Journal articles on the topic 'Suicide – Canada – Statistics'

This article presents descriptive statistics on the 66 suicides occurring in federal institutions in Canada over a 4-year period. Criminological and institutional factors of those who committed suicide included lengthy involvement in the criminal justice system, a greater likelihood of being incarcerated for robbery or murder, and involvement in institutional incidents of a serious nature. In addition, 62% of the inmates who committed suicide had been transferred from other institutions within 6 months prior to suicide, though 59% evidenced no indicators of suicidal intent and 44% were not considered to be depressed at the time of suicide. Family problems (29%) were the most commonly hypothesized motivating factor in the suicides, followed by denial of a request for appeal, parole, or transfer (26%), fear of other inmates (24%), and substance abuse problems (21%). Current and planned suicide prevention and intervention strategies of the Correctional Service of Canada are discussed in the context of these findings.

Background: Evidence suggests that suicide mortality increases after high-profile suicide deaths. Indeed, suicide in the United States increased disproportionately after the suicide by suffocation of well-known comedian Robin Williams in August 2014. Such increases are often attributed to irresponsible media coverage of the suicide contributing to “copycat suicides.” However, recent research indicates that the mainstream Canadian media have significantly improved their suicide coverage, with high fidelity to suicide reporting guidelines after Williams’ death. As such, the aim of the present study is to examine suicide mortality in Canada after Robin Williams’ suicide. Methods: We obtained deidentified monthly suicide count data from January 1999 to December 2015 stratified by age, sex, and method of suicide from Statistics Canada. We used time-series analyses to estimate the expected number of suicides in the months following Robin Williams’ death. This was done using a seasonal autoregressive integrated moving averages (SARIMA) method. Expected suicides were then compared with observed suicides. Results: August 2014 was the month with the highest number of suicides from 2010 to 2015. The time-series model indicated a 16% increase in the expected number of suicides during the months from August to December 2014 inclusive. Moreover, males over 30 had the greatest number of excess suicides, and suicides by suffocation (the method used by Robin Williams) were also higher in August and the following months. Interpretation: Suicides increased in Canada after Robin Williams’ death, despite the improved mainstream media coverage witnessed in other studies. Other factors (e.g., social and alternative media) may have contributed to the observed increase in suicide.

Introduction The purpose of this paper is to describe the trends and patterns of self-inflicted injuries, available from Canadian administrative data between 1979 and 2014/15, in order to inform and improve suicide prevention efforts. Methods Suicide mortality and hospital separation data were retrieved from the Public Health Agency of Canada (PHAC) holdings of Statistics Canada’s Canadian Vital Statistics: Death Database (CVS:D) (1979 to 2012); Canadian Socio-Economic Information Management System (CANSIM 2011, 2012); the Hospital Morbidity Database (HMDB) (1994/95 to 2010/11); and the Discharge Abstract Database (2011/12 to 2014/15). Mortality and hospitalization counts and rates were reported by sex, 5-year age groups and method. Results The Canadian suicide rate (males and females combined, all ages, age-sex standardized rate) has decreased from 14.4/100 000 (n = 3355) in 1979 to 10.4/100 000 (n = 3926) in 2012, with an annual percent change (APC) of –1.2% (95% CI: –1.3 to –1.0). However, this trend was not observed in both sexes: female suicide rates stabilized around 1990, while male rates continued declining over time—yet males still accounted for 75.7% of all suicides in 2012. Suffocation (hanging and strangulation) was the primary method of suicide (46.9%) among Canadians of all ages in 2012, followed by poisoning at 23.3%. In the 2014/15 fiscal year, there were 13 438 hospitalizations in Canada (excluding Quebec) associated with self-inflicted injuries—over 3 times the number of suicides. Over time females have displayed consistently higher rates of hospitalization for self-inflicted injury than males, with 63% of the total. Poisoning was reported as the most frequent means of self-inflicted harm in the fiscal year 2014/15, at 86% of all hospitalizations. Conclusion Suicides and self-inflicted injuries continue to be a serious—but preventable— public health problem that requires ongoing surveillance.

Abstract Purpose There is international evidence supporting an association between sensational reporting of suicide and a subsequent increase in local suicide rates, particularly where reporting the death of a celebrity. We aimed to explore whether the observed increase in suicides in the United States, Canada and Australia in the 5 months following the 2014 suicide of the popular actor Robin Williams was also observed in England and Wales. Method We used interrupted time-series analysis and a seasonal autoregressive integrated moving averages (SARIMA) model to estimate the expected number of suicides during the 5 months following Williams’ death using monthly suicide count data for England and Wales from the UK Office for National Statistics (ONS) 2013–2014. Results Compared with the observed 2051 suicide deaths in all age groups from August to December 2014, we estimated that we would have expected 1949 suicides over the same period, representing no statistically significant excess. Conclusions This finding is an outlier among previous studies and contrasts with the approximately 10% increase in suicides found in similar analyses conducted in other high-income English-speaking countries with established media reporting guidelines.

