The association between suicide attempts and ethnic identity and discrimination among Indigenous Sami adolescents in Arctic Norway

ABSTRACT

For young Indigenous people, suicide is among the leading causes of death. High rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed about the suicidal process, as suicide attempts predict later death by suicide. This study aimed to look for associations between suicide attempts and ethnic identity factors and culturally specific factors in Sami adolescents, including possible gender-specific patterns of predictors. In the total group of 442 Sami (15–16-year-olds) in The Norwegian Arctic Adolescent Health Study (NAAHS), multivariable logistic regression analyses showed associations between suicide attempts and the female gender, living in a stepparent family, and a weak family economy. Sami females who reported weak identity exploration had eight times higher odds of reporting suicide attempts. Sami males who had experienced discrimination or showed a strong identity commitment had between six- and eight-times higher odds of reporting suicide attempts. Sami females were less affected by experiencing ethnic discrimination compared to males, as Sami females were more sensitive to family patterns. Public health programmes and prevention strategies targeting adolescent suicidal behaviour should consider gender differences in the association between ethnic identity, cultural and socio-demographic factors, and suicide attempts.

Studies of Indigenous adolescent populations often show higher rates of suicide attempts and suicide completion compared to the general population [1–5]. Completed suicide is one of the leading causes of death for young Indigenous people [6,7], with great variations in rates across Indigenous communities [5,8,9].

Previous suicide attempt(s) is the strongest psychosocial predictor of completed suicide among adolescents [10]. Studies have revealed several correlates associated with suicidal behaviour among Indigenous adolescents, including mental health disorders, stressful life events, and substance abuse [7,11,12]. Additional factors are a lack of community support, disadvantaged socioeconomic status, racism, and cultural disagreements with parents [13]. Trying to explain suicidal behaviour in Indigenous people, Silviken, Haldorsen, and Kvernmo [14] hold the importance of cultural factors such as undermining traditional cultural structures and acculturation as consequences of colonisation and modernisation.

The Indigenous Sami adolescents

As members of an Indigenous minority, Sami adolescents have to face being part of at least two worlds and cultures, the dominant one and their own Sami [15]. Sami youngsters today manage their lives as members of a modern and globalised world. As young members of the Indigenous population of Norway and Scandinavia, they are also part of a harsh history of loss and trauma experienced by generations [15].

Since the 1950s, the educational level of Sami has increased considerably, fostering generations of Sami resisting assimilation and claiming Indigenous rights. In the past few decades, a strong cultural revitalisation increased awareness of Sami traditions as a valued part of Norwegian society Sami nation-building and fostered pride among Sami. In 1989, the Sami people in Norway formed their Sami parliament, an assembly of Sami representatives that promotes Sami interests [16]. Despite this development, many Sami people still experience discrimination, particularly those with a strong Sami affiliation [17].

Among Sami adolescents, one-third learn their Sami language at home, either as monolingual speakers or as bilinguals. Adolescents growing up in the Sami core area are more exposed to the Sami language being spoken at home, as 75% learned Sami at home [15]. Despite somewhat higher rates of suicide attempts in Sami female adolescents compared to the majority peers in The North Norwegian Youth Study [15], the disparities in mental health indicators between Sami and non-Sami adolescents, are small [18,19], and the suicide rates among Sami can be considered moderate compared to other Indigenous groups [14].

Ethnic context

According to Kvernmo [15], certain areas have experienced tremendously high rates of suicide, as for other Indigenous groups, particularly among young males, while different areas have no higher risk. In certain regions, such as the Sami core area, the suicide rate has been high. Although a previous study found that the suicide rates in the general Sami population are slightly higher than in the majority population, there was no significant difference in the prevalence of suicide attempts between Sami adolescents (10,5%) and their non-Sami peers (9,2%) [20].

Previous research showed that cultural activities protected Sami males, while Sami language competence protected Sami females against internalising and externalising symptoms [21,22].

