摘要：Objectives. To compare suicide rates in Aboriginal communities in Labrador, including Innu, Inuit, and Southern Inuit, with the general population of Newfoundland, Canada. Methods. In partnership with Aboriginal governments, we conducted a population-based study to understand patterns of suicide mortality in Labrador. We analyzed suicide mortality data from 1993 to 2009 from the Vital Statistics Death Database. We combined this with community-based methods, including consultations with Elders, youths, mental health and community workers, primary care clinicians, and government decision-makers. Results. The suicide rate was higher in Labrador than in Newfoundland. This trend persisted across all age groups; however, the disparity was greatest among those aged 10 to 19 years. Males accounted for the majority of deaths, although suicide rates were elevated among females in the Inuit communities. When comparing Aboriginal subregions, the Innu and Inuit communities had the highest age-standardized mortality rates of, respectively, 165.6 and 114.0 suicides per 100 000 person-years. Conclusions. Suicide disproportionately affects Innu and Inuit populations in Labrador. Suicide rates were high among male youths and Inuit females. Globally, suicide persists as an urgent public health problem among Indigenous populations in many high-income countries, including the United States 1 and Australia. 2 In Canada, suicide is one of the leading causes of death among Aboriginal people. 3–5 Suicide rates for First Nations (31.8 per 100 000 population) 6 and Inuit (73.6 per 100 000 population) 5 populations are elevated compared with the national rate (10.8 per 100 000 population), 7 although incidence varies substantially at the community level. 8 Rate disparities are especially evident in Indigenous regions such as Nunavut, 5 an arctic territory in northern Canada, and elsewhere in the circumpolar world. 9 Previous research reported a high suicide rate in Labrador 10,11 and suggested that local First Nations and Inuit populations have elevated rates of suicidal ideation 12 and death. 5,10,11,13 However, these studies used a short study period or regionally aggregated data, focused on youths, or did not distinguish among different Aboriginal groups. As a result, they missed possible subregional inequalities 14 and therefore were unable to identify specific populations with the greatest burden. Labrador is a large subarctic area in northeastern Canada that borders Quebec and Nunavut and is politically part of the province of Newfoundland and Labrador. The region’s diverse population is small, relatively young, and dispersed, with a high proportion of Aboriginal people ( Table 1 ). The population includes 3 Aboriginal groups: the Mushuau and Sheshatshiu Innu First Nations, the Labrador Inuit, and the Southern Inuit. These groups are politically separate and have unique cultures, languages, traditional territories, colonial histories, and social circumstances. We identify the Aboriginal groups with the terms used by the respective governing authorities for collective identity. In some cases, these terms may differ from those used by individuals to self-identify. For example, the NunatuKavut Community Council refers to the group it represents as “Southern Inuit” although individually some community members may use the terms “Metis” or “Inuit-Metis.” Most of Labrador’s Aboriginal communities are located along the remote north and southeast coasts, with limited or no road access. TABLE 1— Demographics and Governance in Aboriginal Populations: Labrador and Newfoundland, Canada, 2006 Region or Subregion Population Younger than 30 Years,a % Aboriginal Identityb % of Population Aboriginal Governance Provincial regions Newfoundland 479 100 33.4 Aboriginal: 2.9c Miawpukek First Nation Qalipu Mi’kmaq First Nation Labrador 26 365 41.7 First Nation: 7.2 Inuit: 15.0 Southern Inuit: 15.1 Labrador subregions Innu communities 1 815 65.3 Innu First Nations: 88.4 Sheshatshiu Innu First Nation Mushuau Innu First Nation Labrador West 9 660 38.4 Aboriginal: 6.6 Nunatsiavut 2 415 53.4 Inuit: 89.4 Nunatsiavut Government South Coast-Straits 4 410 36.2 Southern Inuit: 50.0 NunatuKavut Community Council Upper Lake Melville 8 065 39.9 Inuit: 18.7 Southern Inuit 17.5 Open in a separate window Source . 2006 Census, Statistics Canada. aProportion of region or subregion’s total population. bAboriginal Identity is a census variable that refers to an individual’s self-reported identification with the constitutionally recognized Aboriginal peoples of Canada (First Nation, Inuit, and Métis). cAboriginal includes all 3 Aboriginal identities (Innu First Nation, Inuit, and Metis) combined. In Newfoundland, this includes the Miawpukek First Nation, the Qalipu Mi’kmaq First Nation, and Innu, Inuit, and Southern Inuit from Labrador who live in Newfoundland. Our comparison region, Newfoundland, is a large island that is geographically separate from Labrador and is located in the Atlantic region of Canada. Both areas are primarily rural, although Newfoundland’s population is older, is mostly non-Aboriginal, and lives within a 300-kilometer drive of a regional center or the provincial capital. The population health profile and socioeconomic and geographic context of Labrador resembles other circumpolar regions such as Alaska and Greenland. Conversely, Newfoundland, although distinct in its own right, has more in common with the provinces of Atlantic Canada. We developed this retrospective, population-based study of suicide mortality in response to requests from communities for local data on suicide. Our objective was to establish baseline trends in suicide epidemiology in Labrador. We compared age, gender, and geographic patterns in incidence rates among Innu, Inuit, and Southern Inuit populations with those of the general population in the Canadian province of Newfoundland and Labrador from 1993 to 2009. This project was a collaborative inquiry that combined community-based and epidemiological research methods. 15