Background. Various studies from Australia, Canada and the United States have shown significant rank correlations between the suicide rates of immigrants and those of their country of birth (COB). This study compares the rank ordering of age standardized suicide rates of immigrants in Australia for two periods, 1961–70 and 1979–90: (a) between each period; and (b) with their COB for each period.Methods. Data were obtained from the World Health Organization Annual Statistics and from the Australian Bureau of Statistics. Comparisons were made for 11 countries from England and Wales, Ireland and Europe, for which there was a sufficiently large number of immigrant suicides to warrant statistical analysis.Results. The data showed considerable heterogeneity in rates of immigrants from various countries, with increased rates in Australia compared with their COB. There were consistently significant Spearman rank correlations between the rates after immigration and those in their COB for each period, and between rates in the two periods for both immigrants and for their COB, despite increases in suicide rates, and considerable socio-economic demographic changes between the various countries over that time span.Conclusions. The findings are used to argue two conclusions: (i) the important influence of pre-migrant social and cultural experiences in subsequent suicide rates in immigrants in their host country; and (ii) to support the case for the reliability of using international suicide data for comparative epidemiological research.

Abstract Suicide rates are high in high-income countries like Canada and the United States, where 10 to 12 people per 100 000 commit suicide every year. In the United States, in 2011 there were 73.3 emergency room visits per 100 000 people for suicide attempts with prescription drugs. The latter were also involved in 13% of completed suicides between 1999 and 2013. In most cases, these drugs were distributed by members of our profession who could not predict this outcome. This led us to create an initiative to teach pharmacy students how to prevent suicide. A literature review and online search were performed to find documentation about pharmacists' commitment to the cause, but very little information exists. Thus, a training session was developed for third-year pharmacy students that includes basic statistics, arguments for involving pharmacists in suicide prevention, role-playing, tools to evaluate suicide risk, thoughtful verbatims of interview techniques, and case studies. It is delivered during the mental health theme of the psychiatry course. In 5 years, around 1150 students have participated in the course, of whom approximately 950 are now practicing pharmacists. This intervention may have prevented some suicides, although the impact is impossible to measure. The objective of this paper is to describe the creative process of designing a suicide prevention training session for pharmacy students, while inspiring a mental health sensitive readership to this noble cause. This article does not provide guidelines on how to replicate this initiative, nor does this article replace proper training on suicide prevention.

LAY SUMMARY The Veteran Suicide Mortality Study describes the risk of death by suicide for Canadian Veterans using data linkage at Statistics Canada. The study includes Veterans released with Regular Force or Reserve Force Class C service over the period 1976-2012. Both male and female Veterans had higher risk of suicide if they released at non-officer ranks. For men, the risk of suicide death peaked around four years after release from the military. For women, the risk of suicide death peaked around 20 years after release. This study provides information for the timing of prevention efforts.

Self-harm has become one of the leading causes of mortality in developed countries. The overall rate for suicide in Canada is 11.3 per 100,000 according to Statistics Canada in 2015. Between 2000 and 2007 the lowest rates of suicide in Canada were in Ontario, one of the most urbanized regions in Canada. However, the interaction between land use, landscape and self-harm has not been significantly studied for urban cores. It is thus of relevance to understand the impacts of land-use and landscape on suicidal behavior. This paper takes a spatial analytical approach to assess the occurrence of self-harm along one of the densest urban cores in the country: Toronto. Individual self-harm data was gathered by the National Ambulatory Care System (NACRS) and geocoded into census tract divisions. Toronto’s urban landscape is quantified at spatial level through the calculation of its land use at different levels: (i) land use type, (ii) sprawl metrics relating to (a) dispersion and (b) sprawl/mix incidence; (iii) fragmentation metrics of (a) urban fragmentation and (b) density and (iv) demographics of (a) income and (b) age. A stepwise regression is built to understand the most influential factors leading to self-harm from this selection generating an explanatory model.