Ethnic identity and enculturation actors

Several studies of immigrant adolescents, but also Native American adolescents, have shown that not only a strong ethnic identity but also a strong identification with the mainstream society act as protective factors for mental health, behavioural problems, and substance abuse [23,24], Jean S [25,26]. Despite the ongoing revitalisation among Sami, developing a secure ethnic identity can be challenging for many Sami adolescents [27]. The impact of ethnic identity and cultural encounters on emotional health has been only sparsely investigated in Sami adolescents, however we know from previous research that Sami adolescents, with a strong ethnic identity showed more behavioural problems but less substance abuse [28,29]. Research shows that Sami adults with a strong sense of Sami identity have remarkable resilience despite considerable exposure to discrimination, and both personal strength and family factors are involved [30].

Ethnic discrimination

The link between ethnic discrimination and negative mental health outcomes is well established [31]. Analysis from SAMINOR, a population-based study in Norway, indicates that experienced ethnic discrimination combined with lower socioeconomic status contributed to inequalities in self-reported health among Sami and non-Sami adults [32]. Their findings showed that 40% of the men and one-third of the women in their study had experienced ethnic discrimination often or sometimes [32]. Among participants in SAMINOR2 with a strong Sami affiliation, nearly 51% reported having been discriminated against, versus 14% of the non-Sami reporting such experiences [17]. Research shows that there is also a relationship between ethnic discrimination and less use of health care services [33].

Self-reported experiences of racial or ethnic discrimination are closely associated with negative mental health and health-related behaviours [34], and a significant association between ethnic discrimination and suicidality has been found even when considering environmental adversities [35]. Several authors stress the need for studies involving child and adolescent health and discrimination and racism and for revealing the complex role that these experiences play as determinants of suicide attempts and general population health [34–36].

Aims of the present study

This study of Sami adolescents aims to increase understanding of suicide attempts in Arctic Indigenous adolescents of Scandinavia. Although data were collected almost two decades ago, the study included many participants, providing a unique opportunity to investigate associations of suicidal behaviour in Sami adolescents.

First, we aimed to look for associations with suicide attempts by examining the impact of socio-demographic (gender, family situation, and family economy), cultural (ethnic context, language, and discrimination), and ethnic identity factors (self-determined ethnicity, exploration, and commitment) on suicide attempts.

Secondly, we aimed to explore gender-specific patterns of associations.

Materials and method

Design and sample

Cross-sectional data from a school-based study: “‘The Norwegian Arctic Adolescent Health Study’” (NAAHS) was used. The NAAHS was a study on health and living conditions among all 10th graders in the three northernmost counties of Norway. The NAAHS was conducted in 2003–2005 among 4,880 students. In total, all 15–16-year-olds (10th graders) were invited, and 83% participated. All junior high schools (292), except for one, agreed to participate. The number of Sami students varied from school to school, with the highest percentage in the schools in the Sami-dominated areas of Finnmark. Approximately 10% of the total sample were Sami (n = 442), which is an equivalent proportion found in the general population in North Norway.

Instruments

The questionnaires included suicidal behaviours, health factors, education, leisure activities, and relational factors.

Outcome variable

Suicide attempt(s)

Suicide attempts were based on the question: Have you ever tried to take your own life? With the options Yes (1) or No (0).

Ethnicity – inclusion criteria

Objective ethnic affiliation was classified as Sami if one parent’s ethnicity was reported as Sami or if at least one of the grandparents’ or parents’ languages was reported as Sami [37]. The questions had the following options: Norwegian, Sami, Kven, Finnish, and Other. Multiple answers were allowed. Respondents were categorised as Sami if they answered Sami on one of them. Subjective Sami ethnic affiliation was based on the 4-point scale question I regard myself as Norwegian/Sami/Kven/Finnish/Other with the option Fully or Nearly fully agree on the Sami option or a report of Sami to the question My ethnicity is? Multiple answers were allowed. The participants who regarded themselves as Sami without reporting Sami objective ethnic affiliation (n = 89), those with only objective ethnic affiliation (n = 121), and those with both subjective and objective Sami ethnicity (n = 232) were included in this study as Sami.

Explanatory variables

Gender

Gender was measured based on self-report: Male (0) or Female (1).

Family situation

The family situation was based on the question Who do you live with? with the options Both parents, Only mother, Only father, Parent and Stepparent, Fosterparents and Other. Two categories were made: Stepparent family (1) vs. Not Stepparent family (remaining options = 0).

