Suicidal behavior among indigenous Sami in Arctic Norway : a special focus on adolescents and young adults

Since the 1950’s the global suicide rates have continued to increase, and today suicide has become an important public-health problem worldwide (World Health Organization (WHO), 2002). According to WHO there are approximately one million deaths from suicide each year worldwide, and about 20 times this number of people attempt suicide (2002). There are substantial variations in the national suicide rates (Lester, 1997), and in addition great variation in rates within the same country and between different ethnic groups (Roberts, Chen & Roberts, 1997). During the last decades suicide rates have increased alarmingly among indigenous people, and especially among indigenous residing in the Arctic, such as the lnuit in Greenland (Leineweber et al., 2001) and in Canada (Sigurdson et al., 1994), and among Alaskan Natives in the US (Borowsky et al., 1999). The increase in suicide rates among indigenous people in the Arctic have been so alarmingly high that it has been described as an epidemic level (Bjerregaard & Lynge, 2006; Leenaars, 2006) and it has been declared that certain indigenous people have the highest suicide risk of any identifiable cultural (or ethnic) group (Leenaars, 2006; Kirmayer, 1994). Unfortunately, suicide has become the leading cause of death for young indigenous people, especially among males, and is a significant contributor to potential years of life lost. Although there is carried out research on the prevalence of suicidal behavior among several indigenous people, e.g. in Canada, Alaska, Greenland, Sweden, Australia, New Zealand, our understanding of suicidal behavior among indigenous people is still limited (Cutcliffe, 2005; Leenaars, 2006; Stewart, 2005). There is no registration of ethnicity in the national population register in Norway, for that reason there are neither official statistics of health and living conditions nor suicide rates for indigenous Sami (hereafter called Sami). There have so far been conducted limited research on health and living conditions among Sami in Norway, and suicidal behavior has not previously been studied in a systematically way. Although some Sami communities have experienced high rates of suicides, there is in general lack of specific prevention strategies. Epidemiological knowledge about suicidal behavior among Sami is important for implementation of appropriate prevention strategies in Sami communities, and in addition useful to public health practitioners and policy makers in addressing this problem

“Mapping suicide prevention initiatives targeting Indigenous Sámi in Nordic countries”

Background - Suicide is a major public health issue among Indigenous Sámi in Nordic countries, and efforts to prevent suicide in the Sámi context are increasing. However, there is no literature on suicide prevention initiatives among Sámi. The aim of the study was to map suicide prevention initiatives targeting Sámi in Norway, Sweden, and Finland during 2005–2019. Method - Initiatives were identified and described through utilizing networks among stakeholders in the field of suicide prevention among Sámi, acquiring documentation of initiatives and utilizing the authors first-hand experiences. The described initiatives were analyzed inspired by the “What is the problem represented to be?” (WPR)-approach. Results - Seventeen initiatives targeting Sámi were identified during 2005–2019, including nine in Sweden, five in Norway, one in Finland and two international initiatives. Analysis with the WPR-approach yielded 40 problematizations regarding how to prevent suicide among Sámi, pertaining to shortcomings on individual (5), relational (15), community/cultural (3), societal (14) and health systems levels (3). All initiatives were adapted to the Sámi context, varying from tailor-made, culture-specific approaches to targeting Sámi with universal approaches. The most common approaches were the gatekeeper and mental health literacy training programs. The initiatives generally lacked thorough evaluation components. Conclusion - We argue that the dominant rationales for suicide prevention were addressing shortcomings on individual and relational levels, and raising awareness in the general public. This threatens obscuring other, critical, approaches, such as broadening perspectives in prevention planning, improving health systems for Sámi, and promoting cultural empowerment among Sámi. Nevertheless, the study confirms considerable efforts have been invested into suicide prevention among Sámi during the last 15 years, and future initiatives might include a broader set of prevention rationales. To improve evaluation and identify the most promising practices, increased support regarding development of plans and implementation of evaluation components is needed

