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Suicide in The Northwest Territories:
Abstract The incidence of suicide among the populations of the Northwest Territories
(NWT) is notably higher than in the rest of Canada. A comparison of
three five-year time periods between 1982 and 1996 reveals an increasing
incidence rate, particularly for Nunavut, the eastern half of the NWT,
occupied primarily by Inuit people. This is largely attributable to
increased use of hanging as opposed to other methods of suicide. A coroner's
record review of suicides occurring between 1994 and 1996 demonstrates
the preponderance of young males and of Inuit among those who committed
suicide, the majority of whom committed suicide in familiar settings,
usually their own homes, and often while others were on the premises.
Thirty-six percent of those who committed suicide had experienced a
recent family or relationship breakup, and twenty-one percent were facing
criminal proceedings. Understanding the impact of these and other reported
circumstances on the imminent risk of suicide requires further investigation.
Introduction Suicide among aboriginal groups in Canada has been reported to be two to four times more frequent than in the population at large.1,2 In the Northwest Territories (NWT), where aboriginal populations represent the majority, considerable attention has focused on an apparent increase in the occurrence of suicide in a number of communities. In 1992 the annual age-standardized suicide rate for the NWT was estimated at 23 per 100,000 population compared to 13 per 100,000 for Canada as a whole.1 In the spring of 1997, the Department of Health and Social Services of the Government of the NWT (GNWT) invited the Field Epidemiology Training Program at Health Canada's Laboratory Centre for Disease Control to collaborate in a review of existing suicide mortality data with the following objectives.
For this report, suicides are defined as deaths due to self-inflicted injury with the intent of causing death. Two approaches were taken to achieve the study objectives: an analysis of a suicide database of suicide events recorded since 1981 and a review and summary of coroner's reports on suicide cases for the period 1994-1996.
The suicide database, containing 343 suicide events recorded between 1981 and 1996, was created by the Social Services Branch of the GNWT (now the Department of Health and Social Services) through cross-referencing of data from the coroner, health services and vital statistics. Events from this source were used to calculate suicide rates for various population subgroups of the Northwest Territories and for different time periods. Average annual rates were calculated by age, sex, ethnicity and region for the period 1986-1996 (11-year period). The population census for 1991 (mid-year for the period) was used as the denominator. For exploring changes over time, rates were calculated for three five-year periods, using mid-year population estimates as the denominators. We calculated direct age-standardized suicide rates using the 1991 Canadian census population for Eastern NWT (Nunavut) and Western NWT, to allow for comparison with the Canadian experience. Otherwise, crude rates were used for both time and geographic comparisons within the NWT. Indirect age-standardized rates, originally calculated using NWT rates as the standard, were not noticeably different from the crude rates used.
The coroner's records of all 78 individuals who committed suicide during the three-year period 1994-1996 were manually reviewed and information was extracted using a standard data retrieval form. Information was retrieved on demographics (age, sex, ethnicity, employment, marital status), cause of death, toxicology findings, events and behaviours immediately preceding death and mental health history, where available.
Over the 11 years from 1986 to 1996, there were 261 deaths due to suicide in the NWT. The average annual rate of suicide for the NWT was 41.3 per 100,000 population. The direct age-standardized rate was 36.7 per 100,000. The crude suicide rate for Nunavut (77.9 per 100,000) was almost four times the crude rate for Western NWT (19.9 per 100,000). Direct age-standardized rates were 67.4 per 100,000 and 18.9 per 100,000, respectively. On a regional basis, the further east the region is located, the higher the crude rate of suicide for both males and females (Figure 1). The higher rate of suicide for Nunavut compared to Western NWT is maintained across age and sex groups. The average annual suicide rate for males is 119 per 100,000 in Nunavut and 34 per 100,000 in Western NWT, while the respective rates for females are 32 and 17 per 100,000. Those aged 15-29 are at highest risk (Figure 2). In our calculations of annual suicide rates by ethnic group, the highest rate occured among the Inuit, at 79 per 100,000, compared with 29 per 100,000 for the Dene and 15 per 100,000 for all other ethnic groups in the NWT, primarily non-aboriginal. |
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Trends Figure 3 illustrates an increase in the suicide rate for Nunavut over three five-year periods from 1982 to 1996. The average annual rate for the most recent period (1992-1996) is almost twice that of the first period (1982-1986). Conversely, the rate of suicide for Western NWT declined over the same time span. For the NWT as a whole, the rate of suicide by hanging doubled over the three time periods while rates by other methods showed a moderate decline (Figure 4). In Nunavut alone, suicide by hanging jumped from 27 per 100,000 for the period 1982-1986 to 57 per 100,000 for the period 1992-1996; suicide by firearms also rose from 19 to 28 per 100,000, a 50% increase.