Objective: The effects of socioeconomic factors on suicide rates in the general population are widely documented. Few of these reports have specifically studied the effects of socioeconomic variables on suicide rates in the elderly population. Elderly persons have the highest suicide rates of any age-group. This group is different from the rest of the population insofar as suicide is concerned. For example, since most elderly persons are no longer in the labour force, it would be expected that they would be affected differently by economic factors such as unemployment. We report the findings of an ecological study of old-age suicide in British Columbia over an 11-year period. Methods: We obtained information on all suicide counts (International Classification of Diseases [ICD-9] codes E590–959) recorded in the 21 health units of British Columbia over the 11-year period from October 1, 1981, to September 30, 1991, from the Division of Vital Statistics of the Province of British Columbia and Statistics Canada. Social, economic, and demographic information for the health units was obtained from census data and included the number of persons per household, proportion of the population that lived in 1-person households, immigration and migration rates for each region, proportion of the population with less than grade 9 education, proportion with less than grade 12 certification, marital status rates, unemployment rates by gender, average household income, average census family income, and labour-force participation rate by gender. We calculated overall and gender-specific suicide rates for elderly persons (65 years and older) and younger populations. Using Poisson regression analyses, we determined the cross-sectional and longitudinal relative risks associated with the socioeconomic variables for the units, and we also examined trends in suicide rates. Results: There were 4630 suicides in the 11-year period. The mean suicide rate (per 100 000 population) for those over age 9 years was 18.6 (between health unit SD 5.2, 95% confidence interval [CI] = 17.0–20.2). The elderly have a higher suicide rate in every region. The male suicide rates (mean = 26.9, SD 6.4, 95% CI = 24.0–30.0) are higher than female rates (mean = 7.5, SD 1.7, 95% CI = 6.8–8.3) in every region. The factors influencing suicides were different for elderly males and elderly females. In all analyses, suicide rates in elderly females remained essentially stable across age-groups and units and over the years. Elderly male suicide rates varied across units and age-groups and over the years. Conclusions: Suicide rates are highest in males over age 74 years. There are regional differences in elderly suicide rates and the factors that influence them. Longitudinal and cross-sectional risk factors differ, and there are gender differences in the risk factors. For both elderly males and females, suicide rates appear to be influenced by social factors in the population as a whole, not just in the elderly population. Male and female employment patterns are associated with elderly male suicide rates, even though the latter are not in the labour force. For suicide in elderly women the important factors are population education, income, and migration levels.

IntroductionSuicide is a major public-health problem in Canada. Data from ‘Statistics Canada’ suggests that there was a 10% increase in suicide rate between the years 1997 and 1999. Studies have found substantial differences in suicide rates (and patterns) amongst ethnic immigrants compared to Canadian-born individuals.AimThe aim of the study was to investigate whether ethnic-immigrant patients differed from Canadian-born patients in their social, demographic, psychiatric and historical associations.MethodsAll registered patients (n = 276) known to have completed suicide from 1966–1997 constituted the study sample. Data were extracted from the written case audits, autopsy and toxicology reports, and medical records.ResultsOf the 276 known cases of suicide, 11 were Afro-Caribbean, 24 were Eastern European, 14 were Asian and 215 were Canadian-born patients. The ethnic-immigrant groups were broadly comparable to the Canadian-born group in terms of the social, demographic, psychiatric and background historical factors (except that the latter had a higher prevalence of alcohol and substance misuse). There were no significant differences between different ethnic immigrant groups themselves.ConclusionsThe most salient implication of the findings are that social, psychiatric and historical associations of mentally ill patients who complete suicide are common across different ethnic immigrant groups, and as such a universal approach to mental health promotion, early identification and treatment would be similarly applicable to patients belonging to all groups.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The article focuses on the study of suicide worldwide and Ukraine in particular. The phenomenon of suicide is relevant in all corners of the world, it affects people of all nations, cultures, religions, articles, and classes. The scientific community in many countries around the world demonstrates indifference to the problem of suicide; Accordingly, suicide is gradually becoming one of the leading causes of death worldwide. Thus, suicide ranks 15th among the leading causes of death. WHO statistics show that suicide is committed twice as often as murder, and emphasizes that this phenomenon is global and reaches critical levels every year. We have analyzed the regulatory framework for suicide at the global level. For example, over the last decades, since 2000, due to the incredible efforts of WHO, this problem has begun to receive national attention. In the developed world, many regulations on suicide prevention have been developed and adopted. In the course of scientific research, we found out that suicide and Ukraine is the seventh cause of death, which confirms the criticality of the problem and the need for its fastest solution. We believe that there is a need today to support such categories of persons as children and young people, servicemen, convicts, and the elderly. The article examines the experience of such foreign countries as the USA, Azerbaijan, Israel, Canada, Australia, New Zealand, Great Britain, and other European countries of the world. Finding out what prevention and prevention measures they have implemented in national suicide prevention programs, we see the possibility of their implementation in Ukraine and are convinced of their effectiveness. According to the results of scientific research, we will develop an administrative and legal mechanism for suicide prevention in Ukraine, which can work if all the steps of the algorithm for reducing suicide rates are fulfilled. Keywords: suicide, administrative and legal mechanism, the algorithm of actions, statistics, suicide rate.

