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Position paper for the 5
th
NRF open Assembly, September 24
th
– 27
th
2008
Suicide in Inuit Nunaat:
An analysis of Suicide Rates and the effect of
Community-level Factors
By
Christopher Penney
1
Sacha Senécal
1, 2
Eric Guimond
1, 2, 3
Ellen Bobet
4
and
Sharanjit Uppal
5
Authors’ Affiliation
1) Strategic Research and Analysis Directorate
Indian and Northern Affairs Canada
2) University of Western Ontario
3) Inter-University Centre for Demographic Study (CIED)
4) Confluence Research
5) Statistics Canada
June 27, 2008
The views expressed in this report are solely those of the authors and do not
necessarily reflect the views of Indian and Northern Affairs Canada (INAC). While
the research and analysis in the report are based on data from Statistics Canada,
the opinions expressed do not represent the views of Statistics Canada.
Position paper for the 5
th
NRF open Assembly, September 24
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th
2008
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First Author contact information
Christopher Penney, M.A.
Strategic Research Manager
Indian and Northern Affairs Canada
Strategic Research and Analysis
Directorate
Terrasses de la Chaudière, 5-J
10 Wellington
Gatineau (QC)
K1A 0H4
Canada
tel. (819) 994-4755
fax. (819) 994-7595
penneyc@sinc-inac.gc.ca
http://www.ainc-inac.gc.ca/pr/ra/index1_e.html
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NRF open Assembly, September 24
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2008
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Introduction
Suicide is one of the areas of greatest concern to Inuit living in Canada’s north, yet there
is little in the way of national statistical evidence to highlight this issue. Besides trying to
come to grips with the scope of the issue, Inuit, along with Federal, Provincial and
Territorial governments, are trying to understand the factors that lead people to take their
own lives, in an attempt to formulate more effective suicide prevention strategies. In this
study, we look at suicide in Inuit Nunaat (land where Inuit live) through a geographical
approach, in the absence of Inuit identifiers in national vital statistics datasets.
Furthermore, we analyse these data using information from the Statistics Canada’s
Census of Population and Aboriginal Peoples Survey to compare suicide rates between
groups of communities based on a variety of community-level factors.
Background
Inuit live primarily in remote, northern communities in regions across Canada’s north
known collectively as Inuit Nunaat. In 2001, there were some 45,000 Inuit in Canada
according to the Census, most of whom lived in one of 53 communities in four regions:
Inuvialuit in the Northwest territories, the Territory of Nunavut, Nunavik, in northern
Quebec, and Nunatsiavut, on the north coast of Labrador. All four of these regions have
settled land claims, and three have formal agreements for Inuit-controlled government.
Suicide is a major problem among Inuit in Canada, with rates far above the national
average. Among Nunavut residents, fully 22% of all the deaths that occurred between
2000 and 2003 were suicides [Hicks 2005]. Despite this, there is no consistent
measurement of suicide rates across the four regions inhabited by Inuit, owing largely to
the difficulty of separating the mortality data for Inuit from those of non-Inuit residents of
the same areas. To monitor suicide rates, some Inuit regions are able to obtain
information from coroners’ reports; others rely on geography-based methods or simply
on local knowledge to produce suicide statistics. The result has been that while some
regions have comprehensive statistics on suicides, others have only basic or sporadic
information. These differences in surveillance make it difficult to produce a national
suicide rate, or compare mortality patterns across regions.
Recent research shows that suicide rates among Inuit in Canada are much higher than
average. Various regional studies have found rates from around 3.5 to 11 times higher
than the national average [Royal Commission 1995; Hicks 2007a; Bobet 2004]. Hicks
[2006] and Boothroyd, et al. [2001] have also reported that suicide rates in at least two
regions have increased during the late 1980s and 1990s.
Suicides tend to cluster in time and space, such that some communities may have serious
problems while others experience few or no suicides [Henderson 2003]. Young males
make up the largest proportion of Inuit suicides; studies have shown that males make up
over 80% of Inuit suicides, and about 70% of all suicide victims were under 25 years of
age [Hicks 2007a; Boothroyd, et al. 2001].
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NRF open Assembly, September 24
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2008
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Indian and Northern Affairs Canada, in conjunction with Health Canada and Statistics
Canada, explored the feasibility of producing suicide statistics for Inuit-inhabited regions
of Canada, following the methodology developed by Wilkins, et al. [2008]. This method
uses a geographic coding methodology to calculate statistics for communities that have a
high proportion of Inuit residents, as identified from the Census of Population, conducted
by Statistics Canada.