Family economy

Participants were asked how they perceived the financial situation in their family compared to other people in Norway. Reply options were Bad, Mediocre, Good, and Very good. Two categories were made: Weak (Bad = 1) vs. Strong (mediocre, good, and very good = 0).

Ethnic context

The ethnic context was based on the location of the school. Options were Sami-dominated areas (areas where Sami people make up the majority), Mixed Norwegian and Sami areas, or Norwegian-dominated areas. Categories were Sami majority (0) vs. Mixed or Norwegian-dominated (1).

Sami language competence

Participants were considered to have Sami language competence if they reported Sami on either What language did you learn at home or What is your primary language in school? Options were Norwegian, Sami, Kven/Finnish, and Another language.

No Sami language competence (1) vs. Sami language competence (0).

Ethnic discrimination

Based on questions, I have been teased and insulted because of my cultural background, and/or I have been threatened or attacked because of my cultural background. Options were totally agree, partly agree, partly disagree, and totally disagree. Categories were made as No (totally disagree to both questions = 0) vs. Yes (remaining options = 1).

Self-determined ethnicity

Self-determined ethnicity was based on the questions: I) I consider myself: with options Norwegian, Sami, Kven, Finnish, Other, with the options totally agree, partly agree, partly disagree, totally disagree on each of the options. Categories were made as Sami (0), Both Sami and Norwegian (1), Norwegian only, Other/I do not know (2)

The multigroup ethnic identity measure (MEIM)

MEIM assesses the exploration of and commitment to ethnic identity that is common to all ethnic groups. The original version has undergone some revisions [38,39]. The total scale with12 items was used.

The exploration variable include the following items: (1) “I have spent time trying to find out more about my own ethnic group such as history, traditions and customs”; (2) “I am active in organizations or social groups that mostly include members of my own ethnic group”; (4) “I think a lot about how my life will be affected by my ethnic group membership”; (8) “In order to learn more about my ethnic background, I have often talked to other people about my ethnic group”; (10) “I participate in cultural practices of my own group such as special food, music or customs”;

The commitment variable include the following items: (3) “I have a clear sense of my ethnic background and what it means for me”; (5) “I am happy that I am a member of the group I belong to”; (6) “I have a strong sense of belonging to my own ethnic group”; (7) “I am very clear about the role of ethnicity in my life”; (9) “I have a lot of pride in my ethnic group and its accomplishments”; (11) “I feel a strong attachment to my own ethnic group”; and (12) “I feel good about my cultural or ethnic background”.

Items are rated on a four-point scale from strongly disagree (1) to strongly agree (4). Scores are derived by adding the items and obtaining the mean; scores range from four (indicating strong ethnic identity and positive attitudes to one’s group) to one (weak ethnic identity and negative attitudes). The internal consistency for the 12-item MEIM scale was α = 0.89. MEIM has been used in various cultural settings [40–43] and also in Indigenous and Sami adolescent populations [21,28,44,45].

As values were between zero and four with one decimal, they were rounded up or down to the nearest whole number between one and four. Identity scores between one and three were categorised as weak (1), and scores equal to four were categorised as strong (0).

Statistical analysis

Data analyses were performed with the current version of SPSS, and the significance level was set to 5% in all statistical tests. Descriptive statistics were used to present the distribution of ethnic identity, cultural, and socio-demographic factors by gender (Table 1). Chi-square tests were used for bivariate analyses of outcome and explanatory variables stratified by gender (Table 1). Univariate logistic regression was carried out for suicide attempts separately for males and females. Interactions between gender and each of the associated variables were investigated (Table 1).

Table 1.

Distribution of outcome and associated factors.

