of death among Aboriginal peoplesNote 1 in Canada. In the 1991-to-2001 period, suicide rates were nearly twice as high among Registered IndianNote 2, and Métis men compared with non-Aboriginal men, and Registered Indian women compared with non-Aboriginal women according to analysis using the Canadian Mortality Database (CMDB) linked to the 1991 Census (Tjepkema et al. 2009)Note 3. In Inuit communities, between 1999 and 2003, suicide rates were 10 times higher than rates for the Canadian population overall (Aboriginal Healing Foundation 2007; Public Health Agency of Canada 2011).

Suicidal thoughts are predictors and precursors of suicide (Clarke 2010; Coombs et al. 1992; Crosby and Sacks 1994; De Leo et al. 2005; Robins et al. 1959), almost always preceding attempts and completed suicides. The prevalence of suicidal thoughts has been shown to be relatively high among some Aboriginal populations (Aboriginal Healing Foundation 2007; Kumar et al. 2012). For example, in 2006, 13% of Métis aged 20 to 59 reported having ever had suicidal thoughts, a figure higher than that in the non-Aboriginal population (Kumar et al. 2012). However, little recent information has been published about suicidal thoughts among First Nations, Métis and Inuit or about factors associated with it.

Risk factors for suicidal thoughts

Several factors including mental health factors such as mood and anxiety disorders, personality traits such as low self-esteem and hopelessness, and social or familial factors including marital discord and social support have been shown to be associated with suicidal thoughts in many populations.

Mood and anxiety disorders have been associated with an increased risk of suicidal thoughts. In a study of risk factors for suicidal thoughts in 17 countries, the presence of mood and anxiety disorders increased the odds of suicidal thoughts around three-fold (Nock et al. 2008). A study of Métis men and women found mood disorder (major depressive episode) to be associated with suicidal thoughts (Kumar et al. 2012).

Even when depression and other characteristics were taken into account, self-esteem has been associated with suicidal thoughts in adolescents (de Man et al. 1992) and adults (de Man and Balkou 1987; Jang et al. 2014; Bagalkot et al. 2014), including Métis in Canada (Kumar et al. 2012). Also, hopelessness and childhood trauma (Mann 2003) have been identified as risk factors for suicidal thoughts.

Drug use has been related to suicidal thoughts, with one study suggesting that an increase in the number of types of drugs used increasingly raised the odds of suicidal thoughts (Borges et al. 2000). As well, compared with depression alone, substance use disorder combined with depression was associated with increased odds of suicidal thoughts (Bronisch and Wittchen 1994). Alcohol consumption, particularly intensity or frequency, has also been identified as a factor in suicidal thoughts (Conner et al. 2003). For instance, among Métis women, heavy, frequent drinking was associated with lifetime suicidal thoughts (Kumar et al. 2012). The depressive effects of alcohol use disorder are suggested to be behind this association (Cottler et al. 2003). Current smoking, too, has been shown to be related to increased risk of suicidal thoughts (Clarke et al. 2010; Hintikka 2009). Chronic smoking has been suggested to promote depression alluding to a potential mechanism for its association with suicidal thoughts (Kenny et al. 2001).

Research has shown that marital status, specifically, being never married, widowed, divorced or separated, is associated with suicidal thoughts (Inder et al. 2014). In eight of nine countries surveyed Note 4, being divorced or separated was associated with suicidal thoughts (Weissman et al. 1999). Marriage is suggested to have a protective effect against suicidal thoughts by increasing sense of belonging (McLaren et al. 2015), providing social support, facilitating social participation and increasing self-esteem (Hagedoorn et al. 2006).

Attending a residential school exposed many Aboriginal children to separation from family; physical and sexual abuse; and suppression of their language and cultural identity (Aboriginal Healing Foundation 2007; Haig-Brown 1988; Indigenous and Northern Affairs Canada 2008; Knockwood 1992). Suicidal thoughts have been reported to be more prevalent among on-reserve First Nations youth with one or more parents who went to a residential school, compared with those whose parents did not have this history (First Nations Information Governance Centre 2005). Residential school experience has been linked to high rates of mental illness, child abuse and family breakdown, all of which are associated with suicidal thoughts (Aboriginal Healing Foundation 2007).