Following the calculation of suicide rates for the period from 1989 to 2003, we analyzed
the findings by comparing rates for various socio-demographic and cultural indicators
from the Census and the companion Aboriginal Peoples Survey (APS). This was
facilitated by the fact that the geographic coding used to calculate suicide rates is the
same as that used for the Census and APS, enabling us to compare suicide rates between
groups of communities divided by differences in socio-cultural characteristics.
Risk Factors and the Explanation of High Suicide Rates
Risk factors for Inuit suicide might be divided into to general categories: mainstream risk
factors that tend to be prevalent in Inuit society, and risk factors specific to Inuit (or at
least Aboriginal) populations, such as colonization and acculturation.
Mainstream, or “standard” risk factors prevalent in Inuit communities include childhood
separation and loss, alcohol abuse, personal mental health problems, domestic
dysfunction and exposure to other peoples self-destructive behaviour [Boothroyd, et al.
2001].
Besides these factors, many researchers point to the rapid social and cultural change,
social and economic marginalization, cultural suppression, political disempowerment and
discrimination that come with a history of colonization and acculturation by western
European powers as risk factors specific to Inuit [Boothroyd, et al. 2001; Kirmayer, et al.
2000]. Researchers link this loss of culture and its accompanying negative effects with
loss of individual self-esteem, ultimately leading to disconnect with an individuals’
culture and community to the point where life can be seen as meaningless and therefore
disposable [Chandler and Proulx 2006]. The effect of cultural change may also explain
the higher rates of suicide among males, where some have suggested that the traditional
domestic role of women is more easily transferred to the modern wage-based service
economy, than the male role of hunting and fishing [Henderson 2003; Advisory Group
2003; Hunter and Milroy 2006].
Recently, researchers have been investigating the link between community characteristics
and suicide rates. Chandler and Lalonde [1998] noted that suicide in a group of First
Nations communities in British Columbia varied wildly, where some communities had
many more suicides than expected, while other communities had no suicides during the
study period. The authors observed that suicide was much less common in First Nation
communities that had cultural facilities, that managed their own health, education and
police services, and that were actively pursuing control of their own lands. The more of
these factors were present, the lower a community’s suicide rate. The authors considered
Position paper for the 5
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2008
5
these factors indicators of “cultural continuity”, though they might just as easily be
considered indicators of the degree to which a community controls its own affairs, and
hence its destiny.
Although the Chandler and Lalonde findings have helped shift the discussion to one of
community characteristics and the local environment, it is not clear to what degree this
paradigm applies to Inuit communities. All of the Inuit regions have settled land claims,
some dating back as far as 1976, and retention of traditional language is strong, with Inuit
languages remaining dominant in some regions, especially Nunavik and Nunavut. In
addition, most Inuit regions now have a substantial amount of local government
1
(although this is a recent development in most cases). These factors would lead us to
predict low suicide rates based on Chandler and Lalonde’s findings, yet, as we will see
below, the Inuit rates are far above Canadian levels, and rising.
One recent theory contends that suicide in Inuit communities can be linked with active
colonialism (i.e. not simply contact, but an overt, deliberate effort to ‘modernize’ Inuit
communities) [Hicks 2007b]. Suicide rates seem to rise in the generation of Inuit born as
this ‘active colonialism’ begins, when culture is in flux, and young Inuit are caught
between a traditional and the modern. As Hicks states:
The young Inuit men at greatest risk appear to be those who are situated
somewhere between the historical Inuit “life script” and the emerging urban Inuit
“life script”, in communities and families where unemployment and social
dysfunction are more common [Hicks 2007b].
Suicide in this scenario comes not from the loss of traditional culture directly, but from a
situation where an inability to cope with the change itself, where young people of the
current generation live in a world in transition, leaves them insufficiently grounded in
either cultural tradition. Such disconnect can also be exacerbated by a domestic situation
where parents have difficulties adapting to change. This creates a situation where
younger Inuit feel connected neither to their past nor to the future.
The Geozone Methodology
The methodology for extracting vital statistics for Inuit-inhabited areas was developed
and described by Wilkins, et al. [2008]. Most Inuit live in one of four regions in Northern
Canada. These regions fall under four separate jurisdictions with varying capacity and
methodology in collecting vital statistics. Inuit therefore cannot be routinely identified in
mortality records across Canada, which makes it difficult to carry out routine surveillance
of suicide trends. However, most Inuit live in isolated northern communities that can be
identified by geographic codes present on the vital statistics records of all provinces and
territories. This coding reflects the person’s usual place of residence, rather than where
1
Nunatsiavut (Labrador) has had formal-recognized local government since Dec 1, 2005, and has had
substantial Inuit influence through institutions such as the Labrador Inuit Health Commission for many
years before that; Nunavik has had Inuit regional government since the James Bay and Northern Quebec
Agreement of 1976; while the Government of Nunavut officially came into being on April 1, 1999.