Variable	Sami (NAAHS)							Univariate logistic regression association w/suicide attempt		Interaction with gender
	Female		Male		Total		Effect of gender	Female	Male
	N	(%)	N	(%)	N	(%)	X2/p
Outcome variable
Suicide attempts	35	(16.4)	16	(7.4)	51	(11.9)	8.34004
No suicide attempts	178	(83.6)	200	(92.6)	378	(88.1)
Associated variables Socio-demographics
Gender
Male					226	(51.1)
Female					216	(48.9)
Living situation							.16.690			4.03 (1.44–11.27)008
Living with both parents, single parent or outside home	198	(91.7)	202	(90.6)	400	(91.1)
Living in a stepparent family	18	(8.3)	21	(9.4)	39	(8.9)		2.86 (1.00–8.23).051	4.04 (1.16–14.09)028
Family economy							2.18.140			6.56 (1.70–25.32)006
Strong family economy	205	(95.8)	218	(98.2)	423	(97.0)
Weak family economy	9	(4.2)	4	1.8	13	(3.0)		4.77 (1.21–18.83)026	4.30 (.42–43.79).219
Cultural variables
Etrhnic ontext							.08.774			2.6 (1.43–4.70)002
Majority Sami area	36	(16.7)	40	(17.7)	76	(17.2)
Minority Sami area or mixed	180	(83.3)	186	(82.3)	366	(82.8)		2.16 (.62–7.52).225	.45 (.15–1.38).163
Language							1.05.307			2.48 (1.37–4.48)003
Sami language competence	56	(25.9)	49	(21.8)	105	(23.8)
No Sami language competence	160	(74.1)	176	(78.2)	336	(76.2)		1.73 (.68–4.44).251	.80 (.25–2.62).715
Ethnic discrimination							4.74029			1.59 (.74–3.40).232
Experienced ethnic discrimination	61	(31.8)	88	(42.3)	149	(37.3)		.98 (.43–2.23).965	4.35 (1.34–14.20)015
Not experienced ethnic discrimination	131	(68.2)	120	(57.7)	251	(62.7)
Ethnic identity factors
Self-determined ethnicity							5.30.071
Sami only	15	(7.0)	24	(10.6)	39	(8.8)
Sami and Norwegian	124	(57.7)	143	(63.3)	267	(60.5)		.76 (.20–2.97).696	.97 (.20–4.65).967	2.31 (1.19–4.49)014
Norwegian only or other	76	(35.3)	59	(26.1)	135	(30.6)		.62 (.15–2.59).512	.36 (.05–2.71).319	1.88 (.85–4.15).119
Ethnic identity exploration							1.55.214			5.74 (1.25–26.46)025
Strong	195	(96.5)	201	(93.9)	396	(95.2)
Weak	7	(3.5)	13	(6.1)	20	(4.8)		4.08 (.87–19.14).075	.98 (.12–8.09).988
Ethnic identity commitment							2.13.145			1.64 (.34–7.83).534
Strong	11	(5.5)	20	(9.3)	31	(7.5)		1.12 (.23–5.43).890	4.21 (1.20–14.79)025
Weak	189	(94.5)	196	(90.7)	385	(92.5)

Multiple logistic regression was carried out in the total sample for suicide attempts (Table 2). All blocks and steps are presented in the final block-wise multiple logistic regression analyses. Finally, separate gender-stratified multiple regression analyses were carried out using the same block-wise model for Sami females (Table 3) and males (Table 4). Both in the total sample of Sami adolescents and the gender-stratified models, the adjusted OR, adjusted for all variables included in each block, is presented for every step. Even though not all variables were significantly associated with suicide attempts in the univariable analysis, all variables were included in the multivariable analysis and presented in the tables.

Table 2.

Multiple regression analysis predicting suicide attempts in the total sample of Sami adolescents.

Variables	Block 1: Socio-demographics			Block 2: Cultural factors			Block 3: Identity factors
	OR	CI (95%)	p	OR	CI (95%)	p	OR	CI (95%)	p
Step 1
Female gender (ref = boy)	2.20	(1.16–4.20)	.016	2.36	(1.19–4.70)	.014	2.70	(1.32–5.53)	.007
Living in a stepparent family (ref = living with one/both parents)	3.11	(1.33–7.25)	.009	3.44	(1.42–8.3)	.006	3.21	(1.30–7.89)	.011
Weak family economy (ref = strong)	4.83	(1.46–16.02)	.010	8.06	(2.15–30.23)	.002	7.61	(2.00–29.10)	.003
Step 2
Mixed/Norwegian-dominated context (ref = Sami-dominated)				.85	(.26–2.74)	.781	.82	(.25–2.70)	.741
No Sami language competence (ref = Sami language competence)				1.83	(.62–5.8)	.270	2.40	(.77–7.48)	.132
Experienced ethnic discrimination (ref = not experienced ethnic discrimination)				1.89	(.94–3.82)	.076	1.84	(.89–3.82)	.100
Step 3
Self-determined ethnicity as both Sami and Norwegian (ref. = Sami only)							1.56	(.31–7.82)	.838
Self-determined ethnicity as Norwegian only (ref. = Sami only)							.68	(.15–3.19)	.629
Weak ethnic identity exploration (ref = strong)							2.91	(.83–10.23)	.097
Strong ethnic identity commitment (ref = weak)							2.12	(.68–6.60)	.196

