Suicide is a threat to the health of all Americans, but some ethnic groups are more affected than others. Limited data indicate that American Indian (AI) youth experience high rates of suicide completions, suicide attempts, and suicidal ideation compared to their non-Latino white counterparts. Many factors contribute to suicidal ideation in AI youth, including depressive symptoms, low self-esteem, substance abuse, hopelessness, forced acculturation, and lack of social support. Cultural interventions (interventions that utilize cultural practices to intervene on health outcomes, as distinguished from interventions that are merely culturally appropriate) have recently been associated with positive health outcomes in AIs as well as other ethnic groups. Still, while it is highly recommended that interventions targeting mental illness in AI youth consider cultural constructs related to health, very few studies have used this approach to-date. North Carolina (NC) is home to the largest AI population east of the Mississippi River. The Lumbee Indian tribe, a non- reservation tribe with a population of about 50,000, is the largest tribe in the state and is largely concentrated in Robeson County. The overall goal of the proposed exploratory study, Lumbee Rite of Passage for Life, is to determine the impact of cultural programs, specifically a culture class conducted by the Lumbee tribe at three tribally owned Boys and Girls Clubs, on suicide ideation in American Indian adolescents between the ages of 12 and 17 years. The study will entail participation from the Lumbee community and will be conducted as a partnership between the Maya Angelou Center for Health Equity (MACHE) at Wake Forest University School of Medicine (WFUSM), the University of NC at Pembroke (UNCP), and the Lumbee Tribe of NC. This exploratory R21 will accomplish two specific aims: (1) to assess perceptions regarding suicidal behavior and risk factors for suicide and examine mental health needs among and services for Lumbee Indian youth (ages 12-17 years) in Robeson County, NC;and (2) to determine the impact of a tribally-run cultural program on suicidal ideation and its risk factors. A secondary aim to Specific Aim 2 is to examine the moderating effects of demographic variables (including gender), sexual orientation, and obesity on the relationship between participation in the culture classes and suicidal ideation.
For Aim 1, we plan in-depth interviews with community gatekeepers regarding availability and quality of mental health resources and focus groups with Lumbee youth to identify impressions of mental health issues, particularly regarding suicide and its risk factors in their community.
For Aim 2, investigators will conduct a feasibility study in conjunction with the Lumbee tribe to measure changes in suicidal ideation and its risk factors that occur as a result of participation in a cultural program that includes native dancing, pow-wow singing, NC Indian history, beading, and pottery. Participants will be randomized into intervention and delayed intervention (comparison) groups, and pre- and post-intervention measures of suicide ideation and factors associated with it will be collected via surveys.

Public Health Relevance

Suicide and its risk factors remain a major public health concern in the United States, and American Indians bear an unequal burden of completed suicides, suicide attempts, and suicidal ideation compared to whites. The proposed exploratory study is a partnership with the Lumbee Indian tribe of North Carolina and will test the feasibility of using a tribally run culture class to promote positive mental health outcomes and reduce suicidal behaviors among Lumbee adolescents. While we acknowledge that culture may only be one of many things that promote good mental health among young people, innovative research such as this could lead to more comprehensive treatment and prevention interventions and therefore add to the body of public health knowledge.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Mental Health Services in Non-Specialty Settings (SRNS)
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Goldstein, Amy B
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Wake Forest University Health Sciences
Public Health & Prev Medicine
Schools of Medicine
United States
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Langdon, Sarah E; Golden, Shannon L; Arnold, Elizabeth Mayfield et al. (2016) Lessons Learned From a Community-Based Participatory Research Mental Health Promotion Program for American Indian Youth. Health Promot Pract 17:457-63
Bell, Ronny; Arnold, Elizabeth; Golden, Shannon et al. (2014) Perceptions and psychosocial correlates of bullying among Lumbee Indian youth. Am Indian Alsk Native Ment Health Res 21:1-17
Arnold, Elizabeth Mayfield; McCall, Vaughn W; Anderson, Andrea et al. (2013) Sleep Problems, Suicidality and Depression among American Indian Youth. J Sleep Disord Treat Care 2:119