Ministry of Community Safety and Correctional Services :: Part B: Suicide

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Office of the Chief Coroner

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The Office of the Chief Coroner’s Death Review of the Youth Suicides at the Pikangikum First Nation

2006 – 2008



Part B: Suicide

B1. Definition of Suicide

Suicidal behaviour essentially refers to a group of self-destructive behaviours, which encompasses terminology such as suicide, attempted suicide and parasuicide.

Emile Durkheim provided the following definition of suicide: “Suicide is applied to all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result.”1 An alternative definition of suicide includes: “The act or an instance of taking one's own life voluntarily and intentionally especially by a person of years of discretion and of sound mind.”2

The World Health Organization has defined parasuicide as: “An act of nonfatal outcome, in which an individual initiates a nonhabitual behaviour that, without intervention by others, will cause self-harm, or ingests a substance in excess of the prescribed or generally recognized therapeutic dosage, and which is aimed at realizing changes which he/she desired via the actual or expected physical consequences.”3

B2. History of Suicides in Pikangikum

In 2000, Pikangikum First Nation was reported to have the highest suicide rate in the world.4 The following excerpt is taken from an article which appeared in the Canadian Press on November 27, 2000 regarding Pikangikum:

“In Pikangikum, eight females - five of them 13 years old - have killed themselves this year. But Pikangikum, a community of 2,000 people 300 kilometres northeast of Winnipeg, has an eight-year average of 213 suicides per 100,000 people between 1992 and 2000, and a nine-year average of 205 suicides per 100,000 people in the period between 1991 and this month, two independent Canadian experts said this week. The latest Pikangikum suicides have sent this year's rate soaring to 470 deaths per 100,000. That's 36 times the national average of 13 per 100,000, and in a city of three million people, would mean 14,100 deaths this year.”

Clearly, there is a long history of suicide amongst residents of Pikangikum that now dates decades. These deaths have touched virtually ever member of the community.

B3. Adolescent Suicide in Canada

Suicide is the second leading cause of deaths for children age 10-18 and is the focus of this report. Young people often do not present for care to their health care providers with suicidal ideation. Canada experiences >500 suicides per year amongst those 15-24 years of age, and it is estimated that for each completed suicide, there are 400 attempts.5

There has been a four-fold increase in teen suicides in the past 40 years.6 Living in a single parent family as a divorced youth, contagion behaviour, and the black box warning by the Food and Drug Administration with subsequent diminished use of selective serotonin reuptake inhibitors (SSRI’s) with increases in completed suicides are considered amongst contributors to the rise in youth suicide.7 An example of an SSRI is Prozac, also known as fluoxetine hydrochloride. For SSRI’s, “current evidence suggests that the risk of not treating depression outweighs the risk of using SSRI’s in this population.”8 It is difficult to know how relevant this information, representing both Aboriginal and non-Aboriginal populations, is to First Nations youths.

Risk Factors9

A host of well recognized risk factors exist and are summarized here:

  1. Mental illness
  • More than 90% of suicide completers have psychiatric illness at the time of their death
  1. Previous attempts
  • A previous attempt confers a 21% risk of committing suicide over the next five years
  • The highest risk is in the month after the initial attempt
  • Substance abusers, those with hallucinations or a plan, are at greatest risk for repeated behaviours
  1. Precipitants
  • Conflict with parents or the end of a relationship may be precipitants
  • Rejection
  • Public disparagement or feelings of humiliation
  1. Impulsivity
  • These youths are more likely to act on their suicidal ideation
  • Physical aggression, fights at school and risk taking behaviour can be markers for impulsivity
  • Substance abuse can impair judgement and exacerbate impulsivity
  1. Family history
  • Family history of suicide, depression, addiction and other mental illness
  • Poor family communication
  • Low parental monitoring
  1. Contagion behaviour
  • Suicide in a friend or family member can lead to a two to four fold increase in suicide risk in teens aged 15-1910
  1. Physical and sexual abuse
  • Common amongst youth who present with suicidal behaviour
  1. Other risk factors
  • Trouble with police
  • Difficulties in school, poor school functioning, lack of academic motivation, perceived poor school performance (independent of intelligence)

Prevention, screening, and treatment are paramount to success in dealing with suicide. Parents are unaware of 90% of suicide attempts made by their teenagers.11

B4. Canadian Suicide Rate Statistics

The table below lists suicide rates for all Canadians broken down by age from Statscan. This review concerns the ages from 10-19, and are included in bold.12

Suicides and suicide rate, by sex and by age group

(Both sexes for Canada)

 

2001

2002

2003

2004

2005

 

Both sexes

 

Suicide rate per 100,000 population

All ages

11.9

11.6

11.9

11.3

11.6

10 to 14

1.3

1.7

1.3

1.3

2.0

15 to 19

9.9

10.1

10.2

9.9

9.9

20 to 24

14.0

12.9

14.0

12.1

13.2

B5. Suicide Among Aboriginal People

In 2003, Statistics Canada identified that there were about 1 million Aboriginal People in Canada consisting of four groups, namely, status Indians under the Indian Act, First Nations non-status Indians, Métis, and Inuit. First Nations make up 62% of the Aboriginal population.

There are over 600 First Nations communities, 11 major language groups and 50 distinct dialects. The median age for the Aboriginal population is 24.7 years, 13 years younger than the non-Aboriginal population. Aboriginal groups have higher mortality rates, with life expectancy 10 years shorter than for the average Canadian.

In 2001, the overall rate of suicide was 11.9 per 100,000 in Canada, which is down from 16.7 in 1979. The First Nation suicide rate in 2000 was 24 per 100,000. However, these statistics are an aberration when considered in isolation.