This adjusted model shows adjusted OR with control for all independent variables included in each block.

Table 3.

Gender stratified multiple regression analysis predicting suicide attempts Sami female adolescents.

Variables	Block 1: Socio-demographics			Block 2: Cultural factors			Block 3: Identity factors
	OR	CI (95%)	p	OR	CI (95%)	p	OR	CI (95%)	p
Step 1
Living in a stepparent family (ref = living with one/both parents)	2.45	(.79–7.65)	.122	2.56	(.80–8.25)	.115	2.70	(.81–9.03)	.108
Weak family economy (ref = strong)	4.74	(1.19–18.96)	.028	6.84	(1.51–30.96)	.013	8.42	(1.70–41.59)	.009
Step 2 Mixed/Norwegian-dominated context (ref = Sami-dominated)				5.13	(.53–50.00)	.159	5.14	(.49–54.54)	.174
No Sami language competence (ref = Sami language competence)				1.20	(.31–4.71)	.792	1.69	(.38–7.50)	.490
Experienced ethnic discrimination (ref = not experienced discrimination)				1.10	(.42–2.92)	.843	.94	(.34.261)	.908
Step 3
Self-determined ethnicity as both Sami and Norwegian (ref = Sami only)							1.29	(.10–17.60)	.849
Self-determined ethnicity as Norwegian or other (ref = Sami only)							.92	(.06–13.13)	.949
Weak ethnic identity exploration (ref = strong)							7.78	(1.33–45.60)	.023
Strong ethnic identity commitment (ref = weak)							.44	(.05–4.23)	.479

This gender stratified model shows the adjusted OR controlled for all variables included in each block.

Table 4.

Gender stratified multiple regression analysis predicting suicide attempts among Sami male adolescents.

Variables	Block 1: Socio-demographics			Block 2: Cultural factors			Block 4: Identity factors
	OR	CI (95%)	p	OR	CI (95%)	p	OR	CI (95%)	p
Step 1
Living in a stepparent family (ref = living with one/both parents)	4.27	(1.21–15.04)	.024	6.79	(1.63–28.32)	.009	6.59	(1.47–29.46)	.014
Weak family economy (ref = strong)	5.33	(.51–55.57)	.162	23.50	(1.04–529.78)	.047	7.59	(.11–547.66)	.353
Step 2
Mixed/Norwegian-dominated context (ref = Sami-dominated)				.231	(.046–1.16)	.076	.35	(.06–1.92)	.224
No Sami language competence (ref = Sami language competence)				2.35	(.44–12.72)	.320	2.18	(.37–12.77)	.389
Experienced ethnic discrimination (ref = not experienced ethnic discrimination)				4.71	(1.29–17.19)	.019	5.75	(1.36–24.35)	.017
Step 3
Self-determined ethnicity as both Sami and Norwegian (ref = Sami only)							.82	(.12–5.59)	.841
Self-determined ethnicity as Norwegian only or other (ref = Sami only)							.19	(.01–2.98)	.236
Weak ethnic identity exploration (ref = strong)							.67	(.06–8.12)	.752
Strong ethnic identity commitment (ref = weak)							7.82	(1.31–46.86)	.024

This model shows adjusted OR with control for all independent variables included in each block.

Results

Distribution of cultural and socio-demographic variables and suicide attempts by gender

There was a significant gender difference in the prevalence of suicide attempts among Sami adolescents; 16% of females and 7% of males reported having ever attempted suicide. Among the associated variables, significant gender difference was observed only for experienced discrimination: 42% of Sami males versus 32% of Sami females reported to have experienced ethnic discrimination (Table SI).

