Protective Effects of Community Institutions Against Suicide Death Among Indigenous Survivors of Historical Trauma in Rural Alaska.

The pattern of historical trauma arising from the internal colonialism of North American Indigenous populations has generated a range of adverse behavioral health outcomes, especially in Arctic areas such as rural Alaska, where suicide rates exceed three times the national average. Although the overall suicide risks are high for Alaska Indigenous people, suicide outcomes vary substantially among communities. The study examined whether indicators constructed from publicly available data of community institutions associated with the cultural continuity hypothesis correlated with lower suicide rates in the 140 small, largely Indigenous communities in rural Alaska. Results of negative binomial regressions for place-level suicide deaths showed that indicators representing community institutions were significantly associated with a large relative and absolute reduction in suicide deaths over an 11-year period among the study communities. Significant effects were found for community institutions in governance, religious practice, livelihoods, and culture. Specific patterns suggested that less fragmentation within each community, signified by unified governance (one local authority), a single religious congregation, economic inclusion, and language fluency across age groups reduced suicide risk. The findings suggest that community institutions that promote cultural continuity may offer protection for a variety of health challenges for survivors of historical trauma, although research to identify the protective role of these institutions must take careful account of the local historical context.