Suicide among Swedish reindeer herding Smi, 1961-2009 Anders Eriksson - PDF document

1 Suicide among Swedish reindeer herding Sámi, 1961-2009 Anders Eriksson 1 , Lars Jacobsson 2 , Jon Petter Stoor 3 1 Dept of Community Medicine and Rehabilitation/Forensic Medicine, Umeå university, Umeå, Sweden 2 Dept of Clinical Science/Psychiatry, Umeå university, Umeå, Sweden 3 Sámi Norwegian National Advisory Unit on Mental Health and Substance Use, Finnmark County Hospital Trust, Karasjok, Norway Introduction Probably the most serious health problem affecting indigenous peoples is excessive mortality caused by injuries (1-5), and among these unnatural deaths, suicide is a major public health problem, especially in the Arctic (6). Generally, it seems as if native populations in circumpolar regions, especially men, might suffer a particularly high risk of violent death [2-5]. The Sámi are the natives in the area called Sápmi, covering northern Scandinavia and the Kola Peninsula. In Sweden there are approximately 20,000-40,000 Sámi, of which about 2,000 belong to reindeer-herding families [7]. However, s ince we don’t register ethnicity in Scandinavia, we know relatively little about suicide among the Sámi. Aim The aim of the present investigation was to analyze in more depth the epidemiology of suicide among Sámi. Material and Methods A cohort of 7,482 members of reindeer-herding Sami families (4,451 men and 3,031 women), constructed in a previous study [8], was further extended regarding suicides by continued information from key informants in the Sámi society. The study period regarding suicides stretched from January 1, 1961 through December 31, 2009. All deaths were then identified in the Swedish-Cause-of Death Register, and death certificates were obtained from the National Cause-of-Death Register. Additional information was also retrieved from the National Board of Forensic Medicine. For cases not found in the files at the National Board of Forensic Medicine, medical records were obtained from hospitals and local health care centres, including records from clinical autopsies. Natural deaths were excluded from further analyses. The study was approved by the Regional Ethical Review Board in Umeå, Sweden. Results General Deaths were classified as unintentionally inflicted (69%), intentionally inflicted (26%) or undetermined whether unintentional or intentional (5%). Accidental deaths for the study period 1961-2001have been presented elsewhere (9); in the following, only results regarding suicides are presented. Suicides

2 The mean age of the suicide victims was 40 years and 86% were males. The cause of death was gunshot wound (57%), hanging (18%), intoxication (15%), drowning (5%) and sharp force trauma (5%). The standardized mortality ratio (SMR) for suicide among the Sámi people in relation to Norwegians, Swedes, and Finns discloses a higher suicide incidence among Sámi men, whereas the risk for women does not differ significantly (Table 1). Table 1. Standardized mortality ratio (SMR) among Sámi compared to majority populations in northern Sweden, Norway, and Finland. COHORT MEN WOMEN Entire cohort 1.17* 0.76* NORTHERN SWEDEN 1961 – 2000 Entire cohort 1.27 NORTHERN NORWAY 1970 – 1998 Entire cohort 1.78* 1.26 NORTHERN FINLAND 1979 – 2010 Geography The geographical distribution of the suicides reveals a significantly higher incidence in the southern part of Sápmi, especially considering the fact that the number of Sámi is much higher in the northern part (Fig 1). Fig 1. Geographical distribution of suicides among Sámi in Sweden, 1961-2009. Significantly more suicides took place in the southern regions than in the northern.