Distribution of cultural and socio-demographic variables and suicide attempts in the total group of Sami adolescents

Nearly 9% of the Sami adolescents live together with a stepparent versus with both parents, single-parent household, or outside the family home. Only a few of the Sami males and females reported that their family economy was weaker compared to others, a total of three percent.

Most of the Sami adolescents live in areas where the Sami people are in minority or in areas of mixed Norwegian and Sami ethnic context. Around 17% of the Sami adolescents live in areas where the Sami people are in the majority position.

Nearly 24% report that they learned Sami at home and/or that Sami is their primary language in school.

In this sample of adolescents with Sami affiliation, nearly 9% consider themselves to have Sami ethnicity only, over 60% report both Sami and Norwegian, and 31% report Norwegian only or another ethnicity. Most of the Sami adolescents reported a strong ethnic identity exploration (around 95%) and a weak ethnic identity commitment (around 93%) (Table SI).

Multiple logistic regression analyses: socio-demographic correlates and cultural correlates associated with suicide attempts

The total group

In the total group of Sami adolescents, when adjusted for all variables included in the model, female gender and stepparent family were associated with three times higher odds. A weak family economy showed nearly eight times higher odds of reporting suicide attempts. None of the cultural or identity variables showed significant associations with suicide attempts in the total group (Table 2).

Gender stratified analyses

When stratifying by gender, there were no shared associations between Sami females and males when all variables were adjusted for each other (Tables 3 and 4).

Females

Females reporting a weak family economy or weak ethnic identity exploration had approximately eight times higher odds of reporting suicide attempts when adjusted for all variables included in the model (Table 3).

Males

Among Sami males, living in a stepparent family was associated with nearly seven times higher odds of suicide attempts (Table 4).

In a fully adjusted model, the association with experienced discrimination showed nearly six times higher odds for suicide attempts.

Finally, a strong ethnic identity commitment gave nearly eight times higher odds of suicide attempts (Table 4).

Discussion

Our main findings for the total group of Sami adolescents revealed that females, adolescents with a weak family economy, or adolescents living in a stepparent family were at risk for suicide attempts. Small sample sizes and large confidence intervals should be considered, especially for the gender-stratified analyses. No ethnocultural factors occurred significantly. Due to the gender differences found, stratified analyses were applied to assess for potential gender-specific predictor patterns.

The stratified analyses showed clearly important gender differences in predictors of suicide attempts. Young Sami females experiencing a weak family economy and weak ethnic identity exploration had eight times higher odds of attempting suicide compared to Sami females with a strong family economy and who were strongly explorative.

Sami males who were exposed to ethnic discrimination had six times higher odds of suicide attempts compared to Sami males who did not report discrimination. For Sami males, living in a stepparent family or having a strong ethnic identity commitment increased the risk of reporting suicide attempts seven and eight times, respectively.

During adolescence, factors such as sexual and physical abuse have been found to be strong predictors of attempted suicide [46]. Further, traditional risk factors for suicidal behaviour include suicidal behaviour among family members or peers, low income family, mental health disorders, substance disorders, cultural factors, and emotional abuse [47–51]. These factors apply to Sami adolescents as well [12,52–55], and, apart from cultural factors, have not been adjusted for in this study. These general determinants intersect with the cultural determinants of suicidal behaviour that Sami adolescents face; the challenges and the protective effects of their Sami affiliation.

The focus of this discussion will be gender-specific associations between suicide attempts and ethnic identity development and experienced ethnic discrimination.

Ethnic identity development and suicide attempts

Even though previous findings from The North Norwegian Youth Study showed somewhat higher rates of suicide attempts in Sami female adolescents compared to the majority peers [15], the disparities in mental health indicators between Sami and non-Sami adolescents, are small [18,19], and the suicide rates among Sami can be considered moderate compared to other Indigenous groups [14].

“The differences in how each set of Indigenous Peoples interacts with the imposition of their specific occupying nation warrant specific research on the issue of Indigenous identity in each country” [56].

Our gender-specific findings show that being less explorative of one’s ethnic identity was a risk factor for the Sami females, while being highly committed was associated with suicide attempts among Sami males. Research on gender differences in identity development shows that females are more often in a state of moratorium than males, while males are more likely to be foreclosed [57]. We found that more males report experiences of discrimination, which might make them committed to their Sami identity at a younger age, compared with females.