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the death occurred. This fact makes it possible to produce routine surveillance data for
Inuit-inhabited areas – that is, for all residents of communities that have substantial Inuit
populations, regardless of the place of occurrence of the death.
To determine Inuit-inhabited communities, we used a cut-off of 33% Inuit inhabitants
according to the 2001 Census of Population, following Wilkins et al. [2008]. While this
sounds low, most communities above this cut-off had a much higher proportion of Inuit
inhabitants, and it included all 53 communities within the Inuit land claim areas.
2
The
final list included
• 6 communities in the Inuvialuit Settlement Region;
• 28 communities in Nunavut (plus 2 “unorganized areas” around the communities
that shared the same postal codes);
• 14 communities in Nunavik;
• 6 communities in Labrador/Nunatsiavut.
In the parts of the study that involved combining mortality data with explanatory
variables from the Aboriginal Peoples Survey (APS), this list had to be reduced slightly,
since five of these communities were missing from the APS sample.
As a consequence of using a geographic-based approach, about 21 % of the total
population covered is non-Inuit, though this proportion varies from region to region (see
Table 1).
Table 1 Inuit-inhabited areas, 1996
1
population by stated identity
Inuit single-identity All other identities Total
Number % Number % Pop’n
Nunatsiavut (Lab) 2,309 68.1 1,080 31.9 3,389
Nunavik (Que) 7,628 88.0 1,069 12.0 8,697
Nunavut 20,489 83.1 4,176 16.9 24,665
Inuvialuit (NWT) 3,199 55.5 2,561 44.5 5,760
Total 33,625 79.1 8,886 20.9 42,511
1
The 1996 Census count is the mid-point of the time-period covered in this study.
Most non-Inuit living in the North tend to be better educated, employed, paid and housed
than their Inuit neighbours (see Table 2). It would be expected that the non-Inuit
population would also have better health outcomes than the local Inuit population. Hicks
[2007a] reported that of 221 suicides in Nunavut from 1999 to 2006, only 3 involved
non-Inuit. As a result of this, we believe that our estimates of suicide rates in these
communities are conservative, and underestimate the actual Inuit suicide rates.
Additionally, this geographic method misses about 20% of the Inuit population, who live
outside of the land claim areas.
2
The 33% cut-off also let to the inclusion of one community, Northwest River, NL, from outside of the
Inuit land claim areas.
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Table 2 Population characteristics compared: Canada, Inuit-inhabited areas, and Inuit
living in Inuit areas, 2001 Census data
Characteristic Canada Inuit-inhabited
areas
Inuit-identity pop’n of
these areas
(single or multiple
identity)
% under 15 years 19.4 36.6 40.3
% < high school
diploma
31.1 51.4 62.0
% with some
university
25.8 12.2 3.2
% unemployed 7.3 16.9 22.4
Avg household size 3.6 5.1 5.4
Avg income per person $23K $15K $11K
Reproduced from Wilkins et al. 2007
Against these limitations, the method has a number of strengths. It covers nearly 80% of
the Inuit population without requiring identification of specific individuals as Inuit, and
since vital statistics data are routinely compiled, the data are available for years into the
past and are likely to be equally available in future, without the costs involved in
mounting a separate data-collection exercise. Importantly, the geographic coding is
standard enough that the same method can be applied to many other datasets—allowing
analytical projects like the current one to combine mortality figures with data from other
sources such as the Census and various surveys. In short, although the method does not
remove the need for more rigorous ways of studying Inuit health, it does provide a means
of routinely tracking mortality rates over time, is cost-effective, and opens up many
possibilities for analytical studies.
Methods for the analytical portion of the study
In the analytical portion of this study, we grouped communities according to explanatory
variables, and then calculated suicide rates for these groupings. For example, we
compared suicide rates in the group of communities in which school attendance was high
to rates in the group of communities where attendance was low. The explanatory
variables were drawn from two sources: the 1996 Census and the 2001 Aboriginal
Peoples Survey (APS). The choice of variables was based on the literature and influenced
by whether or not the variable was available on the Census or APS. The final list
included basic socio-demographic variables (community size, identity, employment,
education), measures of tradition and language, and measures of community function and
well-being.