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study

Source at http://dx.doi.org/10.1136/bmjopen-2019-031810. Objectives: Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations. Design: Population-based cross-sectional study. Setting: The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014. Participants: The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m2) whereof 1384 underestimated their weight (42%). Primary and secondary outcome measures: Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status. Results: A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status. Conclusions: Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women

"Sorg er tungt. Det er ikke bare å glemme" – Etterlatte ved selvmord i samiske områder

Selvmord er et betydelig samfunns- og folkehelseproblem globalt og nasjonalt. Selvmord forekommer også i samiske samfunn hvor flere bygder og familier er hardt rammet. Det er med andre ord mange etterlatte ved selvmord i Sápmi. Dette kapitlet setter søkelys på ulike utfordringer som etterlatte i samiske områder kan oppleve i møte med det lokale hjelpeapparatet. I kapitlet diskuteres utfordringer knyttet til det å motta hjelp i små samfunn og manglende tillit til hjelpeapparatet. Avslutningsvis problematiseres betydningen av å ha kunnskap og forståelse for etterlattes situasjon og den kulturelle konteksten han eller hun lever i.Iešsorbmen lea fuopmášahtti servodat- ja álbmotdearvvašvuođaváttisvuohta globálalaččat ja sisriikkalaččat. Iešsorbmen dáhpáhuvvá maiddái sámi servodagain gos ollu gilit ja bearrašat leat bahuid vahágahtton. Eará sániiguin, Sámis leat ollu oapmahaččat maŋŋá iešsorbmema. Dát kapihtal čalmmustahttá iešguđetlágán hástalusaid maid oapmahaččat sámi guovlluin vásihit go deaivvadit báikkálaš veahkehanásahusain. Kapihttalis digaštallat hástalusaid čadnon dasa go galgá veahki oažžut smávva servodagažiin ja veahkkeásahusa váilevaš ipmárdusa. Loahpas problematiseret makkár mearkkašupmi lea máhtus ja ipmárdusas oapmahaččaid dilálašvuođa birra ja dan kultuvrralaš konteavsttas mas son eallá

Symptovmh byöpmedimssturremidie jïh madtjelesvoetese jïjtse kråahpine

I dagens samfunn er overvekt og fedme hyppig forekommende og har derfor blitt mer akseptert i store deler av befolkningen. Samtidig fokuseres det i media på at idealet er å være slank, sunn og i god fysisk form. I to studier av deltakere i SAMINOR 2 – den kliniske undersøkelsen (2012–2014), var vi interessert i å studere symptomer på spiseforstyrrelser (Studie 1) og om underestimering av overvekt hadde sammenheng med lavere grad av symptomer på angst og depresjon (Studie 2). Vi fant at kvinner gjennomsnittlig hadde høyere totalskår med hensyn til symptomer på spiseforstyrrelse enn menn. De som rapporterte symptomer på spiseforstyrrelse, var nesten alle overvektige og hadde også høyere sannsynlighet for å rapportere angst og depresjon. Det var ingen betydelige forskjeller mellom samisk og ikke-samisk befolkning når det gjelder disse sammenhengene, men samer rapporterte mer trøstespising. Blant samiske menn og ikke-samiske kvinner var det lavere forekomst av symptomer på angst og depresjon blant de som var overvektige, men som selv enten synes de var normalvektige eller tynne. For samiske kvinner og ikke-samiske menn fant vi ingen slik sammenheng.Daan beajjetje seabradahkesne bijjieleavloe jïh buajtehksvoete daamtaj gååvnesieh jïh leah dan åvteste vielie jååhkesjamme sjïdteme stoerre bieline årroejijstie. Seamma tïjjen medija jarngesne åtna åvteguvvie lea skaejlies, aejlies jïh vervesne årrodh. Göökte goerehtimmine dejstie mah lin meatan SAMINOR 2 – klinihkeles goerehtimmesne (2012–2014), ïedtjem utnimh symptovmh goerehtidh byöpmedimssturremasse (Goerehtimmie 1) jïh mejtie fer vuelege aarvehtse bijjieleavloste naan såarhts ektiedimmiem utni viesjiehtåbpoe symptovmigujmie asvese jïh depresjovnese (Goerehtimmie 2). Mijjieh gaavnimh nyjsenæjjah gaskemedtien jienebh symptovmh byöpmedimssturremidie utnin goh ålmah. Mahte gaajhkesh dovnesh mah symptovmh byöpmedimssturremidie reektin, bijjieleavloem utnin jïh dah sån aaj stuerebe aarvehtsem utnin asvem jïh depresjovnem reektedh. Ij lij naan stoerre joekehtsh saemien jïh daaroen årroji gaskem gosse lea daej ektiedimmiej bïjre, men saemieh vielie soelkehtsbyöpmedimmien bïjre reektin. Saemien ålmaj jïh daaroen nyjsenæjjaj gaskem lij vaenebh symptovmh asveste jïh depresjovnese dej gaskem mah bijjieleavloem utnin, men mah jïjtjh vïenhtin dah iemie leavloem utnin jallh lin siegkie. Saemien nyjsenæjjide jïh daaroen ålmide idtjimh dagkeres ektiedimmiem gaavnh

Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates

Objectives. Self-rated health (SRH) and associated risk and protective correlates were investigated among two indigenous adolescent populations, Greenlandic Inuit and Norwegian Sami. Design. Cross-sectional data were collected from ‘‘Well-being among Youth in Greenland’’ (WBYG) and ‘‘The Norwegian Arctic Adolescent Health Study’’ (NAAHS), conducted during 2003 2005 and comprising 10th and 11th graders, 378 Inuit and 350 Sami. Methods. SRH was assessed by one single item, using a 4-point and 5-point scale for NAAHS and WBYG, respectively. Logistic regressions were performed separately for each indigenous group using a dichotomous measure with ‘‘very good’’ (NAAHS) and ‘‘very good/good’’ (WBYG) as reference categories. We simultaneously controlled for various socio-demographics, risk correlates (drinking, smoking, violence and suicidal behaviour) and protective correlates (physical activity, well-being in school, number of close friends and adolescent parent relationship). Results. A majority of both Inuit (62%) and Sami (89%) youth reported ‘‘good’’ or ‘‘very good’’ SRH. The proportion of ‘‘poor/fair/not so good’’ SRH was three times higher among Inuit than Sami (38% vs. 11%, p50.001). Significantly more Inuit females than males reported ‘‘poor/fair’’SRH(44% vs. 29%, p50.05),while no gender differences occurred among Sami (12% vs. 9%, p50.08). In both indigenous groups, suicidal thoughts (risk) and physical activity (protective) were associated with poor and good SRH, respectively. Conclusions. In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer SRH among Sami and Inuit. The Inuit Sami differences in SRH could partly be due to higher ‘‘risk’’ and lower ‘‘protective’’ correlates among Inuit than Sami. The positive impact of physical activity on SRH needs to be targeted in future intervention programs

The association of religious factors with mental health-service utilisation and satisfaction in a mixed Sámi and Norwegian adult population: Adopting the SAMINOR 2 Questionnaire Survey

The Indigenous Sámi have poorer mental health than the majority population and fairly equal access to professional mental healthcare. Despite this condition, certain studies indicate that this group is underrepresented among the users of such services. Religion or spirituality (R/S) often influences mental health-service utilisation and satisfaction among other Indigenous peoples and ethnic minorities. Thus, this study examines the situation in Sámi-Norwegian areas. We utilised cross-sectional data from the population-based SAMINOR 2 Questionnaire Survey (2012; subsample n = 2,364; 71% non-Sámi) in mixed Sámi-Norwegian regions of Northern and Central Norway. We analysed the associations between R/S factors and past-year mental health-service utilisation and satisfaction among individuals reporting mental health problems, substance use, or addictive behaviours. Multivariable-adjusted regression models considering sociodemographic factors, including Sámi ethnicity, were applied. Religious attendance was significantly associated with infrequent past-year use of mental health services (OR = 0.77) and fewer mental health problems, indicating that the R/S fellowship may buffer mental distress and represent an alternative psychological support to professional services. R/S was not significantly associated with lifetime mental health-service satisfaction. We found no ethnic differences in service utilisation or satisfaction