Our finding that Sami males with a strong ethnic identity are at higher risk for suicide attempts supports previous research on ethnic discrimination from other countries [35,58,59]. Sami adolescent males with a strong ethnic identity, living in multi-ethnic contexts, are previously found to have more internalising problems [28]. A strong ethnic identity is previously associated with speaking the Sami language, participating in cultural activities, wearing traditional Sami costumes, etc., and thereby being more “visible” as a Sami in public contexts. Sami males with a strong ethnic identity may, therefore, be more exposed to ethnic discrimination and more vulnerable to its negative effects [17,60].

Only 9% of the Sami males reported strong commitment, as the cut-off was set to 3,5, which is quite high. These 9%, therefore, represent a small group of males who are very culturally active, and perhaps more visible and exposed to discrimination and at risk of suicide attempts.

The Sami females who reported weak ethnic exploration might have less support from their community, ethnic group, or their family compared to those having more opportunities to explore their ethnic identity.

According to Erikson, identity formation takes place through a process of exploration and commitment that typically occurs during adolescence and that eventually leads to a commitment or decision in important identity domains [39]. Ethnic identity development is crucial to the psychological well-being of members of an ethnic group [61]. Also, among non-Indigenous young adults, a weak psychosocial identity was associated with more suicidal behaviour [62].

It is a paradox that a strong Sami identity has been linked to resilience towards discrimination, while it may also increase the likelihood of being targeted for discrimination [17,30]. Ethnic identity might mediate the relationship between discrimination and suicide attempts by increasing visibility, but also moderate the relationship by experiencing less harm from discrimination. This dual role could act as a confounder because the protective effects of ethnic identity might be offset by the risks associated with visibility [63].

Perhaps, the Sami females who spend more time finding out about their ethnic group are more “prepared” for potentially experiencing ethnic discrimination. The strongly explorative females might be more resourceful in general, or the exploration makes them more resilient to life stressors.

A previous study of ethnic identity in Sami adolescents showed stronger ethnic identity in Sami females than in their male counterparts [28]. One of the MEIM questions in our study concerned the exploration of the ethnic group’s history, traditions, and customs. Traditionally, Sami women have had a larger responsibility of passing forward traditional knowledge, culture, and values from one generation to the next [64]. Sami females might feel more pressure than non-Sami majority peers to explore their ethnic identity because they are part of an ethnic minority [39].

Roberts et al. [39] discuss whether a strong ethnic identity derives from close cultural ties within the group or from negative experiences, such as discrimination from other groups. Research shows that those who consider ethnicity important are more likely to have explored and committed to an ethnic identity [61]. Therefore, one should not assume that all areas of ethnic identity are of equal importance for all individuals. According to J. S. Phinney and Alipuria [61], belonging to an ethnic group is not necessarily associated with good or poor mental health, and it is influenced by the extent to which one has thought about and resolved issues regarding one’s ethnicity. Presumably, the process of the exploration is something that gives meaning to the adolescents’ existence and, therefore, protective against suicide attempts.

The effect of a strong ethnic identity may seem contradictory, as it can lead to both resilience and vulnerability to negative experiences such as ethnic discrimination. Researchers reviewing studies on Indigenous identity and well-being in the United States found that identity serves as both a protective factor for mental health and a source of challenges, particularly due to community struggles and discrimination faced by those who are culturally active [56].

Ethnic discrimination among Sami males

Our findings of a higher risk of suicide attempts in Sami males who had experienced ethnic discrimination support existing evidence of the negative health impacts of ethnic discrimination for Indigenous Sami in Norway also after adjusting for family economy, family situation, ethnic context, Sami language competence, self-determined ethnicity, identity exploration and identity commitment [65].

Turi et al. [33] found that Sami adolescents who had experienced ethnic discrimination were less likely to use school healthcare services. This might have serious consequences as Sami males may not seek help when struggling with suicidal thoughts.

