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Open Access Highly Accessed Research article

A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand

Anton C Clifford1*, Christopher M Doran2 and Komla Tsey3

Author Affiliations

1 Institute for Urban Indigenous Health, Edgar Street, Bowen Hills, QLD, 4006, Australia

2 Hunter Medical Research Centre, University of Newcastle, HMRI Building, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia

3 Education for Social Sustainability, School of Education, Cairns Institute, James Cook University, McGregor Rd, Smithfield, QLD, 4878, Australia

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BMC Public Health 2013, 13:463  doi:10.1186/1471-2458-13-463

Published: 13 May 2013

Abstract

Background

Indigenous peoples of Australia, Canada, United States and New Zealand experience disproportionately high rates of suicide. As such, the methodological quality of evaluations of suicide prevention interventions targeting these Indigenous populations should be rigorously examined, in order to determine the extent to which they are effective for reducing rates of Indigenous suicide and suicidal behaviours. This systematic review aims to: 1) identify published evaluations of suicide prevention interventions targeting Indigenous peoples in Australia, Canada, United States and New Zealand; 2) critique their methodological quality; and 3) describe their main characteristics.

Methods

A systematic search of 17 electronic databases and 13 websites for the period 1981–2012 (inclusive) was undertaken. The reference lists of reviews of suicide prevention interventions were hand-searched for additional relevant studies not identified by the electronic and web search. The methodological quality of evaluations of suicide prevention interventions was assessed using a standardised assessment tool.

Results

Nine evaluations of suicide prevention interventions were identified: five targeting Native Americans; three targeting Aboriginal Australians; and one First Nation Canadians. The main intervention strategies employed included: Community Prevention, Gatekeeper Training, and Education. Only three of the nine evaluations measured changes in rates of suicide or suicidal behaviour, all of which reported significant improvements. The methodological quality of evaluations was variable. Particular problems included weak study designs, reliance on self-report measures, highly variable consent and follow-up rates, and the absence of economic or cost analyses.

Conclusions

There is an urgent need for an increase in the number of evaluations of preventive interventions targeting reductions in Indigenous suicide using methodologically rigorous study designs across geographically and culturally diverse Indigenous populations. Combining and tailoring best evidence and culturally-specific individual strategies into one coherent suicide prevention program for delivery to whole Indigenous communities and/or population groups at high risk of suicide offers considerable promise.