Chandler and Lalonde, in studying youth suicide amongst First Nations in British Columbia, found rates in the 196 communities in that province varied from zero to 120 per 100,000 over an eight year period. Although not studied and available for Ontario, there is evidence to suggest that there are marked differences in rates of suicide in First Nations communities in Ontario as well, even when they exist in close geographical proximity. For example, Pikangikum has been characterized as having the highest suicide rate in the world. In 2007, there were ten suicides in the community of 2,400. This translates into a rate of approximately 417 per 100,000 per year. Lac Seul, a First Nations community located south east of Pikangikum, has documented six suicides in 10 years.13

B6. First Nations Youth Suicide Rates

Suicide occurs roughly five to six times more often among First Nations youth than non-Aboriginal youth in Canada. The rate of First Nations youth suicide is extremely high (Figure 1). Among First Nations young men between the ages of 15-24 years it was 126 per 100,000, compared to 24 per 100,000 for Canadian men of the same age group. Young women from First Nations registered a rate of 35 per 100,000 versus only 5 per 100,000 for Canadian women.14 Although this information is currently dated, it retains its relevance.

Figure 1: Suicide Death Rates by Age Group First Nations and Canadian Populations, 1989-1993

Figure 1. Suicide Death Rates by Age Group: First Nations and Canadian Populations, 1989-1993.

Worldwide studies have demonstrated that women are more likely to make attempts, but men are more likely to die by suicide. The difference is accounted for by the lethal means, with men using firearms, jumping from a height and hanging, and women using drug overdose or wrist slashing. In Pikangikum, the female youth use hanging as the method of choice for suicide. Trends in suicide also demonstrate that overall, they are going down, with the exception of youth.

In the Nishnawbe Aski Nation (NAN):

  • from 1986 to 1995, there were 129 suicides of all ages;
  • the number rose dramatically over the ten years, with five suicides in 1986 and 25 in 1995;
  • the vast majority of the suicides were male;
  • of the 129 suicides, 79.8% were youth between the ages of 10 to 25;
  • 20.4% were children between the ages 10 to14; and
  • the NAN rate of suicide was 28 per 100,000 in 1995.15

B7. Suicides in Ontario and in Pikangikum, 2006 - 2008

It must be borne in mind that the actual suicide attempts as reported below are likely much, much higher. There is research on the prevalence of suicidal ideation and attempts. The 2002/2003 Regional Longitudinal Health Study of 10,962 First Nations adults found that 15.8% had made a suicide attempt in their lifetime, and 30.9% reported having suicidal thoughts at sometime during their lives.

The following information was obtained from the Ontario Provincial Police regarding police calls for suicide or parasuicide in Pikangikum.16

Year

Suicides

Attempted Suicides

2001

8

35

2002

3

17

2003

7

40

2004

4

27

2005

5

41

2006

6

48

2007

10

98

2008

7

78

2009

8

97

Total

58

481

The table below shows the Contribution of Pikangikum Youth Suicides to all Youth Suicides in Ontario, 2006-2008:

Year

Total Suicides in Ontario (All Ages)

Suicides 0-18 Years of Age

Suicides in Pikangikum

0-18 Years of Age

% Contribution of Pikangikum Suicides to Total Ontario Suicides 0-18 Years of Age.

2006

1,109

39

4

10.2%

2007

1,121

53

8

15.1%

2008

1,074

36

4

11.1%

Source: Office of the Chief Coroner

B8. Concluding Remarks

This data demonstrates a striking and concerning trend. Despite its population of approximately 2,400 residents, and Ontario’s population of 13,069,18217, the proportionate contribution of the suicides of Pikangikum to youth suicides in the province is extraordinarily high. These statistics are a notable aberration and should serve as a call to action by Ontarians to develop a plan and strategy to address the high rate of suicide in the Pikangikum First Nation. Healthcare providers need the ability to identify communities where high rates of suicide exist so that intervention plans can be developed.

1 Kirmayer, J.K., et al, Suicide Among Aboriginal People in Canada, Aboriginal Healing Foundation, 2007, p.3.

2 http://www.merriam-webster.com/dictionary/suicide

3 Kirmayer, J.K., et all, Suicide Among Aboriginal People in Canada, Aboriginal Healing Foundation, 2007, p.3.

4 http://en.wikipedia.org/wiki/Pikangikum_First_Nation

5 Kostenuk, M., et al., Approach to adolescent suicide prevention, Canadian Family Physician, Vol. 56, August 2010, p. 755.

6 Canadian Taskforce on Preventative Health Care. Prevention of Suicide. London, ON. Canadian Task Force of Preventative Health Care; 2003.

7 Kostenuk, M., et al., Approach to adolescent suicide prevention, Canadian Family Physician, Vol. 56, August 2010, p. 756.

8 Ibid., p. 756.

9 Taken from Kostenuk, M., et al., Approach to adolescent suicide prevention, Canadian Family Physician, Vol. 56, August 2010, p. 757-758.

10 Gould MS., et al, Time-space clustering of teenage suicide. Am J Epidemiology 1990; 131(1):71-8.

11 Friedman RA., Uncovering an epidemic-screening for mental illness in teens. N Engl J Med 2006; 335(26):2717-9.

12 http://www40.statcan.gc.ca/l01/cst01/perhlth66a-eng.htm

13 Personal communication, Police Chief Rick Angeconeb, Lac Seul, October 14, 2010.

14 Hettinga, P., et al, Acting on What We Know: Preventing Youth Suicide in First Nations, Health Canada, 2003.

15 Horizons of Hope: An empowering Journey. Youth Forum, Final Report, Nishnawbe-Aski Nation Youth Forum on Suicide, 1996, p.3-4.

16 Obtained from the OPP, October 2010.

17 http://www.fin.gov.on.ca/en/economy/ecupdates/factsheet.html