Allen James, Wexler Lisa, Apok Charlene Aqpik, Black Jessica, Chaliak James Ay'aqulluk, Cueva Katie, Hollingsworth Carol, McEachern Diane, Peter Evon Taa'ąįį, Ullrich Jessica Saniguq, Grogan-Kaylor Andrew, Lee KyungSook, Fok Carlotta Ching Ting, Berman Matthew, Rataj Suzanne, Rasmus Stacy
University of Alaska Fairbanks, Fairbanks, AK, USA.
Duluth Campus, University of Minnesota Medical School, Duluth, Minnesota, USA.
Prev Sci. 2025 Feb;26(2):246-257. doi: 10.1007/s11121-025-01782-2. Epub 2025 Feb 4.
Suicide research has focused primarily on risk factors at the individual level, overlooking the potential for community-level factors that confer protection from suicide. This study builds on the concept of cultural continuity from the Indigenous suicide prevention literature. It seeks to understand the collective influences shaping individual experiences across time and frames resilience as a culturally situated process that helps individuals to navigate challenges and facilitate positive health behaviors. A collaborative Alaska Native (AN) partnership designed the Protective Community Scale (PCS) to identify mutable community-level protective factors in rural AN communities hypothesized to reduce suicide among youth, who represent the highest risk demographic in this at-risk population. Study objectives were to (a) test the measurement structure of community-level protection from suicide, (b) select best functioning items to define this structure, and (c) test the association of community protection with community-level suicide deaths and attempts. In 65 rural AN communities, 3-5 residents (n = 251) were peer-nominated for their knowledge of local resources and completed the PCS in structured interviews. Findings show community members can reliably assess the theoretically rich, multidimensional community-level protective factor structure of cultural continuity with sufficient precision to establish its inverse association with community-level suicide. Community-level protection emerges as a promising approach for universal suicide prevention in Indigenous contexts that can guide multi-level strategies that expand beyond individual-level, tertiary prevention to focus on the continuity of cultural processes as resources to build protection. These findings point the field toward consideration of cultural continuity and community protection as key factors for Indigenous suicide prevention.
自杀研究主要集中在个体层面的风险因素上，而忽视了社区层面因素对自杀的潜在保护作用。本研究基于原住民自杀预防文献中的文化连续性概念。它试图理解随着时间推移塑造个体经历的集体影响，并将复原力视为一个与文化相关的过程，这个过程有助于个体应对挑战并促进积极的健康行为。阿拉斯加原住民（AN）的一个合作团队设计了保护社区量表（PCS），以确定农村AN社区中可变的社区层面保护因素，这些因素被认为可以降低青少年自杀率，青少年是这个高危人群中风险最高的人群。研究目标是：（a）测试社区层面自杀保护的测量结构；（b）选择最佳功能项目来定义这个结构；（c）测试社区保护与社区层面自杀死亡和未遂事件之间的关联。在65个农村AN社区中，3至5名居民（n = 251）因其对当地资源的了解而被同伴提名，并在结构化访谈中完成了PCS。研究结果表明，社区成员能够可靠地评估文化连续性这一理论丰富、多维的社区层面保护因素结构，其精度足以确定其与社区层面自杀之间的反向关联。社区层面的保护成为原住民背景下普遍自杀预防的一种有前景的方法，它可以指导多层次策略，这些策略超越个体层面的三级预防，转而关注文化过程的连续性，将其作为构建保护的资源。这些研究结果促使该领域考虑将文化连续性和社区保护作为原住民自杀预防的关键因素。
