Inuit Youth Suicide - Mini-Systematic Review [FINAL]

A Comparison of Studies on the Effects of Abuse
on Youth Suicide Rates in the Inuit Population of
Canada: A Systematic Review of the Literature
Amber Armstrong-Izzard, Vithusan Arunakirinathan, Gregory Attersley, Jordyn Delaney
Completed for HLSC 3820U: Public Health I; Dr. Wally J. Bartfay, University of Ontario
Institute of Technology
Abstract
Background and Purpose: There has been very limited amounts of studies conducted to
investigate the risk factors associated with suicidal behaviors in youth belonging to the Inuit tribe
residing in Canada. The purpose of this systematic review of the literature was to evaluate and
identify the factors influencing suicidal behaviors (i.e. suicidal ideation, suicide attempts, and
increased-risk taking) in Inuit youth.
Aims: The aim in this report is to review and integrate the present research literature to develop a
stronger understanding of the factors that influence and origins of the continually increasing
prevalence of suicidal behaviours of Inuit youth in Canada.
Methods: A comprehensive research process and critical appraisal was conducted to identify peer-
reviewed articles of youth suicide risk factors through scholarly databases including PubMed,
ProQuest, Cochrane Library, and the University of Ontario Institute of Technology (UOIT) Library.
Conclusion: Further studies are needed to identify and evaluate the various factors, its interactions,
and impacts that result in the greater prevalence of youth suicide among the Inuit population in
Canada.
Keywords: youth, suicide, Aboriginal, Canada, abuse, depression

The Effects of Abuse on Youth Suicide Rates in the Inuit Population of Canada 1
Armstrong-Izzard, Arunakirinathan, Attersley, & Delaney April 1,
2016
Introduction
The Inuit populations possess a holistic view towards mental wellness. In their perspective, it is a state
of balance with family, community and their environment and because of this, the European model of
treatment has shown to be unsuccessful and often detrimental. The loss of one’s life through suicide is
a tragic reality and has numerous negative impacts in Inuit communities. A review of the literature
shows that Inuit youth suicide (IYS) is occurring at alarming rates across Canada. Suicide rates for
Inuit youth are among the highest in the world which poses a major health concern [1]. Suicide results
from the interaction of many different personal, historical, and contextual factors. Suicide accounted
for 40% of all deaths of young people in Inuit populations versus 8% elsewhere in Canada [2]. Suicide
in Inuit populations can be attributed to multiple factors which include: family problems, alcohol
dependence, culture loss and sexual abuse.
Methods
The aim of the review was to identify current literature pertaining to the relationship between IYS rates
in Canada and its associated factors. A comprehensive search was conducted on PROQUEST,
PUBMED and SCHOLARS PORTAL databases using the keywords: “youth, suicide, Inuit, substance
abuse, Canada and depression”. The search was limited to articles from Canada, articles in English and
articles published in the last 5 years. The specific dates searched were March 2011 to March 2016 and
full text articles were assessed for eligibility. Of the 59 articles extracted using this search method six
of the articles meet the inclusion criteria.
Inclusion and Exclusion Criteria
Articles must include information pertaining to IYS rates, ages 12-24 and the factors that are associated.
Articles were limited to full text format.

Armstrong-Izzard, Arunakirinathan, Attersley, & Delaney April 1,
2016
Figure 1. Diagram of research and review process. The following figure outlines the methods and approach
employed to gather peer-reviewed literature pertaining to youth suicide rates among the Inuit population in
Canada. The primary search criteria involved gathering literature that was published between the period of
January 2011 and March 2016. This diagram also includes the amount of results were gathered from the
respective databases based on a series of applied filters and the defined search criteria.
Impact of Alcohol Abuse on Suicidal Behaviours
Alcohol use was found to be a contributing factor to youth suicide in three of the six articles. One study
examined suicidal and non-suicidal males and females, ranging in age from 18 to 24 years, for alcohol
dependence and its relation to suicide attempts. Of those who attempted suicide during the twelve months
prior to their attempt, 57.1% of males and 43.3% of females abused alcohol [3]. Non- suicidal subjects
reported that 28.6% of males and 39.2% of females were dependent on alcohol [3]. One study found that
in Nunavut 21-46% of the Inuit youth who committed suicide had a history of alcohol abuse [4]. Another

