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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Elder Suicide in Native Communities

How Valuing and Including our Seniors Can Make All the Difference

Paul Kettl, MD

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp. 9-10

Excerpted from Kettl, P. (1998). Alaska native suicide: Lessons for elder suicide. International Psychogeriatrics, 10(2), 205-211. Publisher: Springer Publishing Company Inc., New York, 10012. Used by permission.

Among the many health challenges facing our elders, suicide is all too often a neglected problem. However, in the United States, suicide rates are highest among the elderly5 and continue to rise. Unfortunately, throughout the world, elders present with high suicide rates as well. In Spain12 and Hungary15, suicide rates increase with age. In the United Kingdom, suicide rates peak after age 75.9, 26 In Germany, over half of all suicides are committed by those over age 65.28 Suicide rates are also high for the elderly in Canada.24

High rates of suicide for the elderly, however, are not simply a phenomenon of the western world. In Japan, individuals over age 65 account for 12% of the total population, but account for 29% of all suicides.29 In Singapore, suicide rates for those over age 65 are more than three times the national rate.21 Elderly suicide rates also are high in Australia and New Zealand.24

Elderly suicide rates are generally accepted throughout the world to be the highest of any age group,25 and many reasons have been postulated for this disturbing trend. Obvious biological factors occur with aging, and among these, reduced brain serotonergic activity [i.e., activity involving the brain chemical serotonin] may be associated with suicide.7 Postmortem studies demonstrate that a psychiatric disorder is almost always present in elderly persons who commit suicide. When their histories are reviewed, 90% of elder suicides have at least one Axis I diagnosis as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV2 ).6, 14 Depression is the most common psychiatric diagnosis among these elderly persons. Psychological factors such as stressful life events or somatic illness can also serve as important precipitants for suicide in the elderly.13

Particularly intriguing, however, is the idea that cultural differences can affect elderly suicide rates. Even in countries with high elder suicide rates, such as Australia4 and Singapore,21 elder suicide rates differ among various ethnic groups within that society. Japanese suicide rates have also differed between urban areas, which had relatively lower rates, and some rural areas with very high rates of elder suicide.30

The most prominent reflection on how culture affects suicide comes from Emile Durkheim.11 At the turn of the century in his classic work Suicide, Durkheim introduced the notion that “suicide varies inversely with the degree of integration of domestic society.” [In other words, w]hen one is tightly bound to society, suicide rates should decline, and when one is more peripheral to society, suicide rates should increase. Durkheim theorized that during times of social or economic upheaval, such as the Great Depression, suicide rates rose, whereas at other times when society was drawn together, such as World War II, suicide rates declined.

This theory is particularly useful to partially explain the high suicide rates among the elderly in much of the world. In the United States, for example, a person’s value and identity are often tied to one’s job; when that job is removed at retirement, that person is less “integrated” into “domestic society” and the suicide rate rises. Suicide rates are not only higher for the elderly, but are highest for elderly men who perhaps suffer more from the loss of their job and may be less well “integrated” into society. Our society has been accused of ignoring the elderly and not respecting them or asking them to contribute their years of experience to society. Their suicide rates reflect this sad statement. To further explore this idea, it would be helpful to investigate a culture where elders do not have higher suicide rates than the rest of the population to discover how social factors in a changing society may be protective for them. A study of Alaska Native suicide provides such a perspective.

Alaska Natives constitute Alaska’s indigenous population, numbering about 94,000 individuals, including Eskimos who live in the Arctic, Aleuts who live along the Aleutian chain of islands, and Indians who live in the interior and Alaska’s panhandle coast. Of the 94,000 Alaska Natives, 6,481 are above age 60 and 53% of those are female, according to the 1992 Alaska census estimates. Until the mid-1960s, suicide rates for Alaska Natives were the same as for the rest of the US population.18 However, after oil was discovered on the north slope of Alaska and economic development of the region expanded, Alaska Native suicide rates doubled that of the US rates by 1970.22 Alaska Native suicide rates more than tripled (43/ 100,000 persons) the US rate by the mid-1970s.1 A review of death certificates of Alaska Natives who committed suicide from 1979 to 1984 showed that the prototype suicide victim was a young, single man who shot himself in the early morning hours.19 He was more likely to have a history of alcohol abuse than age-matched controls.20

