A Mixed-method Study of Fluctuations in Suicide Risk and Resilience in Native American Young Adults

Native American young people are more likely to die by suicide than their peers from all other racial or ethnic backgrounds. Though this disparity is well-established, Native American suicide research, particularly that which examines risk factors over time, is remarkably underdeveloped. The proposed project represents the foundation for a program of research that will address this need by examining potential developmental pathways of suicidality over time. The study we propose would examine both risk factors that differ between individuals (e.g., trauma history, impulsivity, emotion regulation) and within individuals (e.g., number of emerging stressful life events over time, alcohol/substance use week to week, variations in depressive symptoms) as they relate to fluctuations in suicidality over-time via a short-term longitudinal study of Native American emerging adults (N=120; ages 18-25) with a recent history of suicide ideation. The study will include one survey per week over the course of four weeks. The first survey will assess for the between-individual factors mentioned above and every survey will assess for the within-individual factors. We will also inquire about a subgroup of participants' (n = 20) views of their risk and resilience pathways through qualitative interviews, where they will be asked a series of open ended questions. Through this project, we aim to: (1) examine the feasibility of recruitment and retention of this population over the course of four short surveys; (2) understand the predictive nature of these risk factors (state and trait) as they relate to fluctuations of suicidal thoughts over time; (3- exploratory) identify themes within Native American emerging adults' conceptualizations of their pathways to suicide risk and resilience over the study period. We hypothesize that we will be able to retain at least 80% of our sample over the four week period. We also hypothesize that fluctuations in life-stress, depressive symptoms, and alcohol or substance use will align with fluctuations in suicide ideation frequency and intensity week-by-week and that a history of childhood trauma, high trait impulsivity, and poor emotion regulation skills will all be independently associated with greater increases in suicide ideation during weeks where participants experienced higher than usual life stress, as opposed to their peers without these histories or traits. We will be assessing for suicide risk and implementing safety protocols at each of the four timepoints. In successfully completing this study, we will be able to provide information to researchers about the feasibility of our work and how we increased feasibility (e.g., through participant payments, collaborators). Further, this project will help us to begin to understand how suicidality changes over time and identify potential predictors of those changes. The data collected will be able to be used as pilot data for future projects that require more resources, such as data collection with daily surveys or larger samples. We hope that this project will act as a catalyst for a body of research that will inform suicide intervention and treatment efforts which ultimately aim to prevent death by suicide in this underserved, high-risk population.