Self-rated health has been associated with suicidal thoughts, even when controlling for mental disorders, common physical illness and socio-demographic characteristics (Goodwin and Olfson 2002). Perception of poor health has been shown to be associated with specific mental disorders including major depression suggesting a potential mechanism for the link between self-rated health and suicidal thoughts.

Social support (Kumar et al. 2012; Park et al. 2010; Wright 2006), have been shown to be protective against suicidal thoughts. The association between availability and use of social support and suicidal thoughts is suggested to be mediated by increased self-esteem (Kleiman and Riskind 2013).

While there is some evidence to indicate that many of these factors are also associated with suicidal thoughts among some Aboriginal populations in Canada (Kumar et al. 2012; Lemstra et al. 2013), it remains to be seen if this is the case in other Aboriginal populations.

This article presents 2012 estimates of the lifetime prevalence of suicidal thoughts among off-reserve First Nations, Métis and Inuit adults, compared with non-Aboriginal people, and examines characteristics associated with such thoughts.

Results

More than one in five Aboriginal people reported suicidal thoughts

Nearly one-quarter of First Nations living off-reserve (24.0%) and Inuit (23.5%) and one in five Métis (19.6%) reported having ever had suicidal thoughts.

Métis women were more likely than Métis men to have had suicidal thoughts (23.4% versus 14.9%), but no differences between women and men were apparent among off-reserve First Nations (25.8% versus 21.4%) or Inuit (23.8% versus 23.1%) (Chart 1)Note 5.

Chart 1 Prevalence of lifetime suicidal thoughts among off-reserve First Nations, Métis, Inuit and non-Aboriginal populations, aged 26 to 59 years, by sex, Canada, 2012

Description for Chart 1

The title of the graph is "Chart 1 Prevalence of lifetime suicidal thoughts among off-reserve First Nations, Métis, Inuit and non-Aboriginal populations, aged 26 to 59 years, by sex, Canada, 2012."
This is a column clustered chart.
There are in total 2 categories in the horizontal axis. The vertical axis starts at 0 and ends at 35 with ticks every 5 points.
There are 4 series in this graph.
The vertical axis is "percent."
The horizontal axis is "Sex."
The title of series 1 is "First Nations living off reserve."
The minimum value is 21.4 and it corresponds to "Men."
The maximum value is 25.8 and it corresponds to "Women."
The title of series 2 is "Métis ."
The minimum value is 14.9 and it corresponds to "Men."
The maximum value is 23.4 and it corresponds to "Women."
The title of series 3 is "Inuit."
The minimum value is 23.1 and it corresponds to "Men."
The maximum value is 23.8 and it corresponds to "Women."
The title of series 4 is "Non-Aboriginal (provinces only)."
The minimum value is 11.1 and it corresponds to "Men."
The maximum value is 13.8 and it corresponds to "Women."

Data table for Chart 1
Table summary
This table displays the results of Prevalence of lifetime suicidal thoughts among off-reserve First Nations Men, Women, Percent and 95% confidence interval (appearing as column headers).
  Men Women
Percent 95% confidence interval Percent 95% confidence interval
  from to   from to
First Nations living off reserve 21.4Note * 19.6 23.3 25.8Note * 22.0 29.5
Métis 14.9 11.2 18.7 23.4Note * 18.3 28.4
Inuit 23.1Note * 16.0 30.3 23.8Note * 19.3 28.2
Non-Aboriginal (provinces only) 11.1Note  9.6 12.5 13.8Note  12.0 15.5

Compared with non-Aboriginal men (11.1%), off-reserve First Nations (21.4%) and Inuit men (23.1%) were more likely to have had suicidal thoughts. It wasn’t the case for Métis men. Women in all three Aboriginal groups were more likely than non-Aboriginal women to report suicidal thoughts (13.8%).