The data covered the 15 years from 1989 to 2003, with all suicide rates standardized to
the age distribution of the Inuit population in 2001. Census data on community
characteristics were drawn from the 1996 Census, since 1996 represents the midpoint of
the 15-year period studied. There was no Aboriginal Peoples Survey in 1996, but the
Position paper for the 5
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2001 version contained an Arctic Supplement that provided valuable information on
participation in traditional activities and related aspects.
3
In both cases, data were
extracted for the population who reported Inuit identity. This means that although the
suicide rates are for the entire population, both Inuit and non-Inuit, of the selected
communities, the explanatory variables are based only on people who identified as Inuit.
The rationale for this decision is that the purpose of the analysis was to identify possible
explanatory variables for Inuit suicide rates, since other sources suggest that up to 98% of
the suicides in these areas are among Inuit.
Since the absolute numbers of suicides involved are fairly small, the explanatory
variables were simply dichotomized, in order to preserve confidentiality. For purposes of
this analysis, we compared communities that were notably “strong” on a given
characteristic to all the remaining ones, rather than dividing at some point such as the
median. Thus we typically compared communities in the top quartile (e.g., the quarter
that had the highest proportions of youth in school) to the communities in the remaining
three quarters. Some exceptions were made if there was an analytical reason to cut at a
different point, or if cutting at the top quartile resulted in too small a group. Appendix 1
lists the cut points that were used for the different explanatory variables.
Patterns of suicide in Inuit-inhabited areas
Even if slightly understated, the area-based figures still show that the Inuit suicide rate is
many times the Canadian average, at 112 per 100,000 from 1999 to 2003. One strength of
the method is that it provides a consistent methodology for all four regions. As seen in
Table 3 below, suicide rates are highest in Nunavik, followed by Nunatsiavut, Nunavut
and then the Inuvialuit Settlement Area. Rates in Nunavik are significantly higher than
the average for the four Inuit regions, and also higher than Nunavut. The remaining
differences between regions do not reach statistical significance.
A look at the trends over time confirms for all four Inuit-inhabited areas what studies in
Nunavut and Nunavik had already observed: suicide rates have increased over the past 15
years. Judging by the figures for all regions combined, the increase from the 1994 to
1998 to the 1999 to 2003 period was particularly pronounced. Increases in Nunavik and
Nunavut over these periods were statistically significant, while all four regions saw
statistically significant increases over the entire 15 year period.
3
The 2001 APS sample contained some 10,755 Inuit, of whom 8,943 responded to the survey, for a
response rate of 83%. [Statistics Canada 2003]
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Table 3 Inuit suicide rates (age-standardized) by region and time period, 1989 to 2003
rates per 100,000 population
ASMR Lower CI Upper CI
Nunatsiavut (Lab) 1989-1993 44.8
1
16.9 72.6
1994-1998 87.5 41.7 133.4
1999-2003 147.7
1
89.4 206.0
Nunavik (Que) 1989-1993 79.0
3
52.2 105.7
1994-1998 76.0
2
50.8 101.2
1999-2003 159.8
2,3
125.0 194.6
Nunavut 1989-1993 64.2
4
49.3 79.1
1994-1998 80.7 64.9 96.5
1999-2003 95.6
4
78.9 112.3
Inuvialuit (NWT) 1989-1993 21.7
6
5.4 38.0
1994-1998 26.8
5
8.1 45.5
1999-2003 69.9
5,6
38.5 101.2
All regions 1989-1993 59.6
8
49.0 70.1
1994-1998 73.2
7
61.7 84.6
1999-2003 112.3
7,8
98.4 126.1
Superscripts indicate that a number is significantly different from the second figure with the same
superscript.
Consistent with past research, the area-based estimates show that young males make up
the majority of deaths by suicide in the Inuit-inhabited areas. Over the 15 years covered
in this study, over 80% of suicides were in males and almost two thirds (65%) involved
people under the age of 25.
