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Suicide Clusters in American Indian and Alaska Native Communities


1. As with the general U.S. population, suicide rates increase with age for AI/AN.

A. True

B. False

2. The highest suicide rate among AI/AN people occurs in:

A. Alaska

B. The Norther Plains

C. The East

D. The Southwest

3. Studies indicate that AI/AN living on reservations or in rural areas have a higher prevalence of suicidal behaviors than those living in urban areas.

A. True

B. False

4. The risk of a suicide after a friend or family member’s suicide is ____ times higher for adolescents between the ages of 15 and 19 years old.

A. 1 - 2

B. 2 - 4

C. 4 - 6

D. 6 - 8

5. How does the AI/AN communities face a perfect storm that contribute to the formation and spread of suicide clusters among youth?

A. Many tight-knit, rural AI/AN communities have high suicide rates with limited or fragmented health care resources, and often adolescents have been exposed to suicidal behavior among their friends and family members.

B. AI/AN youth have experienced the historical discrimination and trauma inflicted on AI/AN populations and often face additional economic marginalization including living in areas with high unemployment and poverty.

C. These suicide clusters, often described as “epidemic,” create feelings of hopelessness, confusion, and panic in AI/AN communities that have experienced multiple traumas, as well as the loss of cultural values and traditions that could otherwise provide anchors of strength in crises.

D. All of the above.

Suicide Clusters and Contagion: Terminology and Concepts

6. A suicide cluster occurs when several suicides or suicide attempts occur close together in _____ and are beyond what would be expected to occur by chance.

A. Time

B. Place

C. Both (A) and/or (B)

D. None of the above

7. Mass clusters are suicides that occur in unusually high numbers over a short period of time and within a distinct geographic area or institution.

A. True

B. False

8. Suicide clusters can span from 2 weeks to 2 years.

A. True

B. False

9. Just one youth suicide can increase the potential for other suicides within a community and increase the potential for a suicide cluster.

A. True

B. False

10. Suicide contagion can occur through:

A. Direct contact with a suicide

B. Word of mouth

C. Reporting by the media

D. All of the above

Risk and Protective Factors

11. Studies have found a greater risk for clusters among all of the following, except for:

A. Females

B. Adolescents / young adults

C. Those who engage in acute or chronic alcohol use

D. All of the above are at a greater risk for clusters

12. Which of the following individuals is at the greatest risk of contagion?

A. Those who have been exposed to suicide.

B. Those who have a strong identification with the victim.

C. Those who are vulnerable because of mental illness, substance use, or family instability.

D. All of the above.

13. Several studies have noted that elements inversely related to connectedness, such as relationship and family problems, isolation, or not having someone to talk to, are strongly correlated to suicidal behavior in AI/AN.

A. True

B. False

14. Although increasing protective factors has been found to reduce the risk of suicidal behaviors, it is not as effective at reducing AI/AN youth suicide rates as decreasing risk factors.

A. True

B. False

The Role of Media and Other Communication Sources during Suicide Clusters

15. Which of the following is a recommendation for how parents and communities should talk about suicide?

A. Misrepresent suicide as a mysterious act by someone who was otherwise “healthy” or “high achieving.”

B. Emphasize that suicide is not inevitable. There are better options.

C. Provide repeated, detailed, and/or explicit descriptions of the suicide and method of suicide.

D. All of the above are recommended for parents and communities.

Considerations for Suicide Cluster Identification and Intervention with AI/AN Communities

16. In some AI/AN communities, it is not appropriate to talk about death and/or suicide.  This silence can hamper efforts to better understand the formation of a suicide cluster, to determine the mechanisms behind contagion, and to identify at-risk youth.

A. True

B. False

Proposed Recommendations: Suggestions to Better Support AI/AN Communities

17. The response plan should be implemented under which condition?

A. When a suicide cluster occurs in the community.

B. When one or more deaths from trauma occur in the community.

C. Both (A) and/or (B).

D. None of the above.

Appendix A: Data Sources for Identifying and Assessing Suicide Clusters in American Indian and Alaska Native Communities

18. What is the advantage of tribal surveillance systems?

A. Access to real-time data that may aid identification of emerging suicide clusters, trends, and characteristics. This information can inform immediate intervention strategies and long-term prevention efforts.

B. Identification of characteristics and patterns that are unique to that AI/AN community.

C. Capacity to provide more comprehensive data across the continuum of suicidal behaviors and self-injury, which can be useful when trying to understand clusters and contagion.

D. All of the above.

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