Mood and/or anxiety disorders, drug use and lack of self-worth were associated with suicidal thoughts

The prevalence of suicidal thoughts was higher among off-reserve First Nations, Métis and Inuit adults who reported mood and/or anxiety disorders, compared with those who did not (Table 1). It was also the case for individuals in all groups whose self-worth was not high compared with those who reported high self-worth.

Even when other factors were taken into account, these associations persisted among men and women in all Aboriginal groups (Table 2). For example, off-reserve First Nations men with mood/or anxiety disorders were more than three times as likely as those without these conditions to have had suicidal thoughts (47% versus 15%Note 6). Inuit who had high self-worth were 60% less likely to have had suicidal thoughts than those who did not have high self-worth (18% versus 43%).

Suicidal thoughts were more prevalent among people who had used prescription drugs for recreational purposes or street drugs than among those who didn’t Note 7. This was seen in all three Aboriginal groups, and among them, for both men and women. This relationship persisted when other characteristics were taken into account. For off-reserve First Nations and Métis men, those who had used these drugs were about twice as likely to have reported suicidal thoughts compared with those who had notNote 6.

Inuit men and women who reported heavy, frequent drinking in the previous year were about twice as likely to have reported suicidal thoughts compared with those who did not (Table 1). When other factors were taken into account, the association was significant only among Inuit women (Table 2). No significant associations remained between those who did and did not report heavy, frequent drinking among off-reserve First Nations and Métis men and women, and Inuit men.

Suicidal thoughts were more prevalent among off-reserve First Nations, Métis and Inuit who were daily smokers (Table 1). However, after adjusting for other characteristics, daily smoking was not associated with suicidal thoughts (data not shown).

Except for Inuit men, adults in all Aboriginal groups who reported to be in excellent or very good health were less likely to have had lifetime suicidal thoughts than were those who rated their health less favourably (Table 1). When other factors were taken into account, only off-reserve First Nations men, Métis women and Inuit women who reported excellent or very good health were less likely to have had suicidal thoughts (18% versus 24% among off-reserve First Nations men, and 18% versus 27% for Métis and Inuit womenNote 6) (Table 2).

Being widowed, divorced, separated or never being married was associated with suicidal thoughts in some Aboriginal groups

Off-reserve First Nations women and Métis men and women who were widowed, divorced or separated as well as those who never married were more likely than those who were married or living in common-law relationships to have reported suicidal thoughts (Table 1). When the influence of other factors was taken into consideration, the likelihood of suicide thoughts remained significantly lower among those who were married or living in common-law relationships compared to those who were widowed, divorced or separated for Métis and Inuit men and for off-reserve First Nations women. This was the case as well when married or common-law Métis men were compared to Métis men who were never married (Table 2).

Off-reserve First Nations women, Métis men and Métis women with personal or familial residential school experience were more likely than those without such experience to have had suicidal thoughts (Table 1). In other groups, while the estimates trended towards higher prevalence among those with personal or familial residential school experience versus those with none, the differences did not reach statistical significance. When other characteristics were considered, suicidal thoughts were marginally Note 8 associated with residential school experience only among Métis women (Table 2). To see if the non-association may be due to small samples sizes, the analysis was repeated using a combined sample (pooled sample of the three groups and both sexes). In this analysis, residential school experience was significantly associated with occurrence of suicidal thoughts (data not shown).

In the unadjusted analysis, higher after-tax household income was correlated with a lower likelihood of having had suicidal thoughts (Table 1). However, the relationship was no longer significant when other factors were considered. No associations emerged between level of education or remoteness and reporting suicidal thoughts (data not shown).

Conclusion

In 2012, more than one in five First Nations living off reserve, Métis and Inuit aged 26 to 59 reported having ever had thoughts of suicide during their lifetime. Except among Métis men, suicidal thoughts were more common among these Aboriginal groups than among their non-Aboriginal contemporaries.

