TABLE 2. Circumstances preceding suicide of American Indian or Alaska Native persons compared with non–American Indian or Alaska Native persons — National Violent Death Reporting System, United States, 2015–2020.
| Circumstance | No. (%)* |
Chi-square p-value† | aOR (95% CI)§ | |
|---|---|---|---|---|
| AI/AN (n = 3,397) | Non-AI/AN (n = 179,850) | |||
|
Decedents with known circumstance
¶
|
2,926 (86.1) |
160,165 (89.1) |
<0.001 |
0.8 (0.7–0.9)** |
|
Suicide event or history
| ||||
| Left a note |
737 (25.2) |
52,401 (32.7) |
<0.001 |
0.7 (0.6–0.8)** |
| Disclosed suicidal intent |
825 (28.2) |
37,837 (23.6) |
<0.001 |
1.2 (1.1–1.3)** |
| History of suicidal thoughts or plan |
1,122 (38.3) |
54,972 (34.3) |
<0.001 |
1.1 (1.0–1.2)** |
| History of suicide attempts |
634 (21.7) |
31,608 (19.7) |
0.009 |
1.0 (0.9–1.1) |
|
Relationship problem or loss
| ||||
| Any relationship problem or loss |
1,607 (54.9) |
67,542 (42.2) |
<0.001 |
1.4 (1.3–1.6)** |
| Intimate partner problem |
1,062 (36.3) |
42,912 (26.8) |
<0.001 |
1.4 (1.3–1.5)** |
| Family relationship problem |
377 (12.9) |
13,993 (8.7) |
<0.001 |
1.2 (1.1–1.3)** |
| Other relationship problem (nonintimate) |
121 (4.1) |
3,467 (2.2) |
<0.001 |
1.4 (1.2–1.7)** |
| Victim of interpersonal violence within previous mo |
42 (1.4) |
684 (0.4) |
<0.001 |
2.7 (1.9–3.7)** |
| Perpetrator of interpersonal violence within previous mo |
105 (3.6) |
3,642 (2.3) |
<0.001 |
1.6 (1.3–2.0)** |
| Suicide of friend or family member |
123 (4.2) |
3,787 (2.4) |
<0.001 |
1.6 (1.3–1.9)** |
| Other death of friend or family member |
180 (6.2) |
10,122 (6.3) |
0.711 |
1.1 (1.0–1.3) |
| Argument or conflict preceded death†† |
762 (26.0) |
25,620 (16.0) |
<0.001 |
1.6 (1.5–1.7)** |
| Injury occurred during argument |
164 (21.5) |
5,674 (22.1) |
0.682 |
1.0 (0.9–1.2) |
| Injury occurred ≤24 hrs, but not during argument |
502 (65.9) |
15,721 (61.4) |
0.012 |
1.1 (1.0–1.3) |
| Injury occurred >24 hrs after argument |
57 (7.5) |
2,715 (10.6) |
0.006 |
0.7 (0.5–0.9)** |
|
Other life stressor
| ||||
| Any life stressor |
1,640 (56.0) |
94,851 (59.2) |
0.001 |
1.0 (0.9–1.1) |
| Victim in custody |
132 (4.5) |
4,037 (2.5) |
<0.001 |
1.7 (1.4–2.0)** |
| Released from institution within previous month§§ |
196 (6.7) |
11,232 (7.0) |
0.509 |
1.0 (0.9–1.2) |
| Jail, prison, or a detention facility |
70 (35.7) |
1,822 (16.2) |
<0.001 |
2.5 (1.8–3.3)** |
| Hospital |
55 (28.1) |
4,559 (40.6) |
<0.001 |
0.7 (0.5–1.0) |
| Psychiatric hospital or other psychiatric institution |
36 (18.4) |
3,589 (32.0) |
<0.001 |
0.4 (0.3–0.6)** |
| Long-term residential health facility |
2 (1.0) |
126 (1.1) |
1.000 |
1.6 (0.4–6.5) |
| Supervised residential facility related to alcohol or substance use treatment |
18 (9.2) |
622 (5.5) |
0.028 |
1.5 (0.9–2.5) |
| Other§§,¶¶ |
15 (7.7) |
514 (4.6) |
0.042 |
1.6 (1.0–2.8) |
| Criminal legal problem |
347 (11.9) |
12,384 (7.7) |
<0.001 |
1.6 (1.4–1.8)** |
| Civil legal problem |
127 (4.3) |
5,391 (3.4) |
0.004 |
1.4 (1.1–1.6)** |
| Physical health problem |
366 (12.5) |
3,4291 (21.4) |
<0.001 |
0.8 (0.7–0.9)** |
| Job problem*** |
179 (6.6) |
15,092 (9.8) |
<0.001 |
0.6 (0.6–0.8)** |
| Financial problem*** |
160 (5.9) |
13,097 (8.5) |
<0.001 |
0.8 (0.6–0.9)** |
| School problem††† |
53 (17.5) |
1,586 (21.6) |
<0.001 |
0.8 (0.6–1.1) |
| Eviction or loss of home |
93 (3.2) |
5,638 (3.5) |
<0.001 |
1.0 (0.8–1.3) |
|
Crisis within previous 2 wks or anticipated in upcoming 2 wks
|
930 (31.8) |
475,96 (29.7) |
0.015 |
1.1 (1.0–1.2) |
| Crisis related to mental health§§§ |
21 (2.3) |
2,679 (5.6) |
<0.001 |
0.4 (0.2–0.6)** |
| Crisis related to alcohol problem§§§ |
74 (8.0) |
2,718 (5.7) |
0.004 |
1.6 (1.3–2.0)** |
| Crisis related to substance use§§§ |
33 (3.5) |
1,619 (3.4) |
0.807 |
1.0 (0.7–1.4) |
| Crisis related to intimate partner problem§§§ |
417 (44.8) |
18,278 (38.4) |