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Results of Coroner's Record Review
Of the 78 cases of suicide reviewed for the period 1994-1996 using coroner's reports, 61 (78%) were male, 56 (73%) were between 15 and 29 years of age, 68 (87%) were Inuit, 53 (68%) were single and never married, 41 (53%) were unemployed and 60 (77%) lived with family members.
Suicide events were almost equally distributed across the three years with 26 in 1994, 24 in 1995 and 28 in 1996. A moderate peaking of events (26/78 or 33%) occurred during the third quarter of the year (summer), July to September. Most suicide acts (actions that led to death) were estimated to have occurred between evening (10 pm) and morning (10 am) [44/71 or 62%]. The length of time between the act and discovery averaged 8 hours, with a median of 2 hours, and ranged between 0 and 108 hours (n=76) . The peak 4-hour period for committing the suicide act was between midnight and 4 am (20/71 or 28%).
Thirteen suicides (17%) occurred among residents of Western NWT and sixty-five (83%) among residents of Nunavut. Among the three regions of Nunavut, Baffin Region had the highest number of suicides (36), representing 46% of all suicides in the NWT between 1994 and 1996. The suicide occurred most often near or in the home of the deceased (58/78 or 74%). Twenty-four suicides (31%) took place by hanging in a bedroom closet.
Our review of coroner's cases revealed hanging as the most frequent method of suicide used by both sexes (13 or 77% of females, and 36 or 59% of males). Among the 68 Inuit who committed suicide, 46 (68%) died by hanging and 20 (29%) died from a gunshot wound. Of the 10 non-Inuit suicide cases, 7 (70%) died from a gunshot.
The events most frequently identified as coincident with the suicide were a family or relationship breakup in the last year (28 or 36% of cases) or a pending criminal proceeding (16 or 21%). Ten of the sixteen individuals with pending criminal proceedings were facing charges of sexual or other assault. Efforts to resuscitate the suicide victim occurred in 30 cases (39%). These resuscitation efforts occurred more often if the method of suicide was hanging (24/49 or 49%) as opposed to the use of a firearm (4/27 or 15%), or if the individual was discovered within the first hour following the suicide act (21/31 or 68% vs 7/35 or 16%). Attempts were made to resuscitate all 16 individuals who used hanging and who were discovered within the hour following their suicide act.
Blood alcohol results were available on 61 of the 78 cases (78%). Results were not available on others primarily because of an inability to take adequate samples of body fluids (blood or urine) from individuals discovered some time after death. Of those sampled, 35 (57%) had no alcohol detected in their blood, and another 6 (10%) had alcohol levels below the legal limit for impairment (17 mmol/L). Those considered impaired at the time of death numbered 20 (33%). Adults 25 years and older were more often intoxicated at the time of death than were youths aged 24 or less (12 of 24, or 50% vs 8 of 37, or 22%). Drug screens based on urinalysis were available for 37 cases (47%) . Of these, 8 tested positive for canabinoids. No other illicit drugs were detected.
Almost all of the suicide victims (73 or 94%) were reported as being with others during the 24 hours prior to their death. Forty-six suicides (59%) were reported as occuring while others were on the same premises. In 68 (88%) of the 78 cases, one or more distressed or unusual behaviours were noted during the 24 hours before death, including 21 cases (31%) who made a statement of suicide intent. Attempts to assist the individual with his or her distressed state were reported in 14 cases (18%).
Thirty-one of the suicide victims (40%) had a history of previous suicide attempts, and forty-four cases (56%) were reported to have made a statement of suicide intent at some time in their past. More than one quarter of the victims (27%) had lost at least one friend or relative to suicide. The records showed that 22 of the suicide victims (28%) had sought help for social or mental health problems, 10 (13%) had seen a professional care-giver in the week prior to the suicide and 50 (64%) had a history of emotional distress or depression. Thirty-six cases (46%) had a reported history of alcohol abuse, and 22 (28%) had a history of drug abuse. Nineteen suicide cases (24%) had a criminal and/or other conviction on record. All 16 individuals with criminal convictions were males (26% of the males).
