Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people
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The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008–2012), the National Insurance Registry (2003–2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003–2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.
KeywordsSuicidal behavior Adolescent Indigenous Epidemiology Longitudinal
Data from the Norwegian Patient Register (NPR) have been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Register is intended or should be inferred.
This work was funded by the Sami Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS). UiT The Arctic University of Norway, the Centre for Sami Health Research, and the Norwegian Institute of Public Health funded the NAAHS study. The registry linkage was funded by the University Hospital of North Norway and Nordland Hospital. The authors would like to thank all the participants of the NAAHS study.
Compliance with ethical standards
Conflict of interest
CE has received research support from the Sami Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS). MTS and SK report no financial or potential conflicts of interest.
The students and their parents were given written information about the study, and the students provided written consent. The Norwegian Data Inspectorate and the school authorities approved the NAAHS. The Regional Medical Ethical Committee approved the NAAHS and the registry linkage. The Norwegian Institute of Public Health and Statistics Norway carried out the linkage.
- 2.World Health Organization (2012) Public health action for the prevention of suicide. WHO Retrieved on 12 Dec 2013 From https://www.who.int/m. doi: 9789241503570
- 6.Cash SJ, Bridge JA (2009) Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr 21:613–619. https://doi.org/10.1097/MOP.0b013e32833063e1.Epidemiology CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Gould MS, Greenberg T, Velting DM, Shaffer D (2003) Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 42:386–405. https://doi.org/10.1097/01.CHI.0000046821.95464.CF CrossRefPubMedGoogle Scholar
- 20.Bolton S-L, Elias B, Enns MW et al (2014) A comparison of the prevalence and risk factors of suicidal ideation and suicide attempts in two American Indian population samples and in a general population sample. Transcult Psychiatry 51:3–22. https://doi.org/10.1177/1363461513502574 CrossRefPubMedGoogle Scholar
- 30.The Norwegian Institute of Public Health. Youth Studies. https://www.fhi.no/en/studies/regional-health-studies/ung/youth-studies-2000-2009/. Accessed 14 Sept 2019
- 31.The Norwegian Directorate of Health (2008) The Norwegian Patient Registry. https://helsedirektoratet.no/norsk-pasientregister-npr. Accessed 14 Sept 2019
- 32.Eckhoff C, Straume B, Kvernmo S (2017) Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study. BMJ Open 7:e012035. https://doi.org/10.1136/bmjopen-2016-012035 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Røysamb E, Schwarzer R, Jerusalem M (1998) Norwegian version of the general perceived self-efficacy scale. https://userpage.fu-berlin.de/~health/norway.htm. Accessed 14 Sept 2019
- 38.Alsaker FD, Olweus D, Dundas I (1991) A growth curve approach to the study of parental relations and depression in adolescence. In: Paper Presented Biannual Meeting of the Society Research on Child Development, SeattleGoogle Scholar
- 40.Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 57:113–118. https://doi.org/10.1080/080394803100009325VLQK29JKUCQ62KT CrossRefPubMedGoogle Scholar
- 41.Statistics Norway (2003). Norwegian Standard Classification of Education Revised 2000. https://www.ssb.no/a/english/publikasjoner/pdf/nos_c751_en/nos_c751_en.pdf. Accessed 14 Sept 2019
- 43.Normann T. Ungdoms levekår (norwegian). Living conditions of youth (title in english).Google Scholar
- 44.OECD Long-term unemployment rate. https://data.oecd.org/unemp/long-term-unemployment-rate.htm. Accessed 14 Sept 2019
- 45.OECD Youth unemployment rate. https://data.oecd.org/unemp/youth-unemployment-rate.htm#indicator-chart. Accessed 14 Sept 2019
- 47.Lewinsohn PM, Rohde P, Seeley JR (1996) Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clin Psychol Sci Pract 3:25–46. https://doi.org/10.1111/j.1468-2850.1996.tb00056.x CrossRefGoogle Scholar
- 49.OECD (2008) Jobs for youth. OECD, NorwayGoogle Scholar