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Figure 1
Suicides by sex and age group, Inuit-inhabited regions of Canada, 1989 to 2003
Males <25
5
1%
M
ales 25+
30%
Females <25
14%
Females 25+
5%
Factors related to suicide in Inuit-inhabited areas
As mentioned above, the second object of this study was to see whether groups of
communities classified by various community characteristics revealed variations in
suicide rates. The choice of variables was inspired by the literature, tempered by the
indicators available on the 2001 Aboriginal Peoples Survey and the 1996 Census. The
variables covered several different aspects of society and culture:
• Education and employment
• Tradition and culture
• Perceptions of community problems
• Social and civic activities
Education and employment
Education and employment are basic determinants of health status that are known to be
related to suicide in southern Canada. Education was measured by looking at the
proportion of a community’s youth aged 15-24 that was still attending school (as of the
1996 Census). The reasoning was not only that school attendance could reflect the hope
of obtaining a job in future, but also that schools provide social networks and gives youth
something to focus on. Communities where over 50% of youth were still in school (that
is, the top quartile) were classed as “high” on school attendance, while the remaining
communities were classified as “low”. Employment was measured in two ways: by
looking at the community’s employment-to-population ratio (in 1996), and also by a
subjective measure—the proportion of residents who declared themselves “satisfied”
with job opportunities in the community (in the 2001 Aboriginal Peoples Survey).
Both youth school attendance and the community’s employment levels were quite
strongly related to suicide rates. However, residents’ perceptions of the job opportunities
in the community showed no relation to suicide rates.
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Table 4 Suicide rates by school attendance and employment variables
Confidence interval
Community characteristic
Rate per
100,000 pop.
Lower
bound
Upper
bound
Statistically
significant?
Youth school
attendance
High 50.9 38.4 63.3 Yes
Low 92.8 84.2 101.3
Employment-to-
population ratio
High 52.1 43.7 60.5 Yes
Low 86.8 78.0 95.7
Satisfaction with
job opportunities
High 69.8 57.7 81.8 No
Low 70.1 63.1 77.2
Tradition and culture
Given the amount of attention that the relationship between acculturative stress and
suicide has received, it is obviously important to include measures of the degree to which
a community has retained links to its traditional culture and way of life. We looked at
four measures. The first looks at retention of Aboriginal language, namely the proportion
of a community’s population that speaks an Inuit language at home. The other three
indicators focus on the extent of participation in traditional land-based activities. They
are, respectively, how many people in the community spent a month or more on the land
in the previous year; what proportion of households contain one or more “harvesters”;
and what proportion of households derive more than half of their meat/fish from
harvesting. Note that the last measure does not necessarily mean that someone in the
household hunts or fishes, since people might have received or bought country food from
others in the community, but it is an indicator of the availability of country food in that
community.
The results are somewhat surprising. On the one hand, retention of Aboriginal language
and the presence of harvesters are strongly associated with suicide rates – but not
necessarily in the way that would be predicted by acculturation theories, since rates are
actually higher in the communities where large proportions of people still harvest and
speak an Inuit language. On the other hand, suicide rates do seem to be lower in the
communities where substantial proportions of residents spend extended periods of time
on the land. The proportion of household meat derived from the land seemed to bear no
relationship to suicide rates.
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Table 5 Suicide rates by indicators of tradition
Confidence interval
Community characteristic
Rate per
100,000 pop.
Lower
bound
Upper
bound
Statistically
significant?
% who speak Ab’l
language at home
High 95.8 84.2 107.4 Yes
Low 49.0 42.9 55.0
% hhlds that contain
a harvester
High 99.6 85.3 113.8 Yes
Low 55.4 49.4 61.4
% residents who
spent a month on the
land
High 62.2 42.8 81.6 Yes
Low 87.3 79.0 95.6
% hhlds that obtain
half their meat from
land
High 68.3 58.9 77.8 No
Low 64.6 57.5 71.7
Community functioning and participation
In light of the research by Chandler and Lalonde and others, it seems reasonable to
investigate whether measures of community functioning affect the suicide risk of
residents. Neither the Aboriginal Peoples Survey nor the Census include indicators
similar to those used by Chandler and Lalonde [1998], but there are a number of useful
indicators available, which fall into two groups: the first is composed of responses to a
multi-part opinion question “Do you think that …is a problem in this community?” In
this way, respondents indicated whether they believed suicide, alcohol abuse, drug abuse,
sexual abuse, family violence, and unemployment were issues in their community. The
second group of indicators focuses more on community ties and activities. It includes the
proportion of residents who say they have strong ties with other family members living in
the community, the proportion who volunteered in the past year for a community
organization or event and the proportion who are satisfied with the recreational facilities
in the community. It also includes one indicator that could be expected to have a major
impact on the quality of life in the community, namely the proportion of residents who
frequently engage in “binge” drinking
4
.