The upward trend in the suicide rate among residents of Nunavut over the last 15 years is striking, as is the difference in rates between Nunavut and Western NWT. This information implies a rising risk of suicide among the Inuit of Nunavut, who make up 85% of the population in this region. From 1986 to 1996, the direct age-standardized rate for Nunavut, was 67.4 per 100,000 persons, five times the national rate reported in 1992 (13 per 100,000). The age-standardized rate for the NWT as a whole was 36.7 per 100,000, almost three times the national rate. In both this review and another one involving the aboriginal people of British Columbia,3 homes were not safe havens for individuals at risk of suicide. Opportunities exist in the home; in the NWT, hanging was the suicide method most often used and is the primary method of recent years. The predominance of hanging, specifically among the Inuit, differs from other suicide studies in which the use of firearms ranks first.1 The most frequent method of suicide used by Manitoba aboriginals was also identified as hanging.4 This report does not offer an explanation as to why suicide rates in the NWT are so high. We do know that, as with other populations in Canada including aboriginal groups, those most at risk of suicide are males and persons 15-29 years of age.1,3,4 In addition, we observed some of the more prominent characteristics and circumstances of the individuals who committed suicide in this NWT population: 36% of the people who committed suicide between 1994 and 1996 had experienced a recent relationship breakup and 21% were facing criminal proceedings. Also in our study, alcohol intoxication at the time of suicide was observed in 33% of the cases. This differs from two other Canadian suicide studies involving aboriginal groups, where alcohol intoxication at time of death was noted in 60% and 65% of cases.3,4 In a study of Alaskan natives, 79% of suicide cases involved alcohol.5 As reported in the literature, the causes of suicide are complex.6,7 There is a need to distinguish between the historic experiences and general characteristics of individuals that place them at higher risk of suicide (distal risk factors) and the more immediate risk factors or triggers (proximal risk factors), such as a family breakup or other stressful life event.8 In the North, distal risk factors may be systemic to the life experience of many communities-unemployment, poverty, poor education, lack of opportunity and loss of cultural identity.1,7,9 Dealing with the distal issues at a societal level may help to reduce the number of people vulnerable to committing suicide in the long term. Of immediate need are tools, methodologies and training opportunities that will help to identify currently vulnerable individuals, the situations or conditions that heighten their vulnerability at any one time and their risk behaviours, so that professionals as well as immediate friends and family can be alerted to the imminent danger of suicide.1,3 Community members need to be empowered to act with the appropriate resources-within themselves or through access to emergency services-in order to avert future tragedies.
The coroner's files consisted of the investigating RCMP officers' and coroner's written documentation of the behaviours and events surrounding each suicide. These were based on the accounts of other individuals who knew the deceased, primarily relatives and friends. Reports concerning the 24 hours preceding the suicide were the most detailed and, because of the immediacy to the event, the most reliable. However, the thoroughness of each investigation and/or completeness of the coroner's report did vary by case. Consequently, behaviours and events captured in this review are likely underreported. Suicide rates for the Northwest Territories can vary dramatically from one year to the next due to the small size of the population (65,000) and any subgroup thereof. We tried to compensate for this instability by combining years of data in order to calculate rates and then estimate average annual rates. By inference, there is a need to continue long-term surveillance of the suicide phenomenon in Nunavut and Western NWT in order to detect true shifts in trends and the impact of any new or enhanced interventions that may be introduced.
1. Health Canada. Suicide in Canada: update of the report of the Task Force on Suicide in Canada. Ottawa: Mental Health Division, Health Services Directorate, Health Programs and Services Branch; 1995; Cat No H39-107/1995E. 2. Mao Y, Moloughney BW, Semenciw RM, Morrison H. Indian reserve and registered Indian mortality in Canada. Can J Public Health 1992;83(5):350-3. 3. Cooper M, Corrado R, Karlberg AM, Adams LP. Aboriginal suicide in British Columbia: an overview. Canada's Mental Health 1992 Sept:19-23. 4. Malchy B, Enns MW, Young K, et al. Suicide among Manitoba's aboriginal people, 1988 to 1994. Can Med Assoc J 1997;156(8):1133-8. 5. Hlady WG, Middaugh JP. Suicides in Alaska: firearms and alcohol. Am J Public Health 1988;78(2):179-80. 6. O'Carroll P. Suicide causations: pies, paths and pointless polemics. Suicide and Life-Threatening Behavior 1993;23(1):27-36. 7. Hasselback P, Lee KI, Mao Y, et al. The relationship of suicide rates to sociodemographic factors in Canadian census divisions. Can J Psychiatry 1991;36:655-9. 8. Moscicki EK. Gender differences in completed and attempted suicides. Ann Epidemiol 1994;4(2):152-8. 9. MacMillan HL, MacMillan AB, Offord D, Dingle JL. Aboriginal health. Can Med Assoc J 1996;155(11):1569-77.
Author References Sandy Isaacs and Jamie Hockin, Field Epidemiology Training Program, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario Susan Keogh, Department of Health and Social Services, Government of the Northwest Territories Cathy Menard, Office of the Chief Coroner, Northwest Territories Correspondence: Sandy Isaacs, Epidemiologist, Wellington-Dufferin-Guelph
Health Unit, 125 Delhi Street, Guelph, Ontario N1E 4J5; |
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Last Updated: 2002-10-22 |  |
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