Risk factors for suicidal behaviors in American Indian and Alaska Native peoples: A systematic review

American Indian/Alaska Natives (AI/ANs) experience disproportionate rates of suicide, but current strategies for suicide prevention have not reduced these health disparities. Therefore, to gain insight into factors that may affect risk trajectories for suicide attempts (SAs) among AI/ANs, we conducted a systematic review of the literature. Forty-five articles met inclusion criteria for the final corpus. Results demonstrate that substance use, depression/hopelessness, childhood maltreatment, violent victimization, and friend/family-member death by suicide serve as robust predictors for SAs. For AI/AN youths specifically, risk-taking behaviors, family conflict, and school environment were associated with SAs. Notable differences in risk factors were identified across age, sex, and region. Limitations of this body of evidence are described, including heterogeneity in study design, measurement, and sampling. Predicated on these findings and limitations, we suggest four key strategies to advance the study of risk factors for AI/AN communities to prevent AI/AN suicide.