Armstrong-Izzard, Arunakirinathan, Attersley, & Delaney April 1, 2016
study found in a univariate analyses that subjects who died from suicide were more likely to have
experienced or suffered from alcohol dependence in their lifetime [5].
Impact of Family Issues on Suicidal Behaviours
The deterioration of a family unit wreaks havoc on the mental well-being of Inuit youth. Five of the six
articles collected investigate the family role. An alarming fact is that Inuit youth are unlikely to seek
assistance from official health service agencies [6]. The prevalence of mental illness over a period of six
months or a lifetime was also found to significantly increase the likelihood of suicide when compared to
non-mentally ill individuals [5]. It was found that the absence of family communication as well as
traditional cultural values and practices leads to the loss of mental well-being and happiness in Inuit
youth [7]. Constant change in the family structure presents itself as a key trigger for a large portion of
IYS due to less interaction with elders [7]. Parental figures suffering from alcoholism as well as drug
and/or gambling addictions are more likely to engage in domestic abuse resulting in most Inuit youth
having experienced violence in the home [8, 6]. A decrease in communication between parents and
youth, less family activities and changing parenting styles are also found to be contributing factors to
increased prevalence of IYS [4]. Youth who had a family history of mental illness and suicide showed
an increase in suicide rates when compared to Inuit youth without a family history of mental illness [5].
Sexual Abuse
Sexual abuse was found to be a contributing factor to youth suicide in three of the six articles reviewed.
One article suggested that unhappiness stemmed from sexual abuse within the family and contributed to
youth suicide [4]. Another article found that 50% of males who attempted suicide in the past 12 months
and 86.4% of females who attempted suicide in the past 12 months reported lifetime sexual abuse [3].
Another article stated that 15.83% of those that committed suicide suffered from sexual abuse [5].

Loss of Cultural Identity and Social Exclusion
Two of six articles reviewed found that culture loss was associated with youth suicide. Two of six articles
reviewed found that culture loss was associated with youth suicide. Both articles suggested that suicide
can be attributed to factors associated with colonial social influence that has altered the Inuit community
[8, 4].
Discussion
There is growing awareness about colonialism and how it influenced the Inuit community. The majority
of available literature addresses the common factors that contribute to poor mental health outcomes
among Inuit youth. However, there are few current studies that examine how all of these factors relate
to the increased prevalence of suicidal behaviours in this population. The analysis of the literature
revealed many similarities in the factors that lead to increased suicidal behaviours including alcohol
abuse, family issues, alcohol dependence and a loss of cultural identity.
A history of alcohol dependence presented itself to be a notable issue that was examined in three
of the six articles included. Each of the three articles found that there was an increased prevalence of
suicide in those who had a history of alcohol dependence. A well-structured survey was conducted which
asked a list of comprehensive questions that did not only pertain to alcohol and drug use [3]. They found
that 57.1% of males and 43.3% of females abused alcohol twelve months prior to attempting suicide [3].
Similarly, another study found 21-46% of youth who did commit suicide also had a history of alcohol
abuse [4]. Researchers also looked into the underlying causes of alcohol use such as the history of sexual
abuse in the survey participants [3]. All three papers present the important fact that greater access to
mental health services for Inuit youth is needed, as well, factors such as sexual abuse may lead to alcohol
abuse. Amongst all of the papers, there is a lack of investigation into how Inuit youth are getting alcohol
and how easy it is. It would be wise to conduct further research in this area.

Family issues proved to be the largest factor associated with higher suicide rates. Five of six
papers examined factors such as a family history of mental illness, substance use and marital status. It
was found that regular changes in family structure was a factor in increasing the likelihood of depression
which is also a factor for increasing the chances of youth committing suicide [7, 5]. The family unit
seemed to be the root of multiple factors, such as parents who are drug or alcohol users were more likely
to abuse their children and abuse is a factor which increases the likelihood of youth suicide [3]. The five
papers pertaining to family issues effectively emphasized factors within the family that lead to suicide;
however, not enough emphasis was placed on factors such as living conditions, environmental conditions
and isolation levels.
Sexual abuse is detrimental to the mental health of youth. One study found 86.4% of females
who attempted suicide in the past 12 months reported lifetime sexual abuse [3]. The studies that
addressed sexual abuse did not investigate who exactly the perpetrator was, frequency of abuse and
setting. More investigation into the specific relationship between abuse, mental health and suicide is
needed.
Loss of culture and social exclusion were found to be a contributing factors to IYS. The two papers
supporting this factor outlined that Inuit youth felt colonial social influence lead to a loss of their culture
which is associated with an increased suicide rate [8, 4]. Both articles failed to ask what aspects of
cultural loss pertained most to Inuit youth. Loss of culture was not investigated as well as factors such
as family dynamics and abuse. However, all other factors may stem from colonial social influence. More
research should be conducted in collaboration with aboriginal researchers.
The factors highlighted in this paper are implications for public health. Public health officials
need to determine ways to help the Inuit community while adhering to their cultural practices. Ways in
which public health officials could intervene include conducting restorative practice circles to