3 DISCUSSION General The Swedish Sámi men have a significantly higher mortality rate for external causes of death than a demographically matched reference population of non-Sami [cf 7, 9]. Similar findings were previously shown for reindeer-herding Sami in both Sweden and Norway who have a significantly higher mortality rate from unnatural deaths than the total population [4, 10]. Apart from transport accidents, suicide is the most common external cause of death in reindeer-herding Sámi families in Sweden. Suicides The incidence of suicide was found to be high among males of reindeer-herding families, but not significantly higher than among other males living in the same region [8]. In the present study it was observed that shooting was the most commonly used method, consistent with a study of Alaskan natives [3]. Shooting and hanging were also common methods among the Inuits in Canada and the Sámi in Norway and Greenland [11-14]. In the general male population of Sweden, the most common suicide methods are poisoning and hanging, followed by shooting [15]. This difference in choice of suicide method is probably a reflection of availability and of the fact that in indigenous cultures, hunting and gun ownership is an integrated part of the lifestyle. The interesting finding of a higher suicide incidence in the southern part of Sápmi compared to the northern part may indicate that the rapid social changes occurring during the moderniz ation of the Arctic in the 1900’s still play a role, and that the Sámi population in the north is less exposed to the rapid social upheavals than in the south. Validity Due to the long follow-up period (almost 50 years), the quality and the extent of the documentation of the circumstances vary. This variation is, in part, due to the improved quality in all aspects of the police and medico-legal investigations of unnatural deaths. This, as well as the fact that the sample was relatively small, indicates that the results should be interpreted with caution. It should also be pointed out that the figures presented in the present paper are not directly applicable to the very small population of reindeer-herding Sámi in Sweden, but to the cohort of reindeer-herding Sámi family members. There are, however, also difficulties in separating “reindeer - herders” from “non - herders”. Many S ámi work part-time in other professions and reindeer-herding is a typical family business in which many family members are involved. This means that the differences between the Sámi population and the non-Sami population of Northern Sweden are weakened. Further, not only making a distinction between a Sámi and a non-Sámi is difficult [16], but when comparing studies from different countries of the definition of “S á mi”, one also needs to be aware of the variations of defining the S ámi lifestyle [17], and that the strength of the Sámi identity may vary. Prevention Strategies for suicide prevention among the Sámi are designed to supplement the suicide prevention work already conducted in the countries of Norway, Sweden, and Finland – regardless of ethnicity. The strategies listed below thus point to specific challenges and needs of the Sámi people, not covered by the general suicide prevention efforts. However, since

4 there is a lack of knowledge about suicide and related problems on the Russian side of Sápmi, it has not been possible to design these strategies to be directly applicable on the Russian side of Sápmi. The strategy is created with the intent to help put focus on suicidality among the Sámi people, inform of research findings and other relevant knowledge, and inspire discussions and action both inside and outside the Sámi community. The strategies should be viewed as recommendations to all social forces working to prevent suicide in Sápmi. The main objectives of these strategies are to help strengthen the mental health and prevent suicide among the Sámi people. Eleven strategies have been identified (18); (i) Focusing efforts on the Sámi men, (ii) Producing statistics and strengthening research on suicide among the Sámi, (iii) Strengthening Sámi self-determination, (iv) Initiating efforts to recognize and deal with historical traumas, (v) Strengthening and protecting the Sámi cultural identity, (vi) Reducing the Sámi's exposure to violence, (vii) Reducing the Sámi's experiences of ethnic discrimination, (viii) Increasing diversity and acceptance in the Sámi community, (ix) Securing the Sámi’s right to equal, linguistically and culturally adapted mental health care, (x) Educating and mobilising the Sámi civil society for suicide prevention, and (xi) Initiating and strengthening cross- border cooperation for suicide prevention. CONCLUSIONS The population of reindeer-herding Sámi men in Sweden run a higher risk of unnatural death, including suicide, than the general male Swedish population. It must also be noted, however, that this enhanced risk is considerably lower than among other indigenous peoples in the Arctic. Eleven strategies for the prevention work, aiming specifically at the Sámi population, have been identified. REFERENCES 1 . Young, K. Hassler, S. Injuries and Violence. In: Health Transitions in Arctic Populations. Eds. Young T. K. and Bjerregaard, P. University of Toronto Press; 2008. 334-358 p. 2. Bjerregaard P. Causes of death in Greenland 1968-85. Arctic Med Res 1988;47:105-123. 3. Marshall D, Soule S. Accidental deaths and suicides among Alaska Natives, 1979-1994. Int J Circumpolar Health 1998;57(suppl 1):497-502. 4. Tynes T, Haldorsen T. Mortality in the Sami population of North Norway, 1970-98. Scand J Public Health 2007;35:306-312. 5. Soininen L, Pukkala E. Mortality of the Sami in Northern Finland 1979-2005. Int J Circumpolar Health 2008;67:43-55. 6. Young TK, Revich B, Soininen L. Suicide in circumpolar regions: An introduction and overview. Int J Circumpolar Health. 2015;74:27349. 7. Hassler S, Johansson R, Sjölander P, Grönberg H, Damber L. Causes of death in the Sami population of Sweden, 1961-2000. Int J Epidemiol 2005;34:623-629.