During the years suicide rates vastly increased, Alaska had an economic “boom” similar to the gold rush it experienced previously in its history. The development of vast oil deposits on the north slope of Alaska brought economic prosperity but also cultural confusion for Alaska Natives. With this influx of money through the “oil boom” and influence of western civilization through the oil industry and television, young Alaska Natives were offered many options for a new life but were removed from their own “domestic society.” The influx of money and social change offered Alaska Natives new choices in lifestyle but eliminated traditional ways. Young Alaskans often could choose any lifestyle, but were removed from their past and traditions. Another cost of this rapid economic development was an increase in suicide rates.17

Remarkably, however, the rise in suicide rates occurred entirely in young persons. In the late 1960s, there was no increase in suicide rates in those persons over age 35,3 and by the 1970s despite the general increase in suicide rates, Alaska Native elder suicide rates were decreasing.23 Furthermore, from 1979 through 1984, no Alaska Native over the age of 55 committed suicide.19 While the Alaska Native lifestyle was undergoing a remarkable change, youth suicide rates skyrocketed but elder suicide rates dropped to zero.

An update and further exploration of these data help to provide clues to the cultural factors affecting elder suicide rates. …. Despite the increase in Alaska Native suicide rates with the Alaska oil boom, elder Alaska Native suicide rates decreased and then became nonexistent. These rates still remain much less than for age-matched White Alaskans or for those in the same age group in the United States or other countries [see Table 1]. This remarkable fact deserves further explanation.


Graph in Elder Suicide in Native Communities by Paul Kettl
Table 1. Suicide rates per 100,000 persons, 1985-1994, for both sexes


When cultural change affected Alaska Native society, young people were further distanced from the teachings of their traditions and their suicide rates greatly increased. However, with this change, Alaska Native elders enjoyed growing respect and admiration for their knowledge of Alaska Native culture and tradition, which were being overwhelmed by economic growth and the introduction of television. Alaska Native elders were revered because they had survived several periods of change, including a Japanese invasion of Alaska in World War II, the transition to statehood, and the economic expansion that came with the oil boom. These elders also knew, understood, practiced, and could teach others the traditions of a lifestyle that had nurtured a society for centuries at the inhospitable edge of the earth. The status and social importance of Alaska Native elders grew as the rate and amount of change increased. The maintenance of the traditional ways of the elder population, in the midst of social and cultural changes within Alaska Native society, helped prevent their suicide rate from rising and possibly may have contributed to the decline in the rate. Unfortunately, over the last decade, as cultural and economic changes settled, suicide rates for Alaska Native elders began to increase and now are approaching general US rates. Still, Alaska Native suicide rates decrease with age after age 50, and suicide is nonexistent after age 80.

Eastern Europe provides another example of how cultural change can raise general suicide rates. With the fall of communism, vast social change has occurred in these countries. Comparing suicide rates for 1987 with rates for 1991/1992 showed an increase in suicide rates in general in eastern European countries, but a decrease in suicide rates for those over age 75.27

The cultural lesson from Durkheim’s thoughts on suicide and the Alaska Native experience is that factors that bind elders to a society should decrease suicide rates. These need not be grand ideas or changes, but simple factors linking the elderly to the rest of society. In Italy, a study that examined a telephone service designed to provide elders with home assistance or an alarm that the elder can activate to call for help showed that those elders who were connected to the system had a much lower suicide rate than the general elderly population.8

Those who provide medical care for the elderly should also recognize depression and suicide as potential problems. In Ontario, Canada, over 80% of persons over age 65 who committed suicide had not had psychiatric care.10 The elderly may not express symptoms of depression directly,16 but any elder who does not have support from his or her family, peer group, or other social networks must be viewed as being more at risk for suicide.

Even though suicide rates throughout the world increase for the elderly, the epidemiology [i.e. the study of the factors associated with the presence or absence] of Alaska Native suicide over the last few decades demonstrates that elderly suicide rates need not be high. The economic and cultural changes associated with the “oil boom” in Alaska dramatically raised general suicide rates. At the same time, the Alaska Native elders were drawn closer to their “domestic society,” and their suicide rates decreased. With the acculturation of these changes over the last several decades, Alaska Native elder suicide rates are beginning to come closer to general US rates.

The lesson from the Alaska Native experience is that high suicide rates among our elderly are not inevitable. Social changes that connect elders to the rest of society may reduce their suicide rates.

About the author
Paul is Chair of the Department of Psychiatry at Pennsylvania State College of Medicine, USA

The complete list of the studies footnoted in this article is available upon request or by consulting the article in its complete and original journal format.

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