Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation

Objectives. We evaluated the efficacy of 15 years of a public health-oriented suicidal-behavior prevention program among youths living on an American Indian reservation. Methods. All suicides, suicide attempts, and suicidal gestures were monitored. Age-specific analyses over time were used to assess outcomes. Results. Both descriptive and linear regression analyses indicated that a substantial drop occurred in suicidal gestures and attempts. Suicide deaths neither declined significantly nor increased, although the total number of self-destructive acts declined by 73% (P=.001). Conclusions. Data from this community-based approach document a remarkable downward trend-measured-by both magnitude and temporal trends in the specifically targeted age cohorts-in suicidal acts. The sequential decrease in age-specific rates of suicide attempts and gestures is indicative of the program's success.