encourage youth to talk about their family problems, or sexual abuse. Also, they should advertise the
importance of seeking help from elders in their community to restore family relationships.
Conclusion
The current review of literature identified family problems, alcohol dependence, culture loss, and
sexual abuse as contributing factors to IYS. The results of this study contribute to the literature
addressing the risk factors associated with Inuit youth suicide. Youth suicide is not only a problem in
Inuit communities but among various Aboriginal communities on and off reserves. Further research is
needed in order to determine other contributing factors and effective ways to decrease suicide among
Aboriginal youth. Further research can assist in the adoption of new practices by the Canadian
government to increase the quality of life in Aboriginal youth.

References
1. Health Canada [Internet]. [Place unknown]: Health Canada; [updated 2016 Mar 1]. Available from:
http://www.hc-sc.gc.ca/fniah-spnia/promotion/mental/index-eng.php
2. Oliver L. N., Peters P. A., Kohen D. E., Statistics Canada [Internet]. [Place unknown]: Statistics
Canada. Mortality rates among children and teenagers living in Inuit Nunangat, 1994 to 2008; 2015
Jul 17 [Cited 2016 Mar 28]. Available from: http://www.statcan.gc.ca/pub/82-003-
x/2012003/article/11695-eng.htm
3. Fraser S. L., Geoffroy D., Chachamovich E., Kirmayer L. J. Changing Rates of Suicide Ideation
and Attempts Among Inuit Youth: A Gender‐Based Analysis of Risk and Protective Factors.
Suicide Life Threat Behav [Internet]. 2015 Apr [Cited 2016 Mar 22]; 45(2):141-156. Available
from Scholars Portal:http://journals1.scholarsportal.info.uproxy.library.dc-
uoit.ca/details/03630234/v45i0002/141_crosiaaorapf.xml?q=Changing+Rate+of+Suicide+Ideation
+and+Attempts+Among+Inuit+Youth%3A+A+Gender-
Based+Analysis+of+Risk+and+Protective+Factors+&search_in=anywhere&date_from=&date_to=
&sort=relevance&sub=
4. Kral M. J., Idlout L., Minore B. J., Dyck R. J., Kirmayer L. J. Unikkaartuit: Meanings and
Experiences of Suicide Among Inuit in Nunavut, Canada. Int J Indigenous Health [Internet]. 2014
[Cited 2016 Mar 23]; 10(1):55-67. Available from Proquest:
http://search.proquest.com.uproxy.library.dc-uoit.ca/docview/1662573576?pq-origsite=summon
5. Chachamovich E., Kirmayer L. J., Haggarty J. M., Cargo M., McCormick R., Turecki G. Suicide
Among Inuit: Results From a Large, Epidemiologically Representative Follow-Back Study in
Nunavut. Can J Psychiatry [Internet]. 2015 [Cited 2016 Mar 23]; 60(6):268-275. Available from
Proquest: http://search.proquest.com.uproxy.library.dc-
uoit.ca/docview/1691010283/fulltext/D43FB39A4F4941A7PQ/1?accountid=14694

6. Young K. T., Revich B., Soininen L. Suicide in circumpolar regions: an introduction and overview.
Int J Circumpolar Health [Internet]. 2015 [Cited 2016 Mar 24]; 74:1-8. Available from PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/?term=Suicide+in+circumpolar+regions%3A+an+introducti
on+and+overview
7. Kral M. J. Postcolonial Suicide Among Inuit in Arctic Canada. Cult Med Psychiatry [Internet].
2012 Jun [Cited 2016 Mar 23]; 36(2):306-25. Available from PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/22392639
8. Kral M., Salusky I., Inuksuk P., Angutimarik L., Tulugardjuk N. Tunngajuq: Stress and resilience
among Inuit youth in Nunavut, Canada. Transcult Psychiatry [Internet]. 2014 Oct [Cited 2016 Mar
22]; 51(5):673-92. Available from Scholars Portal:
http://journals1.scholarsportal.info.uproxy.library.dc-
uoit.ca/details/13634615/v51i0005/673_tsaraiyinc.xml?q=Tunngajuq%3A+Stress+and+resilience+
among+Inuit+youth+in+Nunavut+Canada&search_in=anywhere&date_from=&date_to=&sort=rel
evance&sub=

Appendix
Table 1. Studies examining suicide factors among Inuit youth. Of the 59 articles extracted using the detailed
search method, six peer-review articles satisfied the inclusion criteria detailed previously. This table includes the
source for which the study was retrieved from, study design employed, factors contributing to suicide, the
variables in the study and the research findings.
Source Study
Design
Suicide Risk
Factors
Variables Research findings
Fraser S. L.,
Geoffroy D.,
Chachamovic
h E.,
Kirmayer L.
J., 2015
Nunavik,
Quebec
Cross-
section
al
(Level
IV)
 Cannabis
use
 Alcohol use
 Sexual
abuse
 Physical
violence
 Sex
 Suicide
attempt
 Non-suicide
attempt
 Inuit youth suicide rates are high
 Physical violence and sexual abuse were
associated with suicide
 Anger was associated with suicide
Kral M. J.,
2012
Nunavut,
Canada
Qualita
tive
(Level
VI)
 Peer
influence
 Depression
 Family
problems
 Colonialism
 Romance
 Suicide is contagious among Inuit youth
 Suicide is associated with the feeling of being
rejected by family
 Childhood experiences of observing violence
and abuse between parents leads to develop
parallel characteristics in their own
relationships (i.e. transference)
 Decreased sense of belonging and social
isolation can manifest itself causing
association with others who have committed
suicide and tend to follow a similar path
Kral M.,
Salusky I.,
Inuksuk P.,
Angutimarik
L.,
Tulugardjuk
N., 2014
Nunavut,
Canada
Qualita
tive
(Level
VI)
 Cannabis
use
 Bullying
 Family
problems
 Culture loss
 Romantic
problems
 Stressors
 Coping and
resilience
 Relatively high rates of various psychiatric
disorders and/or prior history among study
cohort
 Challenges and adversity faced in early life
and psychopathology are concomitant with the
increased deaths by suicide
Kral M. J.,
Idlout L.,
Minore B. J.,
Dyck R. J.,
Kirmayer L.
J., 2014
Nunavut,
Canada
Qualita
tive
(Level
VI)
 Alcohol use
 Sexual
Abuse
 Family
problems
 Culture loss
Romantic
problems
 Loneliness
 Romantic
relationships
problems
 Family
problems
 Anger
 Hiding
distress
 Peer
influence
 Ongoing social changes, family and cross-
generation communication was fundamental
for well-being were vital factors, absence of
this was associated with suicide
 A prior history of sexual abuse is a risk factor
for Inuit youth suicide

Young K. T.,
Revich B.,
Soininen L.,
2015
Nunavik,
Canada
Baffin,
Canada
System
atic
review
of
observ
ational
studies
(Level
III)
 Depression
 Family
problems
 Age
 Sex
 Regional
variation
 Excessive risk-taking and substance abuse
increased major depressive symptoms and
subsequently the increased amounts of evident
suicidal behaviours
 Suicide among the younger ages within the
youth group as well as females showed a
greater prevalence in suicidal rates
Chachamovic
h E.,
Kirmayer L.
J., Haggarty
J. M., Cargo
M.,
McCormick
R., Turecki
G., 2015
Nunavut,
Canada
Qualita
tive
(observ
ational
?)
(Level
VI/Lev
el
IV)?)
 Alcohol
 Sexual
abuse
 Depression
 Family
problems
 Sex
 Relationship
status
 Criminal
record
 Career and
Education
 Abuse (i.e.
physical,
psychological
, sexual)
 Relatively high rates of various psychiatric
disorders and/or prior history among study
cohort
 Challenges and adversity faced in early life
and psychopathology are concomitant with the
increased deaths by suicide

Table 2. Strengths and limitations of studies examining suicide factors among Inuit youth based on
reviewed literature
Source Strengths Limitations
Fraser S. L.,
Geoffroy D.,
Chachamovich
E., Kirmayer L.
J., 2015
Nunavik,
Quebec
 Examined various underlying causes of
specific risk factors (i.e. alcohol abuse)
on suicidal behaviours
 All variables were assessed to consider
the gender differences, family situations
(e.g. married vs. single) of the
respondents
 Researched factors employs great depth
including various socio-cultural and
environmental factors and its
psychological attributes
 Research measures were extensive in
including sociodemographic
characteristics, substance abuse,
environmental exposures, etc.
 No insight on the means through which the
youth are obtaining the alcohol supply (i.e.
remains very superficial)
 Excludes documented survey results for
youth between the ages of 12 and 18 who
experienced violence and sexual abuse –
this age period is a critical time period of
development and creates a biased few of
the impacts of these factors
 Respondents may have been resistant to
disclosing extremely sensitive information
about traumatic experiences pertaining to
violence, giving room for
misrepresentation and misinterpretation
 Due to cross-sectional study design, clear
insight into antecedents and consequences
was not obtained
Kral M. J.,
2012
Nunavut,
Canada
 Effectively identifies and explains the
influence of colonial factors and its
impact on indigenous responses
 Recognizes the key difference of colonial
impacts on the Inuit community and its
greater impact compared to First Nations ,
and Metis
 Strong emphasis on other historical
impacts of the government during 1950s
and how some of those impacts continues
to be displayed in the current population
 Research is culturally safe and sensitive
through the incorporation of community-
based participatory research models that
has an equal and collaborative
distribution of power
 Displays minor biases and subjectivity to
collectivist culture attitudes in the
determination of the impacts of suicidal
risk factors
Kral M.,
Salusky I.,
Inuksuk P.,
Angutimarik
L., Tulugardjuk
N., 2014
Nunavut,
Canada
 Incorporates personal accounts from
respondents to reinforce the impacts of
certain risk factors on suicidal behaviours
 Adhered to cultural sensitivity and safety
practices by providing adequate training
to the interviewers of the respondents
 Little consensus on definitions of suicidal
risk factors (i.e. resilience) which showed
discrepancies due to little consideration of
cultural variations
Kral M. J.,
Idlout L.,
Minore B. J.,
Dyck R. J.,
Kirmayer L. J.,
2014
 Employed a participatory research
methodology that alights with the Inuit
values of sharing and equality, thus more
culturally-sensitive
 Research measures failed to mention other
vital factors such as various socio-cultural
and environmental factors and its
psychological attributes
 Study did not assess the impact of key
sociodemographic characteristics,

Nunavut,
Canada
 Study design had contributions from the
members of the population for which the
study was being conducted on
 Findings were interpreted on the basis of
massive and continual social change, on-
going colonial impacts, and the impact of
multigenerational trauma
 Provides suggestions for potential
interventions and the importance of
prevention strategy for Inuit youth suicide
substance abuse, environmental exposures,
etc.
Young K. T.,
Revich B.,
Soininen L.,
2015
Nunavik,
Canada
Baffin, Canada
 Research findings focuses on the depth
and impact of various factors influencing
suicidal behaviours and/or thoughts while
incorporation strong variation of findings
across Artic States and their northern
regions
 Recognizes the importance of the
methodological approach with respect to
the statistical procedure of age
standardization used for the study
population in the respective region.
 Little information is presented on potential
youth-focused intervention programmes,
especially for those in these northern
regions
 Some of the regions included smaller
populations compared to others, which
could have potentially resulted in the
suicidal rate fluctuations from year to year
(i.e. suicidal rate inconsistencies)
Chachamovich
E., Kirmayer L.
J., Haggarty J.
M., Cargo M.,
McCormick R.,
Turecki G.,
2015
Nunavut,
Canada
 Effective research measures in terms of
the consideration of risk factors from a
sociodemographic, psychopathological,
and personal behaviours.
 Method for recruitment of study
participants was not completely inclusive
as control subjects were only selected from
individuals registered in the Nunavut
Health Care Registration database – thus
people not registered were not included
and represents a potential bias
 Study participant age group did not reflect
key aspects of youth aged 12-18 years of
age

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