Perceived problems in the community
Understandably, communities with high suicide rates also have high proportions of
people who indicate that suicide is a problem in their community. Suicide rates are also
higher in the communities where large majorities of people agree that unemployment is
an issue. The remaining results are surprising: for many indicators that are generally
linked with suicide, the association is either non-significant, or in the opposite direction
to what one would expect. Thus, there is no significant relationship between suicide rates
and perceptions of either drug abuse or sexual abuse, although other research has shown
4
Statistics Canada [2003] defines “binge” drinking as having five or more drinks on one occasion, and
“frequent” binge drinking as doing this once a month or more.
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that both of these factors are closely related to suicide risk. As for alcohol abuse and
family violence, suicide rates are actually higher in the communities where people are
least concerned about these issues. One possible explanation is that people’s perceptions
of community problems are not particularly accurate. An alternative explanation is that
suicide risk is highest in communities where people are either unaware of the problems or
not prepared to admit them—although both of these explanations beg the question of why
the relationship is simply not statistically significant for some of the variables, rather than
showing a significant difference in an unexpected way. Additionally, the question on the
perceptions of suicide is the most strongly correlated of all community characteristics,
making it clear that respondents had no difficulties in accurately reporting it.
Table 6 Suicide rates by perceptions of problems in the community
Confidence interval
Community characteristic
Rate per
100,000 pop.
Lower
bound
Upper
bound
Statistically
significant?
% who think
alcohol abuse is a
problem
High 55.3 48.6 61.9 Yes
Low 81.5 71.4 91.6
% who think drug
abuse is a
problem
High 57.6 50.0 65.2 No
Low 65.4 57.9 72.8
% who think
sexual abuse is a
problem
High 61.1 53.3 68.9 No
Low 70.5 62.2 78.8
%
unemployment
a problem
High 81.8 72.7 90.8 Yes
Low 51.7 44.6 58.9
% who think
family violence a
problem
High 56.5 49.0 64.0 Yes
Low 74.8 66.2 83.4
% who think
suicide is a
problem
High 120.7 105.4 136.0 Yes
Low 48.0 42.4 53.6
Social and civic activities in the community
Are suicide rates related to other measures of community functioning – such as
recreational facilities, the proportion of binge drinkers, levels of volunteerism, or strength
of family networks? Our results suggest that some of them are associated with suicide
rates. Rates are slightly lower in the communities where residents are most satisfied with
recreational facilities, but — surprisingly — there is no statistically significant
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relationship between the proportion of frequent binge drinkers in a community and
suicide risk.
The relationship with the proportion of residents who volunteer for community events is
not statistically significant, but it is possible that the measure of volunteerism used in the
Aboriginal Peoples Survey applies poorly to Inuit communities. Ellis suggests that
standard measures of volunteer work fail to capture all the time that Inuit give to their
extended families and to other people in their household [quoted in Henderson 2003: 21].
The suggestion that community involvement takes place largely through the extended
family is consistent with the fact that this study—like much of the previous research—
suggests that suicide risk is strongly associated with whether residents have close ties to
other family members living in the community. In fact, of all the variables examined in
this study, family ties seem to be the most strongly predictive of suicide rates, as
measured by the size of the difference between the “high” and “low” communities, other
than a perceived problem with suicide in the community.
Table 7 Suicide rates by indicators of social life in the community
Confidence interval
Community characteristic
Rate per
100,000 pop.
Lower
bound
Upper
bound
Statistically
significant?
% with strong ties
to other family
High 32.0 24.7 39.3 Yes
Low 80.3 72.9 87.8
% who volunteer
High 52.6 34.4 70.9 No
Low 71.6 65.2 78.0
% satisfied with
recreation opps.
High 56.6 46.1 67.2 Yes
Low 69.5 62.8 76.3
% of residents who
binge frequently
High 75.0 62.4 87.6 No
Low 68.6 61.4 75.8
Discussion
This study has demonstrated that it is possible to extract suicide data for communities
with substantial Inuit populations based on a geographic methodology. The rates
calculated from these data may be considered conservative because of the number of non-
Inuit included in the numbers. Nonetheless, we can see suicide rates many times that of
the general Canadian population, rates which have increased dramatically over the 15
year period of study.
As demonstrated in the present study, one of the advantages of extracting data by this
method is the potential to link to other data sources, thus opening up many possibilities
for analysis. We have taken advantage of the common geographic approach to group
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communities according to variables on the Census and the Aboriginal Peoples Survey,
and to compare the suicide rates by different groupings of communities.
