The social context and epidemiology of suicide in Labrador

Abstract

In Canada, many Inuit and First Nations populations have elevated rates of suicide, though there is substantial variation at the community level. The factors that contribute to suicide are complex and entrenched in colonization. Labrador is a circumpolar region in eastern Canada where suicide has been a persistent social problem in Inuit and Innu communities since the 1970’s. As a result, suicide prevention has become a policy and program priority. Indigenous leaders and health system stakeholders in Labrador identified a need for local evidence on suicide to inform community programs and services. The aim of this thesis was to examine the social context and epidemiology of suicide in the region. To this end, we established research partnerships with community members, Indigenous governments, and the regional health authority. Within a population health approach founded on the principles for ethical research involving Indigenous peoples, we integrated community-based methods with qualitative and epidemiological study designs. This work began with a series of community consultations which engaged health and social service providers to better understand research priorities related to suicide. In a qualitative study, we then used focus groups to gather information about local risk and protective factors for suicide. Participants viewed suicidal behaviour, problematic alcohol and substance use, and mental disorders as the downstream outcomes of social inequity and historical trauma. To build on this knowledge, we conducted a population-based observational study to investigate disparities in suicide mortality between Innu and Inuit communities and the general population of the province. The results showed that the suicide rate was higher in Labrador (31.8 per 100,000 person-years) than in Newfoundland (8 per 100,000 person-years); at the subregional level, suicide rates were elevated in Inuit and Innu communities, at 165.6 and 114.0 suicide deaths per 100,000 person-years. To put the data from Labrador in a global context, we undertook a systematic review on the incidence of suicide among Indigenous peoples worldwide. Suicide rates were elevated in many Indigenous populations, though rate variation was common. Strikingly, rate disparities in Labrador were among the highest globally. Recognizing challenges related to monitoring suicide, we analyzed the public health approach to suicide surveillance in Canada. To improve surveillance capacity, we proposed strategies such as integrating Indigenous identifiers into national data sets and building an inclusive data governance model to better track progress in suicide prevention in Indigenous communities. This thesis concludes with a discussion of the scholarly contributions of this work and identifies opportunities for future research.