Hidden suicides of the Indigenous people of the Brazilian Amazon: Gender, alcohol and familial clustering.

abstract
Objective: To evaluate the coverage, characteristics and the risk of suicide in the indigenous
people of Tabatinga in the Brazilian Amazon.
Methods: An active surveillance strategy for suicide cases was used: records of the Ministry of
Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper
River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of
Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry
offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates
were estimated using the direct method and according to age. A descriptive analysis was
performed and the hypothesis tests were considered significant if p-values were <0.05.
Results: The coverage of indigenous suicide was 82.8%, since 11 (17.2%) were classified as
hidden suicides. For men between 15 and 29 years of age, and for women aged from 12 to
20 years, the probability of suicide was around 70.0%. In 17.2% of the sample there was a
record of alcohol consumption before death and relationship between victims. The corrected
adjusted mortality rate was 111.7/100,000 (95% CI, 84.6–148.6).
Conclusions: The risk of suicide in the indigenous people of the Tabatinga is very high.
Coping strategies should consider the complex relationship between suicide and alcohol
consumption, gender differences and the existence of vulnerable groups, such as young
people, especially those with close relatives who have committed suicide.