The results of this study indicate that some of the relationships between suicide risk and
explanatory variables are more complex than they appear. The findings for the tradition
and culture variables suggest a different picture than some of the one-directional theories
about the impact of acculturation might predict. A few indicators of traditionalism, such
as time spent on the land, appear to be associated with lower suicide rates; yet others that
might be expected to lower suicide risk—such as speaking an Aboriginal language in the
home and the presence of a harvester in the home—are actually associated with higher
suicide rates. These findings argue for a more nuanced view of acculturation, as reflected
in recent theories that postulate that suicide is linked to cultural transition rather than to
acculturation per se.
What of other indicators of community wellbeing? The results here were mixed, and it is
particularly surprising that the measure of binge drinking did not seem to be associated
with higher suicide rates. Admittedly, the questions on drinking tend to have low
response rates, and may also suffer from a social desirability bias. A number of the
questions on perceived social problems in the community gave counterintuitive results,
suggesting that more work must be done evaluating “perception” questions in terms of
what exactly they measure. However, the results do suggest that social ties and belonging
are clearly tied to lower suicide rates, and should be measured in future studies.
Interestingly, school attendance of youth turned out to be one of the variables most
strongly related to lower suicide rates. Given that the majority of Inuit suicides involve
youth, perhaps future studies should focus on indicators that relate to youth.
For instance, sample size permitting, it would be interesting to look at suicide in relation
to youth employment rates, youth recreation, and so forth.
Clearly, many of the variables used in this study are inter-related. For instance,
employment, community size, language, and a community’s ethnic composition are all
likely to be linked. Further, some of these factors—particularly language—are likely to
vary systematically between the four Inuit regions.
Conclusion
This study has demonstrated that, in the absence of a Canada-wide Inuit identifier on vital
statistics or data linkage program, it is still possible to obtain meaningful mortality data
on suicide in Inuit communities. This first attempt has established suicide rates for four
Inuit-inhabited regions of Canada, and also helped to identify a number of community
factors related to suicide which are worth further investigation.
This socio-cultural analysis has identifies several indicators that appear to be associated
with variations in suicide rates. What are some of the practical implications of the
results? It would be unwise to base any firm conclusions on such preliminary findings,
yet the data do suggest some avenues for exploration. For instance, the association
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between school attendance and lower suicide rates is an interesting one, and raises the
possibility that interventions to improve school retention might have spin-off benefits
beyond their obvious effects on education. The findings with respect to tradition are also
interesting, in that they raise some questions about the widespread view that greater
retention of traditional ways in a community is always associated with lower suicide risk.
Various initiatives in recent years have sought to raise self-esteem by restoring pride in
heritage—e.g., by encouraging contact between elders and youth, reintroducing
traditional language in schools, or promoting traditional drumming and dancing—and
there is no doubt that this has been helpful to many people. If, however, the impact of
acculturation has more to do with coping with transition, as suggested by recent research,
then perhaps emphasis should not be placed solely on restoring traditional practices, but
on helping youth find ways to integrate traditional values and practices into their current
lifestyles. Finally, the results with respect to family ties reaffirm past findings that the
maintenance and strengthening of social networks is of vital importance in preventing
suicides.
All of the results have to be interpreted with caution; these suicide rates must be
considered conservative in comparison to the suicide rate of the Inuit population. An
analysis restricted to data for Inuit alone might give somewhat different results, but this is
not feasible with the geography-based method. Based on the results of this initial
exploration, these studies should focus on indicators of social networks, employment,
schooling, and tradition. They must also take a closer look at the role of such indicators
the retention of traditional language and way of life, which do not appear to be
automatically associated with lower suicide rates in a community.
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References
Advisory Group on Suicide Prevention (2003). Acting on What We Know: Preventing
Youth Suicide in First Nations. Health Canada.
Bobet, Ellen (2004). Suicide statistics for Inuit regions, 1999-2003. Unpublished
document.
Boothryoyd, L., Kirmayer, L., Spreng S., Malus, M., Hodgins, S. (2001). “Completed
suicides among the Inuit of northern Quebec, 1982-1996: a case-control study.”
Canadian Medical Association Journal 165(6): 749-755.
Chandler, M. and Lalonde, C. (1998). “Cultural continuity as a hedge against suicide in
Canada’s First Nations.” Transcultural Psychiatry 35: 191-219.
Chandler, M. and Proulx, T. (2006). “Changing selves in changing worlds: youth suicide
on the fault-lines of colliding cultures.” Archives of Suicide Research 10: 125-40.
Henderson, A. (2003). Report of the workshop on best practices in suicide prevention and
the evaluation of suicide prevention programs in the Arctic. Prepared by Ailsa Henderson
for the Government of Nunavut, April 2003.