A scoping review of Indigenous suicide prevention in circumpolar regions

Background. Suicide is a serious public health challenge in circumpolar regions, especially among Indigenous youth. Indigenous communities, government agencies and health care providers are making concerted efforts to reduce the burden of suicide and strengthen protective factors for individuals, families and communities. The persistence of suicide has made it clear that more needs to be done. Objective. Our aim was to undertake a scoping review of the peer-reviewed literature on suicide prevention and interventions in Indigenous communities across the circumpolar north. Our objective was to determine the extent and types of interventions that have been reported during past decade. We want to use this knowledge to support community initiative and inform intervention development and evaluation. Design. We conducted a scoping review of online databases to identify studies published between 2004 and 2014. We included articles that described interventions in differentiated circumpolar Indigenous populations and provided evaluation data. We retained grey literature publications for comparative reference. Results. Our search identified 95 articles that focused on suicide in distinct circumpolar Indigenous populations; 19 articles discussed specific suicide-related interventions and 7 of these described program evaluation methods and results in detail. The majority of publications on specific interventions were found in North American countries. The majority of prevention or intervention documentation was found in supporting grey literature sources. Conclusion. Despite widespread concern about suicide in the circumpolar world and active community efforts to promote resilience and mental well-being, we found few recorded programs or initiatives documented in the peer-reviewed literature, and even fewer focusing specifically on youth intervention. The interventions described in the studies we found had diverse program designs and content, and used varied evaluation methods and outcomes. The studies we included consistently reported that it was important to use communitybased and culturally guided interventions and evaluations. This article summarizes the current climate of Indigenous circumpolar suicide research in the context of intervention and highlights how intervention-based outcomes have largely remained outside of peer-reviewed sources in this region of the world

What is known about the health and living conditions of the indigenous people of northern Scandinavia, the Sami?

The Sami are the indigenous ethnic population of northern Scandinavia. Their health condition is poorly known, although the knowledge has improved over the last decade.The aim was to review the current information on mortality, diseases, and risk factor exposure in the Swedish Sami population.Health-related research on Sami cohorts published in scientific journals and anthologies was used to compare the health condition among the Sami and the majority non-Sami population. When relevant, data from the Sami populations in Swedish were compared with corresponding data from Norwegian and Finnish Sami populations.Life expectancy and mortality patterns of the Sami are similar to those of the majority population. Small differences in incidences of cancer and cardiovascular diseases have been reported. The traditional Sami lifestyle seems to contain elements that reduce the risk to develop cancer and cardiovascular diseases, e.g. physical activity, diet rich in antioxidants and unsaturated fatty acids, and a strong cultural identity. Reindeer herding is an important cultural activity among the Sami and is associated with high risks for accidents. Pain in the lower back, neck, shoulders, elbows, and hands are frequent among both men and women in reindeer-herding families. For men, these symptoms are related to high exposure to terrain vehicles, particularly snowmobile, whereas for women psychosocial risk factors seem to more important, e.g. poor social support, high effort, low reward, and high economical responsibilities.Although the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami. Most of these problems have their origin in marginalization and poor knowledge of the reindeer husbandry and the Sami culture in the majority population. It is suggested that the most sustainable measure to improve the health among the reindeer-herding Sami would be to improve the conditions of the reindeer husbandry and the Sami culture

A review of protective factors and causal mechanisms that enhance the mental health of Indigenous Circumpolar youth

Objectives: To review the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North. Study design: A systematic literature review of peer-reviewed English-language research was conducted to systematically examine the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with elements of a realist review. From 160 records identified in the initial search of 3 databases, 15 met the inclusion criteria and were retained for full review. Data were extracted using a codebook to organize and synthesize relevant information from the articles. Results: More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature