The social context and epidemiology of suicide in Labrador

In Canada, many Inuit and First Nations populations have elevated rates of
\nsuicide, though there is substantial variation at the community level. The factors that
\ncontribute to suicide are complex and entrenched in colonization. Labrador is a
\ncircumpolar region in eastern Canada where suicide has been a persistent social problem
\nin Inuit and Innu communities since the 1970’s. As a result, suicide prevention has
\nbecome a policy and program priority.
\nIndigenous leaders and health system stakeholders in Labrador identified a need
\nfor local evidence on suicide to inform community programs and services. The aim of this
\nthesis was to examine the social context and epidemiology of suicide in the region. To
\nthis end, we established research partnerships with community members, Indigenous
\ngovernments, and the regional health authority. Within a population health approach
\nfounded on the principles for ethical research involving Indigenous peoples, we integrated
\ncommunity-based methods with qualitative and epidemiological study designs.
\nThis work began with a series of community consultations which engaged health
\nand social service providers to better understand research priorities related to suicide. In a
\nqualitative study, we then used focus groups to gather information about local risk and
\nprotective factors for suicide. Participants viewed suicidal behaviour, problematic alcohol and substance use, and mental disorders as the downstream outcomes of social inequity
\nand historical trauma. To build on this knowledge, we conducted a population-based
\nobservational study to investigate disparities in suicide mortality between Innu and Inuit
\ncommunities and the general population of the province. The results showed that the
\nsuicide rate was higher in Labrador (31.8 per 100,000 person-years) than in
\nNewfoundland (8 per 100,000 person-years); at the subregional level, suicide rates were
\nelevated in Inuit and Innu communities, at 165.6 and 114.0 suicide deaths per 100,000
\nperson-years.
\nTo put the data from Labrador in a global context, we undertook a systematic
\nreview on the incidence of suicide among Indigenous peoples worldwide. Suicide rates
\nwere elevated in many Indigenous populations, though rate variation was common.
\nStrikingly, rate disparities in Labrador were among the highest globally. Recognizing
\nchallenges related to monitoring suicide, we analyzed the public health approach to
\nsuicide surveillance in Canada. To improve surveillance capacity, we proposed strategies
\nsuch as integrating Indigenous identifiers into national data sets and building an inclusive
\ndata governance model to better track progress in suicide prevention in Indigenous
\ncommunities. This thesis concludes with a discussion of the scholarly contributions of
\nthis work and identifies opportunities for future research.

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