Suicide interventions for American Indian and Alaska Native populations: A systematic review of prevention strategies, logics, and rationales

Objective: We conducted a systematic review to answer the following research question: “What logics or rationales have structured interventions aimed at preventing suicidal behaviors among AI/AN populations?” Method: Our screening and searching process yielded 32 publications that overlapped considerably in terms of suicide prevention strategies, logics, and rationales. Results: Regarding suicide prevention strategies, most studies featured interventions that sought to promote connectedness, create protective environments, identify and support people at risk, and teach coping and problem-solving skills, while others strengthened access and delivery of suicide care, lessened harms and prevented future risk, and strengthened economic support. The rationales justifying these suicide prevention strategies varied from strategy to strategy. Discussion: While most program developers related their choice of suicide prevention strategy to distress at the individual level, each and every developer foregrounded their efforts in collectivist-attitudes, social relations, non-professional services, and community-driven projects rooted in decolonization efforts. This focus may reflect a need to honor Indigenous assumptions about suicide in community-based prevention programs. Conclusion: Altogether, our analysis points to a multi-level ecosystem of interventions that incorporates individual-centered rationales and interventions so long as they also consider systems, contexts, and a collectivist mentality.