Hicks, J. (2005). Statistics on deaths by suicide in Nunavut (and other Inuit regions in
Canada) 1975 to 2004. Powerpoint presentation prepared October 2005.
Hicks, J. (2006). The social determinants of elevated rates of suicide by Inuit youth.
Presentation to the Public Policy Forum: Economic Transformation North of 60°.
December 13, 2006.
Hicks, J. (2007a). Statistics on deaths by suicide in Nunavut (and other Inuit regions)
1975 to 2006. Powerpoint presentation, January 2006.
Hicks, J. (2007b). “The social determinants of elevated rates of suicide among Inuit
youth.” Indigenous Affairs vol 4: 30-37.
Hunter, E. and Milroy, H. (2006). “Aboriginal and Torres Strait Islander suicide in
context.” Archives of suicide research 10: 141–157.
Kirmayer, L. J., Brass, G. and Tait, C. L. (2000). “The mental health of Aboriginal
peoples: transformations of identity and community.” Canadian Journal of Psychiatry
September 2000, 45: 607-616.
Royal Commission on Aboriginal Peoples (1995). Choosing life: a special report on
suicide among Aboriginal people. Ottawa: The Commission. Cat no Z1-1991/1-41-4E.
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Statistics Canada (2003). Aboriginal Peoples Survey 2001: Concepts and Methods Guide.
Catalogue 89-591-XIE. Ottawa: Ministry of Industry. Available at www.statcan.ca/egi-
bin/downpub/freepub.cgi.
Wilkins, R., Uppal, S., Finès, P., Senécal, S., Guimond, E. and Dion, R. (2007).
“Mortality surveillance for the Inuit-inhabited areas of Canada.” Presented at the
Symposium on First Nations, Inuit and Métis Health Data, Ottawa, March 27-28, 2007.
Wilkins, R., Uppal, S., Finès, P., Senécal, S., Guimond, E. and Dion, R. (2008). “Life
expectancy in the Inuit-inhabited areas of Canada, 1989 to 2003.” Health Reports 19(1),
catalogue no. 82-003-X : 1-13.
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Appendix 1: Definitions and cut points for the explanatory variables
As a general rule, comparisons were made between communities that fell into the top
quartile (or close to it, if cutting at the quartile would meant allocating communities with
the same value into different groups) vs all the remaining ones.
Census variables (1996)
Employment-to-population ratio (popn. age
15-64)
Top quartile of communities: ratio of 65
and over.
School attendance of youth age 15-24 Top quartile: 51% and over.
APS variables (2001)
Land – Spent one month or more on land in
past year
Cut at top quartile: any value > 10%.
Range is 1-28%.
Binge drinking. Frequent bingers defined
as those who had five or more drinks at a
sitting once a week or more often. Note
that proportion of binge drinkers was
calculated based on the total population of
the community, not just the drinkers.
Cut at top quartile, 13% or more frequent
bingers.
Range is 1-71%.
Volunteer—residents who volunteered in
the past year for either (a) a community
organization or (b) a community event.
Cut at top quartile, values 65%+
Range 32 to 85
Satisfied with recreation facilities in
community
Cut at top quartile, values 79%+
Range 7 to 100.
Family ties—residents who describe their
ties with other family members living in
the community as “strong” or “very
strong.”
Cut at top quartile, values 82%+
Range 38 to 100.
Aboriginal language in the home.
If cut at first quartile, that would be 95%
and over. Too high: cut instead at 85%,
which includes 26 of the 51 CDs that show
values for this variable. Proportions based
on total pop’n of community.
Cut at 85%.
Range is 2-100%.
Feel suicide is a problem in the community Cut at top quartile, 85%
Range 3 to 98
Feel unemployment is a problem in
community
Top quartile would be 94%. Using 90%
instead gives 25 communities above the
Cut at 90%
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cutpoint
Feel family violence is a problem in the
community
Cut at top quartile, 74%
Feel sex abuse is a problem in the
community
Cut at top quartile, 70%
Feel drug abuse is a problem in the
community
Cut at top quartile, 85%+
Feel alcohol is a problem in the community Cut at top quartile, 88%
Persons satisfied with job opportunities in
the community
Cut at top quartile, 55%
Households that contain at least one
harvester (someone who hunts, fishes, or
gathers wild berries or shellfish).*
Cut at median 85%
Households that derive more than half their
meat from harvesting.*
Cut at median 36%
*Not enough households in group if cut at the quartile.