Discrimination had no significant effect on suicide attempts among females. The gender differences in resilience to discrimination might be associated with different socialisations of girls and boys. Males not sharing their feelings about discrimination might be more vulnerable to suicide attempts [66]. Self-reliance norms have been associated with a greater risk of suicidal ideation among Australian male adolescents [67]. Especially among male reindeer herders, the suicide rates have been high [68–70] and linked to the difficulties of maintaining the traditional livelihood of reindeer herding [71]. Reindeer herders experience conflicts with authorities and local communities that are sometimes perceived as discrimination, including derogatory speech/actions [72].

Strengths and limitations

In a cross-sectional study, such as this one, we are not able to establish the temporal sequence needed to establish causality [63]. In other words, we do not know whether the suicide attempt occurred before or after experiences of discrimination, which might cause a temporal bias [63]. When interpreting the results, the relatively small number of Sami participants in each group (gender) or category (variables) must be considered The conducting of research on ethnic minorities is often faced with small numbers, which makes interpretation of the results in need of a careful approach. This fact can, however, not hinder further and needed research to be done. Our data are nearly two decades old and can, therefore, be considered as out of date for Sami adolescents of today. However, the study aimed to examine risk factors and concepts that are still reported as relevant for Sami adolescents, such as ethnic discrimination, ethnic identity development, language competence, etc. Also, the data offers a unique possibility to provide insight into specific determinants of suicidal behaviour among Sami adolescents, as ethnicity is not included in the Norwegian population register, and we therefore believe these data are valuable due to their unfilled research potential [73]. Our findings may, therefore, contribute to the knowledge gap that exists for Indigenous and Sami adolescents’ mental health.

We chose to measure the experience of ethnic discrimination based on the two questions: I have been teased and insulted because of my cultural background, and/or I have been threatened or attacked because of my cultural background. The validity of such measures has, however, been discussed by several researchers, as it is based on the participants’ self-evaluation of their own experiences. Further, the self-reporting of suicide attempts may lead to bias, as information obtained by questionnaires is affected by the characteristics of the individuals in question [63]. As a result, the external validity, or generalisability, is limited because of possibly lowered sensitivity and specificity [63]. Sensitivity, in this study, has to do with the probability of correctly identifying an individual who has attempted suicide, and specificity indicates the probability of correctly identifying those who have not attempted suicide, through the questionnaires administered [74].

Future research and clinical implications

Future research needs further focus on ethnic discrimination and the various ways it affects the health and lives of the people who experience it and can include experienced discrimination on social media. Gender roles should be further investigated, as we have seen that Sami males are more sensitive to experienced discrimination compared to female counterparts. The effect of colonisation and ethnic revitalisation on today’s generation of Indigenous adolescents is an area that needs more knowledge.

In future research, our results can be broadened by merging data with registry data on the use of mental health services, diagnosis, and death statistics. Due to a good response rate, our data is suitable for this purpose. Such follow-up studies can provide important knowledge on the impact of adolescent suicide behaviour on later mental health problems and suicides committed.

Research on suicidal behaviour in Indigenous people is increasing. Rather, few epidemiological studies have, however, studied the impact of both sociodemographic and ethnocultural predictors as done in this study. Barker, Goodman, and DeBeck [75] state that “while the majority of suicide interventions to date are under the purview of clinical-based health services, Indigenous suicide is the product of the cultural, community and historical oppression, and not an individual response to personal pathology”. Barker et al. [75] discuss the emerging evidence base for culture as treatment – “a novel approach to suicide that emphasizes the significance of interconnectedness in healing, alongside the revitalization of traditional values to reclaim community wellness”.

Suicide prevention and treatment should consider the importance and relevance of cultural and ethnic perspectives for Sami adolescents and possibly for other Indigenous adolescents as well. Culturally competent mental health services are needed to create a supportive environment for Sami adolescents and to address the complexity of ethnic identity development. Also, Sami adolescents should have easy access to such services. Schools provide a unique platform to educate students about discrimination, promote language preservation, and support cultural revitalisation through traditional Sami activities.

Conclusion

Our findings indicate that ethnic discrimination, ethnic identity, and family economy are strongly associated with suicide attempts among Sami adolescents. Our findings highlight the need for culturally informed preventive programmes with a focus on identity and experienced discrimination against Sami Indigenous adolescents.

Funding Statement

This work was supported by the The Research Council of Norway.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/22423982.2025.2561279