Whites must be considered. In the Epidemiologic Catchment Area study (ECA) of the 1980s, African Americans had higher levels of any lifetime or current disorder than whites (Robins and Regier, 1991). This was true both over the respondent’s lifetime (Robins and Regier, 1991) and over the past month (Regier et al., 1993). When the ECA study and the more recent National Comorbidity Survey (NCS) (Kessler et al., 1994) took into account differences in age, gender, marital status, and socioeconomic status, the black–white difference was eliminated.

The impact of these findings on suicide is difficult to discern, especially in light of the findings of the NMHA (2000) survey on attitudes and beliefs about depression in the African-American community. This survey revealed that the majority think depression is a “personal weakness” and only a third (compared to 69% of the general population) recognize depression as a “health problem” for which they would be willing to take prescribed medication. For further discussion of these issues, see Chapter 6, and the sections in Chapter 7 on faith-based interventions, and Chapter 9 on barriers to treatment.

Native Americans3 and Alaska Natives

The rate of suicide among Indians and Alaska Natives of the United States is about 1.7 times the rate of the nation as a whole (Indian Health Service, 1999). Between 1975 and 1977 the rates peaked at 22.5/100,000 and decreased to a low of 16.0 in 1984 through 1986. Since then it increased to its current rate of 19.3 per 100,000 in 1995 (Indian Health Service, 1999). In contrast, over the past 40 years, rates of violence have generally declined for American Indians (Hisnanick, 1994). Suicide takes a significant toll.

As illustrated in Figure 2-6, suicide deaths for American Indian males are substantially higher overall than for other ethnic groups. They also show a different pattern across the life-span. For ages 5 through 14 the suicide rate is three times higher for Indian males than the general population, ages 15 through 34 years it is 2.5 times higher, and for ages 35 through 44 years it is 1.5 times higher (Indian Health Service, 1999). The male rate peaks at 67 per 100,000 in ages 25–34, and is somewhat lower for the next youngest age group (15–24) at 54 per 100,000. However, by age 45 Indian males complete suicide at a rate that is approximately the same as


The term American Indian is used throughout this manuscript to denote those residents of the United States and Canada who belong to ethnic groups indigenous to North America (prior to 1492). This is the general term preferred by many Natives in the United States, when it is not possible to denote specific tribal affiliation.

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