摘要：The National Strategy for Suicide Prevention highlights the importance of improving the timeliness, usefulness, and quality of national suicide surveillance systems, and expanding local capacity to collect relevant data. This article describes the background, methods, process data, and implications from the first-of-its-kind community-based surveillance system for suicidal and self-injurious behavior developed by the White Mountain Apache Tribe with assistance from Johns Hopkins University. The system enables local, detailed, and real-time data collection beyond clinical settings, with in-person follow-up to facilitate connections to care. Total reporting and the proportion of individuals seeking treatment have increased over time, suggesting that this innovative surveillance system is feasible, useful, and serves as a model for other communities and the field of suicide prevention. Suicide is a tragic event that shocks and reverberates through families and communities. In the general population, suicide deaths in children and adolescents are rare, increase in frequency in adolescence and early adulthood, and peak in late adulthood. 1 However, patterns differ among American Indian (AI) populations, in which suicide peaks among youths and is less prevalent in older individuals. Suicide is the second leading cause of death for AI persons aged 15 to 24 years, and suicide rates among AI persons aged 10 to 24 years are the highest of any US racial/ethnic group. 2,3 Although suicide rates vary considerably across tribes, youth suicide is one of the AI population’s most serious health disparities. 4 To reduce rates of suicidal behavior, the National Strategy for Suicide Prevention 5 strongly recommends to increase the timeliness and usefulness of national surveillance systems relevant to suicide prevention and improve the ability to collect, analyze, and use this information for action through improved timeliness of reporting vital records data, increased usefulness and quality of suicide-related data, as well as the expansion of state/territorial, tribal, and local public health capacity to routinely collect, analyze, report, and use suicide-related data to implement prevention efforts and inform policy decisions. 5 (p79) Existing national and regional surveillance systems 6–10 are limited by (1) data collection only in clinical settings or through coroners’ reports, (2) lack of detail in data collection, and (3) delays in data reporting, which impede timely prevention and intervention development and research programs. To address high rates of suicide in youths, the White Mountain Apache Tribe (WMAT, or Apache), with technical support from the Johns Hopkins University Center for American Indian Health (JHU), developed a community-based suicide surveillance system that has evolved to include community-based reporting of suicidal and related behavior, engagement and referral of affected individuals, and the development of prevention strategies reflecting patterns of suicidal behavior on the reservation. The system received a Bronze Psychiatric Services Achievement Award in 2011 from the American Psychiatric Association in recognition of an innovative community–academic partnership to implement suicide surveillance and prevention. 11 It also received a National Behavioral Health Achievement Award for Community Mobilization in Suicide Prevention from the Indian Health Service (IHS) in 2012. Our goal is to (1) describe the background and history of the surveillance system; (2) outline the system’s methods, including terms and definitions, surveillance system protocol and data collection forms, surveillance team roles and training, data management, and confidentiality; (3) review process data from 2007 to 2011; and (4) discuss implications for suicide prevention and public health surveillance among AIs and other at-risk populations.