For men and women in all Aboriginal groups, having mood and/or anxiety disorders and drug use were associated with an increased likelihood of suicidal thoughts, while high self-worth was associated with the opposite, even when other factors were taken into account. Associations with heavy, frequent drinking; self-reported health; and marital status were less consistent, varying with the specific Aboriginal group and the sex of respondent.

Suicidal thoughts were more prevalent among off-reserve First Nations women, Métis men and women with a personal or familial experience of residential schools before controlling for other factors. After adjusting for other factors, residential school experience was marginally associated with suicidal thoughts only among Métis women. The small samples available for analysis when each Aboriginal group was disaggregated by sex may have contributed to the observed lack of association. When data for all three Aboriginal groups and sexes was combined, residential school experience was significantly associated with suicidal thoughts suggesting that the previous findings may be the result of small sample sizes.

Many of the characteristics found to be significant in this study have been associated with suicidal thoughts in other populations. Consistent with this, parallel analyses using the 2012 CCHS-MH data (data not shown) indicated that, similar to the Aboriginal groups, mood and/or anxiety disorders, lack of high self-worth and drug use were associated with higher prevalence of suicidal thoughts among non-Aboriginal adults. However, for non-Aboriginal men and women, being widowed, divorced or separated was not associated with suicidal thoughts, in contrast to the association found for off-reserve First Nations women, and Métis and Inuit men. Furthermore, for non-Aboriginal adults of both sexes, being single was associated with suicidal thoughts Note 9, whereas this was the case only for Métis men. Other studies have yielded mixed results, with some suggesting an association between marital status and suicidal thoughts (Weissman et al. 1999) while others do not (Kessler et al. 2005). Reporting excellent or very good health was associated with lower likelihood of suicidal thoughts among non-Aboriginal men and women, whereas this was true only for off-reserve First Nations men and for Inuit and Métis women.

Overall, some risk factors such as mood or anxiety disorders, lack of high self-worth and drug use were associated with suicidal thoughts in all three Aboriginal groups and in the non-Aboriginal population. The higher prevalence of some of the risk factors such as mood disorders in off-reserve First Nations and Métis compared to the non-Aboriginal population (Gionet and Roshanafshar 2013) may suggest a greater importance of this risk factor for suicidal thoughts among these Aboriginal populations. Other characteristics such as marital status and self-rated health were differentially associated among the Aboriginal groups and the non-Aboriginal population.

This study provides the latest prevalence estimates for lifetime suicidal thoughts for three Aboriginal groups, off-reserve First Nations, Métis and Inuit, and for each sex among them. It also identifies characteristics associated with suicidal thoughts among these Aboriginal groups. More research is needed to examine other characteristics such as social support, life stress and feelings of hopelessness. The identification of both common and unique factors associated with suicidal thoughts among different Aboriginal groups adds to existing literature on factors that could inform development of suicide prevention programs.

Limitations

Suicidal thoughts may be under-reported owing to the stigma attached to suicide, and also, to an inability to recall such thoughts, especially if they occurred a long time ago.

The prevalence estimates for Aboriginal and non-Aboriginal people come from separate surveys (APS and CCHS-MH) that use different sampling frames, questions, and sequencing and placement of questions. In addition, “lifetime suicidal thoughts” is a one-item variable in the APS data, but a derived variable in the CCHS-MH data. These differences may affect the comparability of the estimates.

The exclusion of the on-reserve First Nations population from the Aboriginal Peoples Survey prevented the analysis of this population. In Manitoba, suicide rates have been shown to be higher among on-reserve First Nations compared with off-reserve First Nations (Malchy et al. 1997). Nationally, lifetime suicidal thoughts were reported by 22.0% of on-reserve First Nations adults during the 2008-to-2010 period (First Nations Information Governance Centre 2012), somewhat higher than the figure for off-reserve First Nations individuals aged 18 or older in 2012 (19.5%).

As noted above, several characteristics such as social support, life stress and feelings of hopelessness that have been associated with suicidal thoughts in previous research could not be explored here because they or adequate proxies were not available in the Aboriginal Peoples Survey. Also, the reference periods for characteristics such as heavy, frequent drinking and household income are not the same as the reference period for the suicidal thoughts.

Some associations and their strengths may be affected by the validity of the measures in the 2012 APS. For example, self-reports of diagnosed mood and/or anxiety disorders may not produce prevalence estimates comparable to those that would be obtained using a validated instrument such as the World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI) (World Health Organization 2004). Similarly, the ability of a single question to measure self-worth compared with a validated multi-item scale is unknown, as is the impact of using this variable in the analysis. And, while heavy, frequent drinking is the measure of alcohol consumption employed here, other research has used measures of drinking frequency and intensity as potential predictors of suicidal thoughts (Conner et al. 2003).

Finally, the data are cross-sectional, representing a snapshot in time. Although this analysis shows several characteristics to be associated with suicidal thoughts, cause-and-effect relationships cannot be inferred.

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Appendix

Data and methods

Data

The data are from the 2012 Aboriginal Peoples Survey (APS) and the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). The former was used for the analysis of suicidal thoughts among off-reserve First Nations, Métis and Inuit; the latter was used to compare the APS estimates with those for the non-Aboriginal population.

The 2012 APS was a national survey of First Nations people living off reserve, Métis and Inuit aged 6 or older. It was the fourth cycle of the APS and focused on education, employment and health. The survey excluded residents of Indian reserves and settlements and certain First Nations communities in the Yukon and the Northwest Territories. The response rate was 76%, resulting in an Aboriginal sample of 28,410 (Cloutier and Langlet 2014). The study population for this analysis was restricted to 26- to 59-year-olds who responded to questions on suicidal thoughts, yielding a sample of 10,306. This age group was chosen because the characteristics associated with suicidal thoughts among people in this age range are expected to differ from those among young adults (18 to 25) and seniors (60 or older).

The 2012 CCHS-MH was a cross-sectional survey of the mental health status of Canadians and their use of mental health services (Statistics Canada 2012). Data were collected from the household population aged 15 or older in the 10 provinces. The survey excluded residents of Indian reserves and settlements Note 10, full-time members of the Canadian Forces, and the institutionalized population. The response rate was 68.9%, yielding a sample of 25,113 (Statistics Canada 2013c). The study population for this analysis was 26- to-59-year-olds who did not identify as an Aboriginal person (“non-Aboriginal") yielding a sample size of 11,822.

The questions on suicidal thoughts in the two surveys differed. For the APS, respondents were asked a series of questions on suicidal thoughts and attempts, including “Have you ever seriously considered committing suicide or taking your own life?” Those who responded “Yes” to this lifetime question were asked about past-year suicidal thoughts: “Has this happened in the past 12 months?”

In the CCHS-MH, the presence of “lifetime suicidal thoughts” was based on a variable derived using a combination of questions: 1) “Has [this] ever happened to you: You seriously thought about committing suicide or taking your own life”; and 2) “Think of the period of two weeks or longer when your feelings of being [depressed] and other problems were most severe and frequent. During that time, did you seriously think about committing suicide/taking your own life?” Those who responded “Yes” to this lifetime question were asked about past-year suicidal thoughts: “In the past 12 months, did [this] happen to you: You seriously thought about committing suicide or taking your own life.”

