title: Toward understanding suicide among youths: results from the White Mountain Apache tribally mandated suicide surveillance system, 2001-2006.
abstract: OBJECTIVE
  We examined suicide and suicide attempt rates, patterns, and risk factors among White Mountain Apache youths (aged < 25 years) from 2001 to 2006 as the first phase of a community-based participatory research process to design and evaluate suicide prevention interventions.
  
  
  METHODS
  Apache paraprofessionals gathered data as part of a tribally mandated suicide surveillance system. We compared findings to other North American populations.
  
  
  RESULTS
  Between 2001 and 2006, 61% of Apache suicides occurred among youths younger than 25 years. Annual rates among those aged 15 to 24 years were highest: 128.5 per 100 000, 13 times the US all-races rate and 7 times the American Indian and Alaska Native rate. The annual suicide attempt incidence rate in this age group was 3.5%. The male-to-female ratio was 5:1 for suicide and approximately 1:1 for suicide attempts. Hanging was the most common suicide method, and third most common attempt method. The most frequently cited attempt precipitants were family or intimate partner conflict.
  
  
  CONCLUSIONS
  An innovative tribal surveillance system identified high suicide and attempt rates and unique patterns and risk factors of suicidal behavior among Apache youths. Findings are guiding targeted suicide prevention programs.
authors.affiliation: Johns Hopkins Center for American Indian Health, 621 N Washington St., Baltimore, MD 21205, USA. bmullany@jhsph.edu
authors.forename: Britta
authors.initials: B
authors.lastname: Mullany
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.forename: Francene
authors.initials: F
authors.lastname: Larzelere-Hinton
authors.forename: Mary
authors.initials: M
authors.lastname: Cwik
authors.forename: Mariddie
authors.initials: M
authors.lastname: Craig
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
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