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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.154880v1 99/10/1840    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Mullany, B. Articles by Walkup, J. T. PubMed PubMed Citation Articles by Mullany, B. Articles by Walkup, J. T. Related Collections Adolescent Health Injury/Emergency Care/Violence Mental Health Public Health Workers Native Americans Surveillance

Britta Mullany, PhD, MHS, Allison Barlow, MPH, Novalene Goklish, Francene Larzelere-Hinton, BA, Mary Cwik, PhD, Mariddie Craig and John T. Walkup, MD

Britta Mullany, Allison Barlow, Novalene Goklish, Francene Larzelere-Hinton, Mary Cwik, and John T. Walkup are with the Johns Hopkins Center for 9American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Mariddie Craig is with the White Mountain Apache Tribal Court, Whiteriver, AZ. J. T. Walkup is also with the Johns Hopkins Medical Institution, Baltimore.

Correspondence: Correspondence can be sent to Britta Mullany, Johns Hopkins Center for American Indian Health, 621 N Washington St, Baltimore, MD 21205 (e-mail: bmullany{at}jhsph.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. We examined suicide and suicide attempt rates, patterns, and risk factors among White Mountain Apache youths (aged < 25 years) from 2001 to 2006 as the first phase of a community-based participatory research process to design and evaluate suicide prevention interventions.

Methods. Apache paraprofessionals gathered data as part of a tribally mandated suicide surveillance system. We compared findings to other North American populations.

Results. Between 2001 and 2006, 61% of Apache suicides occurred among youths younger than 25 years. Annual rates among those aged 15 to 24 years were highest: 128.5 per 100 000, 13 times the US all-races rate and 7 times the American Indian and Alaska Native rate. The annual suicide attempt incidence rate in this age group was 3.5%. The male-to-female ratio was 5:1 for suicide and approximately 1:1 for suicide attempts. Hanging was the most common suicide method, and third most common attempt method. The most frequently cited attempt precipitants were family or intimate partner conflict.

Conclusions. An innovative tribal surveillance system identified high suicide and attempt rates and unique patterns and risk factors of suicidal behavior among Apache youths. Findings are guiding targeted suicide prevention programs.