(119) Mental Health and Suicide: Are American Indians and Alaska Natives Neglected? A Narrative Review

Introduction: American Indians/Alaska Natives (AI/AN) have the highest suicide rates among all racial & ethnic groups in USA. The suicide rates are increasing disproportionally compared to other minority groups in the US. This review aims to explore the factors and disparities that contribute to the recent suicide trends among AI/AN people, with focus on healthcare access and use, especially mental health & substance use disorder (SUD) services.

Methods: We searched PubMed, PsycINFO, and Google Scholar databases for peer-reviewed articles published from 2003 to 2023 that reported on healthcare access and use among AI/AN people in the United States, as well as suicide rates, risk factors, & prevention strategies.

Results: We identified 23 articles that met our inclusion criteria. The articles covered various topics, such as health insurance coverage, Indian Health Service (IHS) utilization, mental health and SUD treatment, suicide prevention, and barriers & facilitators of healthcare access and use. Main themes that emerged from the literature were: 1) AI/AN people have lower health insurance coverage and higher uninsured rates than non-Hispanic whites (NHW); 2) AI/AN people have diverse patterns of healthcare access & use, influenced by unique preferences and needs for culturally-responsive and community-based health care services; 3) AI/AN people have higher rates of mental health disorders, SUDs, and suicide than NHW, but lower access to mental health and SUD services; 4) AI/AN people face multiple barriers to health care access and use, such as lack of resources, trust, and historical trauma; 5) AI/AN people have specific risk factors for suicide, such as intergenerational trauma, acculturative stress, and loss of identity; 6) AI/AN people have protective factors for suicide, such as cultural resilience, spirituality, family support, and community engagement.

Conclusions: This review provides an overview of the current state of knowledge on healthcare access and use among AI/AN people and its relationship with rising suicide rates despite increased mental health awareness in recent years. It highlights the gaps & challenges in addressing healthcare disparities & needs of this population. It also suggests directions for future research to improve quality and equity of healthcare services for AI/AN people.