This report is the first phase of a larger project to generate indicators of disparities in care and unmet need in Alaska. It provides prevalence estimates of serious behavioral health disorders. Prevalence estimates provide a standardized basis for defining the need for services in a population. The second phase of this larger project assesses the number of individuals who actually receive services. The third phase combines the information to generate indicators of unmet need and disparities in care. The project is an initiative of the Division of Behavioral Health (the Division) of the Alaska Department of Health and Social Services. The Division contracted with the Western Interstate Commission for Higher Education (WICHE) Mental Health Program to facilitate the project. Phase I prevalence estimates were generated by an epidemiologist who has developed a technology specifically for this purpose. The synthetic estimation technology has been used for mental disorders by ten western states; Alaska is the first to use the substance use estimates.
GOALS: There were two goals for the study: (1) to do an in-depth demographic analysis of the suicides in Alaska for three years from September 1, 2003 through August 31, 2006 and (2) to conduct interviews with key informants for as many suicide cases as possible. This report is divided into two sections, Section 1 addressing the epidemiological data and Section 2 addressing the data derived from the interviews.
PURPOSE: The purpose of the data gathering, reporting, and analysis was to better understand the etiology and antecedents of suicide among Alaskans, in order to identify potential points of
intervention and strategies to reduce the rate of suicide.
METHODS: Death certificates attributed to suicides occurring in Alaska between September 1, 2003, and August 31, 2006, were reviewed retrospectively. Information from the Alaska State
Medical Examiner, State Troopers, and other law enforcement agencies was collated and reviewed for each suicide death. A cadre of Native and non-Native interviewers was trained in how to use the interview protocol and how to conduct follow-back interviews
with survivors of the decedents. All information was entered into a secure database. All efforts to protect confidentiality were in accordance with the Institutional Review Board requirements of the Alaska Native Medical Center, the University of Alaska Anchorage,
and the National Institutes of Health (Certificate of Confidentiality).
RESULTS: There were 426 suicides during the 36 month study period. The average annual suicide rate for the three year study period was 21.4/100,000 (U.S. Census, 2005 estimated population). Males out-numbered females 4 to 1. The age-group of 20 to 29 had both the greatest number of suicides and the highest rate per 100,000 population. Alaska Natives had a significantly higher average rate of suicide than the non-Native population (51.4/100,000 compared to 16.9/100,000). The leading mechanism of death was firearms, accounting for 63% of the suicides. The use of handguns was more prevalent in the non-Native population whereas long guns were used more often by Alaska Natives. The EMS region with the greatest number of Native suicides was Region 4, which includes Bethel and the Yukon-Kuskokwim Delta. Region 2, which includes the Northwest Arctic census area had the highest overall rate of suicide deaths. Follow-back interviews were
conducted with 71 informants for 56 of the suicide decedents. Reported alcohol/drug use was the same for Urban as for Rural Native decedents. The same alcohol/drug use pattern was seen for Urban and for Rural non-Native decedents. Toxicology results were
received for 33% of all the suicide cases. Alcohol was found in 44% of the toxicology tests and THC (marijuana) was found in 15%.
CONCLUSION: This study adds volumes of information to our existing knowledge of suicide in Alaska. More in-depth studies are already in progress, which will continue to add to our knowledge
base while bringing in additional resources for prevention and treatment. The report also highlights the need for better death data collection, to quantify alcohol and drug involvement and other contributing factors.