<0.001 |
1.2 (1.0–1.3)** |
| Crisis related to family relationship problem§§§ |
68 (7.3) |
3,589 (7.5) |
0.794 |
0.7 (0.5–0.9)** |
| Crisis related to other relationship problem§§§ |
19 (2.0) |
799 (1.7) |
0.393 |
0.9 (0.6–1.5) |
| Crisis related to criminal legal problem§§§ |
140 (15.1) |
5,536 (11.6) |
0.001 |
1.4 (1.1–1.6)** |
| Crisis related to civil legal problem§§§ |
31 (3.3) |
1,628 (3.4) |
0.885 |
1.0 (0.7–1.5) |
| Crisis related to physical health problem§§§ |
85 (9.1) |
7,067 (14.8) |
<0.001 |
1.0 (0.8–1.2) |
| Crisis related to job problem***,§§§ |
34 (4.0) |
3,509 (7.7) |
<0.001 |
0.5 (0.3–0.7)** |
| Crisis related to financial problem***,§§§ |
16 (1.9) |
2,069 (4.5) |
<0.001 |
0.5 (0.3–0.8)** |
| Crisis related to school problem†††,§§§ |
12 (12.8) |
404 (17.7) |
0.218 |
0.7 (0.4–1.3) |
| Crisis related to eviction or loss of home§§§ |
25 (2.7) |
2,290 (4.8) |
0.003 |
0.6 (0.4–1.0)** |
| Crisis related to recent suicide of friend or family§§§ |
39 (4.2) |
442 (0.9) |
<0.001 |
3.8 (2.7–5.3)** |
| Crisis related to other death of friend or family§§§ |
38 (4.1) |
1,710 (3.6) |
0.424 |
1.3 (0.9–1.8) |
|
Mental health or substance use
| ||||
| Any current substance use problem |
1,340 (45.8) |
47,285 (29.5) |
<0.001 |
2.0 (1.9–2.2)** |
| Alcohol problem |
918 (31.4) |
29,109 (18.2) |
<0.001 |
2.3 (2.1–2.5)** |
| Other substance use problem |
778 (26.6) |
27,403 (17.1) |
<0.001 |
1.6 (1.5–1.7)** |
| Reported alcohol use in hrs preceding death |
902 (30.8) |
31,185 (19.5) |
<0.001 |
1.9 (1.7–2.0)** |
| Any current diagnosed mental health problem |
1,215 (41.5) |
78,744 (49.2) |
<0.001 |
0.7 (0.7–0.8)** |
| Depression or dysthymia |
859 (29.4) |
58,580 (36.6) |
<0.001 |
0.7 (0.7–0.8)** |
| Bipolar disorder |
146 (5.0) |
11,776 (7.4) |
<0.001 |
0.6 (0.5–0.8)** |
| Schizophrenia |
100 (3.4) |
4,714 (2.9) |
0.133 |
1.1 (0.9–1.4) |
| Anxiety disorder |
219 (7.5) |
15,810 (9.9) |
<0.001 |
0.7 (0.6–0.8)** |
| Posttraumatic stress disorder |
92 (3.1) |
4,235 (2.6) |
0.095 |
1.2 (1.0–1.5) |
| Attention deficit hyperactivity disorder |
37 (1.3) |
2,161 (1.3) |
0.694 |
0.5 (0.4–0.7)** |
| Current depressed mood (not diagnosis) |
986 (33.7) |
55,385 (34.6) |
0.320 |
1.0 (0.9–1.1) |
|
Mental health or substance use treatment
| ||||
| Current mental health or substance use treatment |
569 (19.4) |
41,894 (26.2) |
<0.001 |
0.6 (0.6–0.7)** |
| History of mental health or substance use treatment | 862 (29.5) | 56,260 (35.1) | <0.001 | 0.7 (0.7–0.8)** |
Abbreviations: AI/AN = American Indian or Alaska Native; aOR = adjusted odds ratio.
* Denominator includes all suicide decedents.
† Pearson’s chi-square test result for difference between AI/AN and non-AI/AN populations; Fisher's exact test when one or more of the cell counts in a 2×2 table is <5.
§ aORs measure the association between the decedent having the precipitating circumstance present and the race of the decedent being AI/AN. Each aOR used Non-AI/AN as the referent group and controlled for age group and sex.
¶ Denominator includes only suicides with one or more precipitating circumstance, unless otherwise noted. Sum of percentages in columns might exceed 100% because a suicide could have more than one precipitating circumstance.
** p<0.05 for aOR significance test.
†† Denominator includes only those suicides in which argument or conflict preceded death.
§§ Denominator includes only those decedents released from an institution within the previous month.
¶¶ Supervised residential facilities not related to alcohol or substance use treatment, and other or unknown type of institution.
*** Denominator includes only decedents aged ≥18 years with at least one known circumstance.
††† Denominator includes only decedents aged 10–17 years with at least one known circumstance.
§§§ Denominator includes only those suicide decedents with any crisis within the past or upcoming 2 weeks.