Assessing Suicide and Risk Behaviors in an Incarcerated American Indian Population: Investigating Culturally Sensitive Risk Assessment Instruments and Procedures

Christine Wilson Duclos, Univ. of Colorado Health Sciences Ctr

ABSTRACT
Objectives: To determine if a current suicide screening assessment tool was culturally appropriate for use with American Indians within a bordertown county jail population and whether the employment of different suicide screening protocols make a difference in the responses of detainees with regard to honest reports of suicide ideation and risk factors.

Methods: Data were gathered utilizing two self-report surveys to ascertain validation data as well as honesty and comfortableness of protocol procedures. Additionally focus groups were convened to review item-level response to assessment tool as well as process issues.

Results: Prevalence of suicide ideation was the same across Indian and nonIndian groups; a rate lower than expected. Validity concordance was low in sensitivity for suicide screening assessment tool, especially with American Indians. Focus group results point to nondisclosure of suicide ideation as well as risk factors due to both wording, and procedural and culturally specific issues. Timing of the assessment, wording of the assessment tool, building a trusting relationship, and a concerning demeanor were found to increase honesty as well as comfortableness for full disclosure. Indian-specific concepts of community, mental health, loss, respect, ghost illness, and direct negative questioning were found influential.

Conclusions: There are many reasons why American Indian detainees hesitate to disclose suicide ideation and other personal information. Historical distrust of uniformed officers, multiple and complex histories of trauma, cultural mores and definitions around self-disclosure, the importance of relationship, and spirituality all have an impact onjail procedures that are the products of the dominant culture. Non-Indian detainees, however, also resist making honest self disclosures and voice interest in having a trusting and empathic interviewer as a pre-condition to their revealing personal information. Research findings carry many implications for the public and justice policy and regulatory demands currently made on detention centers, especially in areas where particular cultural groups are represented.

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Updated 05/20/2006