1/18/96

Researcher explores skills Indian youth can use to say no to suicide

"I just want to be dead for a little while."
- 1995 comment of an 8-year-old Ojibwa boy in Northern Canada to a Stanford researcher

"Nothing much as I see in my future years, I hopefully will enjoy my suicide future. Thank you and good-bye."
- 1990 class worksheet of a Zuni High School student, Zuni, New Mexico

"When you think about reservations as homelands, they are both a gift and a burden, " said LaFromboise, an associate professor of educational psychology, as she munched a sandwich on campus one recent day.

"A lot of people don't feel they have a place to call home, a place where their family continues generation after generation, or the attachment to mother earth that goes with that," LaFromboise said. "We have all that, and our extended families, which are a gift, too. But the fact is that you also have a greater opportunity to experience loss because you are in an extended family network, and most reservations are in remote areas." Statistics show, she said, "that people who live in geographically isolated places are more prone to suicide."

LaFromboise grew up in a small Indiana town with many non-Indian residents, but she sought connections through her grandmother to her Miami tribal home. LaFromboise's daughter, who has lived much of her 19 years on college campuses with her mother, is at her other home now, the Turtle Mountain reservation in North Dakota where her father was raised.

Preventing suicide among Indian adolescents became a major focus of LaFromboise's work in the late 1980s, shortly after leaders of Zuni Pueblo, a reservation of about 9,000 tribal members in New Mexico, asked if Stanford could provide some help. As a result of that, the W. K. Kellogg Foundation will make available to each of 500 American Indian tribes a copy of LaFromboise's American Indian Life Skills Development Curriculum, a course guide to be published in April for high school or middle school students that is designed to reduce suicidal thinking and behavior. It is the only such curriculum tailored to American Indians, and is different from most suicide prevention programs in its scope and methods.

The curriculum, as LaFromboise sees it, is a work in progress, a template that Indian communities can modify to fit their particular needs. It comes in computer disk form as well as in book form, she said, so it can be modified by teachers and counselors to be used with adults or younger children, or with teenagers who engage in other types of risk-taking behavior, such as substance abuse or unprotected sex.

Asking for assistance with suicide was a big step for Zuni because even thinking about suicide is against Zuni beliefs, LaFromboise said. Tribal leaders spent more than a year discussing it among themselves before consulting the Stanford Zuni Committee, a group of faculty who already were involved in various projects with the pueblo.

"At that time, Zuni had had a number of adolescent suicides and was really concerned," LaFromboise said. "We agreed to do some work but said we weren't just going to be outside consultants who come in for a week." Carolyn Harris, a student in anthropology, spent the summer at Zuni, before LaFromboise and graduate assistant Mary Jiron Belgarde began work on a curriculum with assistance from the Stanford Health Promotion Resources Center and a Kaiser Foundation grant.

"Our thinking, as cognitive behavioral psychologists, is to target the behavior you want to change," LaFromboise said. "In this case, that was self-destruction as a way of solving problems. So we presented first the lessons about suicide intervention, followed by lessons about general life skills development. We took it to Zuni, and people at the school said, 'You can't do that. We don't even want suicide in the title. Preserving life is what we are about.' "

The researchers returned to their drawing boards, this time asking Zuni teachers and counselors to help design the lessons on self-esteem that they felt were necessary before bringing up suicide in class. After one year's trial, the program was modified, again with assistance from a teacher at the school who spent the summer at Stanford.

The curriculum is now part of a year-long course offered within language arts classes that students at Zuni High School take in their freshman year. They are given information about such subjects as depression and anger and the skills that people use to deal with them effectively or ineffectively. Examples of strategies that Indians have used to survive difficult situations, both historical and contemporary, are included as well as strategies taken from mainstream life skills research.

The teacher demonstrates skills to the class, students are asked to role play and the teacher gives feedback - what educational psychology calls a "social skills learning-based" model, as opposed to the therapeutic approach to mental health, LaFromboise said.

