males in the general population. Over the age of 55 the rate declines dramatically to half that of general population males. For Indian and Alaska Native males, the risk is highest in the young years but tapers off substantially in the older years, the very years when white males most commonly complete suicide.

Young Indian females (5–34) have rates of suicide that are 2.2 to 3.6 times higher than females in the general population. For example, for ages 15–24 the rate is 11/100,000. However, by 35 through 44 years, the rate is 1.5 times the general population, and 45 years to 75 years is approximately the same as or slightly less than the general female population. At 55–75, the rate is 5/100,000. American Indian women 75 years of age and older do not complete suicide with any measurable frequency. Therefore, while Indian and Alaska Native females have substantially lower rates than Indian and Alaska Native males, their rates are higher than other women in the country until age 44, and then they are approximately the same until age 75, when suicides no longer occur (Indian Health Service, 1999).

The decrease in Indian suicide during the early 1980s has been attributed to the changing denominators in the United States, stemming from better enumeration of Indians in Census data and an increased tendency for self-identification as Indian or Native. But the more stable and easily-monitored data from the State of New Mexico, where neither of these phenomena have occurred over the same time period, has also shown a definite and similar reduction in incidence of suicide among Indians. Among the three major Indian cultural groups (the Navajo, Pueblo, and Apache) in the late 1980s, a substantial drop occurred and a leveling of rates was evident in the 1990s (New Mexico Vital Records and Health Statistics, 2000; VanWinkle and May, 1993). In fact, the aggregate rates for the nineteen Pueblo Indian tribes have continued to drop throughout the 1990s (VanWinkle and Williams, 2001).

Among American Indian and Alaska Native suicide, gunshot wounds, hanging, and other violent means predominate (Wallace et al., 1996). American Indians also have high rates of other violent deaths including motor vehicle crashes (Guerin, 1991; Guerin, 1998; Jarvis and Boldt, 1982; Katz and May, 1979; May, 1989), a small percentage of which are believed to be covert suicides (Hackenberg and Gallagher, 1972; May, 1987; Stull, 1972; Stull, 1973; Stull, 1977; Wills, 1969). In studies of Alaska Natives, firearms have been the predominant method of suicide at 75 to 85 percent (Forbes and Van Der Hyde, 1988; Hlady and Middaugh, 1988; Kost-Grant, 1983), as in studies of the American Plains, and 55 percent in the American Southwest during the same period (Shuck et al., 1980; VanWinkle and May, 1986; VanWinkle and May, 1993). In Canada the same pattern prevails where firearms account for 55 to 82 percent (Butler,



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