Suicide, a serious mental health issue, has remained significantly higher among American Indian and Alaska Native (AI/AN) populations than the national suicide rate (22.1 vs 14.0 per 100,000). Inequities are even more pronounced among youth and young adults (39.7 per 100,000 compared to 9.9 per 100,000 for ages 15 to 24). Whereas suicide rates peak at midlife in the general U.S. population, AI/AN populations exhibit the highest suicide rates during adolescence and young adulthood, and suicide comprises the second leading cause of death among young AI/AN populations. New Mexico (NM) has the second highest proportion of AIs in the country and suicide deaths increased in all age groups in the state between 1999 and 2017, with a 50% increase among 10-24 year olds. People with opioid use disorders are thirteen times more likely to die by suicide than people without. The relationship between key risk and protective factors for suicide and opioid use remain largely unexplored for AI/AN youth. Social networks factors, which can be either positive or negative mediators in both suicide and opioid use, have not been explored for AI/AN youth. The structure of adolescent social networks affects the etiology of behavior, and research has shown that AI/AN youth have fewer ties at school than non- Hispanic whites, have fewer reciprocated friendships, have a smaller circle of in-school friends, and are members of less cohesive personal networks. In NM, social support networks at home, school, and in the community are associated with decreased odds of suicide among AI/AN high school students. A recent study examining AI/AN youth social support networks revealed that the adjusted odds of suicide attempts among AI/AN students with low support compared to those with high support declined from 2011 to 2015, but low social support remains a significant risk factor for suicide. Yet, the role support from social networks plays in mediating and moderating the association between opioid use and suicide remains understudied among AI/AN youth. Using the NM Youth Risk and Resiliency Survey (NM-YRRS) from 2003-2019, this study will examine this tri-relationship and specifically examine how these associations change for AI/AN youth living on and off the reservation and in rural and urban settings. Our overarching goal is to reduce the high rates of suicide among AI/AN youth in the Southwest. The first step to achieving our goal is to characterize the overall and stratified prevalence of suicide and opioid use over time among AI/AN youth in NM using the factors gender, grade, residence on/off reservation, and urban/rural status (Aim 1); determine how social network support moderates the association between suicide and opioid use among AI/AN youth in NM (Aim 2); and assess the overall moderation effect for on/off reservation residential status and rural/urban status on the relationship between suicide attempts and opioid use, and how these relationships change with respect to levels of social support (Aim 3). The outcomes of this study will provide nuanced models of risk and protective factors that may inform social support and drug use interventions seeking to reduce mortality among AI/AN youth in diverse geographic contexts.
We propose to conduct a quantitative study that assesses the relationships between opioid use, social support, and suicide among Native American youth in New Mexico using restricted 2003-2019 data from the New Mexico Youth Risk and Resiliency Survey. These data will be used to untangle and evaluate the multifactorial associations between these risk and protective factors for suicide in Native American youth populations both on and off the reservation and in both rural and urban areas. The outcomes of this research will provide crucial information about how social networks can be leveraged through public health and community interventions to address the relationship between opioid use and suicide in geographically diverse Native American youth populations.