In a study of the program, LaFromboise and Beth Howard-Pitney of the Stanford Health Promotion Resources Center compared students in the program to another group in the same school who did not take it. They found that the group that took the course showed significantly fewer feelings of hopelessness, although not less depression, than the control group, or than they themselves had shown at the start of the school year. The students also demonstrated a higher level of both problem-solving and suicide intervention skills when judged in role playing by outside judges who did not know which students had taken the course and which had not.

The results were extremely encouraging, LaFromboise said, although she suggested that it would be better to start teaching life skills to younger children and to offer periodic "booster" sessions in high school and adult education. Booster sessions would reinforce the use of the coping skills that are taught in class but are not necessarily used by other important people in the young person's life. Providing training for parents at the same time as children also may be a good idea, she said.

"If you are going to wait until high school, it should be done in the freshman year with booster sessions in the junior or senior years," she said, "because the kids who are the most vulnerable to suicide are those who leave a formal educational setting and are hanging out."

Researchers do not know why suicide is more likely among young American Indians than older ones. (For Anglo Americans, the rate of suicides increases with age, although suicide is on the rise among white American teenagers as well.) The suicide rate among Indians varies substantially from tribe to tribe, but in general, the typical victim is a male under age 30. Women make more suicide attempts than men but succeed less often.

There are only three empirical studies of suicide attempt behavior among adolescent Indians, LaFromboise said, including her study of Zuni youth. She found a high rate of depression and hopelessness or sense of a limited future among adolescents. Like the other two studies, hers found that the best predictors of a suicide attempt were a previous attempt by the person or a family member or friend, substance abuse or physical abuse.

If she were to do the study again, LaFromboise said, she would like to include questions that would measure how much of adolescent depression or hopelessness could be attributed to a sense of "unresolved grief or loss. "

"One of every 10 Indian adolescents has lost a mother or father," LaFromboise said. "The amount of loss due to accidental death - car wrecks, hunting accidents, you name it - is great."

On top of that, she said, there is a relative loss of culture, such as younger generations not being able to speak the language of their elders. "In some tribes, you can't even pray to the Creator if you are not praying in your own language," LaFromboise said. It would be helpful to know, she said, if those who were most vulnerable to suicide were more or less traditional in their cultural background, in comparison to others in their tribe.

Other locations

The curriculum is being used by six reservation schools in Wisconsin, she said, in programs aimed at preventing other forms of adolescent risk-taking behavior such as unprotected sex, substance abuse and violence. It is being used by the American Indian Art Institute in Santa Fe with young adult artists who are talented in art but not necessarily skilled in interpersonal dynamics or group problem solving, she said, and with Indian girls in Madison, Wisc., as part of federal Title 9 educational support for American Indians in urban settings. It also is used by a multiple tribe boarding school in Oklahoma.

LaFromboise hopes to expand and improve on the curriculum as she gets more information from another research project: the development of an instrument for measuring an individual's "bicultural competence." She defines this broadly as being skilled at moving between two or more quite different cultural environments.

"When you are going to teach life skills to students who are geared for the armed forces or any kind of training beyond high school, or if you are preparing students to go to high school off the reservation, the critical skills to teach are the things you need to do to be successful in non-Indian environments," she said. She has assembled focus groups of Indians and non-Indians to help her identify skills that may have been overlooked in previous social science research and theory on dual cultural acquisition.

"The literature doesn't talk much about social isolation and loneliness, but I think that people who are operating between two worlds are going to find themselves in situations where they don't have a very strong reference group and have to be able to withstand long periods of isolation in order to, for example, get the educational training they want."

The focus groups have helped her to see, she said, that Indian leaders who have been ambassadors or bridges to the white world are not the only Indians who need to be able to move between two cultures. "Many people have this dual-world experience as a result of foster care and adoption, cross-cultural marriages, inter-tribal marriages or even just from being raised in different generations with different expectations."

Some social scientists have theorized that bicultural individuals contribute greatly to society as a whole but suffer negative psychological consequences. LaFromboise said she believes, however, that it is quite possible to be happy and successful i