title: Nonsuicidal self-injury in an American Indian reservation community: results from the White Mountain Apache surveillance system, 2007-2008.
abstract: OBJECTIVE
  To describe characteristics and correlates of nonsuicidal self-injury (NSSI) among the White Mountain Apache Tribe. NSSI has not been studied before in American Indian samples despite associated risks for suicide, which disproportionately affect American Indian youth.
  
  
  METHODS
  Apache case managers collected data through a tribally mandated surveillance system. Data from 2007 and 2008 (N = 182) were examined for rates, methods, precipitants, functions, past history of self-injury and service use, by age and gender.
  
  
  RESULTS
  The rate of NSSI among all ages was 600 in 100,000, with individuals 10 to 14 years old disproportionately affected at a rate of 3,000 in 100,000. More females (65%) reported NSSI, and cutting was the preferred method (98%) for both genders combined. Most frequently reported precipitants were peer pressure/copying, conflict with boy/girlfriend and "depression." A substantial proportion (22%) was intoxicated/high at the time. More reported the function of NSSI was to "effect internal state" (45%) than "effect circumstances" (15%). More than one-third (39%) received ED treatment and referrals for aftercare (36%). Of those referred, only 30% followed up with services. Most (79%) reported past NSSI; 30% reported past suicidal ideation and 25% attempts.
  
  
  CONCLUSIONS
  NSSI is a significant, largely unaddressed mental health problem among the White Mountain Apache Tribe and likely other reservation communities, especially as NSSI could serve as a precursor to suicide in this population. Interestingly, another self-destructive behavior, severe substance use, was reported to the surveillance system by Apaches and described in terms similar to NSSI, an important preliminary finding worth further exploration.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, USA. mcwik@jhsph.edu
authors.forename: Mary F
authors.initials: MF
authors.lastname: Cwik
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.forename: Lauren
authors.initials: L
authors.lastname: Tingey
authors.forename: Francene
authors.initials: F
authors.lastname: Larzelere-Hinton
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D002648:Child; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007198:Indians, North American; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D012652:Self Mutilation / Q000453:epidemiology* / Q000209:etiology*; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000209:etiology*; D013406:Suicide, Attempted / Q000639:trends; D055815:Young Adult