Analysis

The data analyzed in this study concern lifetime suicidal thoughts: having ever (at any point in a person’s lifetime) seriously thought of taking her/his own life.  “Lifetime suicidal thoughts” was chosen instead of past-year suicidal thoughts to increase the sample size and because many characteristics potentially related to suicidal thoughts were expected to be relatively consistent over time, including high self-worth (Brown and Marshall 2006) Note 11, or they pertained to lifetime experience/occurrence, such as ever being diagnosed with a mood and/or anxiety disorder. Separate analyses were conducted for men and women, and the three Aboriginal groups because of: 1) a higher prevalence of suicidal thoughts among women in many populations (Crosby and Sacks 1994; Weissman et al. 1999), including Métis (Kumar et al. 2012); 2) the varied historical and contemporary experiences of First Nations, Métis and Inuit (Bartlett et al 2007; Peters  2007); and 3) reported differences in predictors of suicidal thoughts among Métis men and women (Kumar et al. 2012).

Prevalence estimation

The prevalence of lifetime suicidal thoughts was estimated using methods that account for the complex survey designs of the APS and the CCHS (Cloutier and Langlet 2014; Statistics Canada 2013c). Missing values (“don’t know,” “not stated,” “refusal”) were excluded from the denominator when calculating percentages unless they constituted more than 5% of the total (as in the case of residential school experience). Statistically significant differences were determined using tests specific for complex survey data (Isik 2009; Miller et al. 2011; RTI International n.d.; Wiener et al. 2015).

Characteristics or risk factors associated with lifetime suicidal thoughts

The risk factors considered in this analysis are based on the literature and their availability in the Aboriginal Peoples Survey. These include health-related and socio-economic characteristics. The former comprise of mood and/or anxiety disorders, self-worth, drug use, alcohol abuse or misuse, and self-reported health.  The socio-economic characteristics include marital status, household income, highest level of schooling, remoteness and personal or familial history of residential school.

In this study, the health-related risk factors were operationalised as follows:

The socio-economic characteristics were operationalised as follows:

Other characteristics such as social support (Kumar et al. 2012; Park et al. 2010; Wright 2006), hopelessness, and childhood trauma (Mann 2003), which have been associated with suicidal thoughts in the literature, were not included in the analysis because they or adequate proxies were not available in the Aboriginal Peoples Survey.

Bivariate and multivariate analyses

Bivariate analyses were conducted to determine if individuals with specific characteristics were more or less likely to have had suicidal thoughts. One characteristic at a time was examined without adjusting for other potentially associated factors. Statistically significant differences were identified using tests specific for complex survey data (Isik 2009; Miller et al. 2011; RTI International n.d.; Wiener et al. 2015). For ordinal variables such as household income quintiles, trends in correlation between categories of the variable and suicidal thoughts were tested using Cochran-Armitage Trend Test (SAS Institute 2010).

Logistic regression analyses that considered many variables simultaneously were then performed to identify characteristics significantly associated with having ever had suicidal thoughts while controlling for the other characteristics. The characteristics included in the logistic regressions were those that were correlated with suicidal thoughts in the bivariate analyses or that have been shown to be associated in previous research.

The final analysis usually retained only characteristics that were statistically associated with suicidal thoughts. However, some were kept regardless of significant associations if they had been consistently/strongly associated with suicidal thoughts in previous research (Vittinghoff et al. 2012, p. 147) Note 17. Adjusted after-tax household income was retained as a proxy for factors such as life stress, especially economic stress (Dooley et al. 1989; Hintikka et al. 2009), that are related to suicidal thoughts but for which no data were collected in the survey.

The marginal prevalence ratio (increase in likelihood with the presence of a characteristic, in the case of yes/no characteristics, when adjusting for other characteristics) of having had suicidal thoughts was estimated for individuals with and without each characteristic. Increase or decrease in likelihood (“fold change” or “marginal prevalence ratio” (Bastos et al. 2015; Buettner et al. 2012)) was calculated by dividing the likelihood estimate for respondents with a characteristic by that for respondents without the characteristic. For example, if the fold change was 2.0 for a particular characteristic, individuals with the characteristic were twice as likely to have had suicidal thoughts compared with those who did not have the characteristic after controlling for other characteristics. By contrast, if the change was 0.5 for a characteristic, individuals with the characteristic were half as likely to have had suicidal thoughts compared with those without the characteristic.

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