Developing self-efficacy and 'communities of practice' between community and institutional partners to prevent suicide and increase mental health in under-resourced communities: expanding the research constructs for upstream prevention.

Abstract

Background: Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15-24), who experience suicide rates significantly higher than the general U.S. youth population. In under-served, remote AN communities, building on existing local and cultural resources can increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention by family members, workers and community members, which can be important for preventing suicide in places where mental health services are sparce. This study expands the variables we hypothesize as important for reducing suicide risk and supporting mental wellness. These variables are: (1) perceived suicide prevention self-efficacy, (2) perceived wellness self-efficacy, and (3) developing a 'community of practice' (CoP) for prevention/wellness work.

Method: With a convenience sample (N = 398) of participants (ages 15+) in five remote AN communities, this study characterizes respondents' social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents' wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone (3), reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community.

Results: Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with "working together" behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction.

Conclusions: The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles (2), developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.