Suicidality is an important contributor to disease burden worldwide. We examine the developmental and environmental correlates of reported suicidal ideation at age 15 and develop a new evolutionary model of suicidality based on life history trade-offs and hypothesized accompanying modulations of cognition. Data were derived from the National Longitudinal Survey of Children and Youth (Statistics Canada) which collected information on children’s social, emotional, and behavioral development in eight cycles between 1994 and 2009. We take a model selection approach to understand thoughts of suicide at age 15 ( N ≈ 1,700). The most highly ranked models include social support, early life psychosocial stressors, prenatal stress, and mortality cues. Those reporting consistent early life stress had 2.66 greater odds of reporting thoughts of suicide at age 15 than those who reported no childhood stress. Social support of the primary caregiver, neighborhood cohesion, nonkin social support of the adolescent, and the number of social support sources are all associated with suicidal thoughts, where greater neighborhood cohesion and social support sources are associated with a reduction in experiencing suicidal thoughts. Mother’s prenatal smoking throughout pregnancy is associated with a 1.5 greater odds of suicidal thoughts for adolescents compared to children whose mother’s reported not smoking during pregnancy. We discuss these findings in light of evolutionary models of suicidality. This study identifies both positive and negative associations on suicidal thoughts at age 15 and considers these in light of adaptive response models of human development. Findings are relevant for mental health policy.

Abstract Background Suicide is the second leading cause of death among Canadian adolescents. Youth who make near fatal suicide attempts, such as those requiring intensive care unit (ICU) level care, are the closest proxy to those that die by suicide; however, there is limited data on this group. Objectives To evaluate the minimum incidence rate and patterns of presentation of youth (under 18 years of age) admitted to the ICU for medically serious self-inflicted injury. Design/Methods From January 2017 to December 2018, over 2,700 paediatricians/subspecialist members of the Canadian Paediatric Surveillance Program were electronically surveyed on a monthly basis regarding cases of medically serious self-harm. Participants completed a detailed questionnaire about the reported case and descriptive statistics were used for analyses. Results Ninety-four cases (71 female; mean age 15.2 years) of confirmed (n=87) and suspected/probable (n=7) medically serious self-harm were reported. The majority (87%) of cases were reported from 4 out of 13 provinces and territories in Canada (Alberta, British Columbia, Ontario, Quebec). There were 11 deaths by suicide (M>F; p<.05). Medication ingestion was the most common method of self-harm among females (76% F vs. 52% M; p=.03) compared with hanging among males (14% F vs. 39% M; p=.009). More females than males had a prior suicide attempt (62% F vs. 32% M; p=.07) and a history of non-suicidal self-injury (NSSI) (65% F vs. 14% M; p<.05), although only history of NSSI reached significance. More females than males had a past psychiatric diagnosis (77% F vs. 55% M; p=.05), and past use of mental health services (69% F vs. 30% M; p<.001), although only service use reached significance. Half of the youth left evidence of intent (54%) and 33% of parents of included youth were aware that their child was considering suicide. Family conflict was the most common precipitating factor for suicide attempt in both females and males (46%). Conclusion These Canadian findings are consistent with international epidemiologic data that observe a gender paradox of higher rates of suicide attempts in females and greater mental health care engagement but increased suicide mortality in males with decreased involvement with mental health care. This study suggests that family conflict is a potential target for suicide prevention interventions among youth. Future research focusing on gender-specificity in risk factor identification and effectiveness of primary prevention interventions among youth is warranted.

From each of 15 health regions, potential years of life lost (PYLL) before age 75 for Status Indians is compared for select causes of death with all other residents. Mortality data from 1991 to 2001 for rates of PYLL (standardized to the 1991 population) are from tables of the British Columbia Vital Statistics Agency and First Nations and Inuit Health Branch in 2002. PYLL rate differences and rate ratios were compared for two groups with significance of the former indicated by the 95% confidence interval. Overall, the rates of PYLL for suicide, homicide, and deaths due to motor vehicle accidents were about 224%, 340%, and 248% higher among Status Indians than all other residents. Rates of PYLL for homicide and deaths from motor vehicle accidents among Status Indian women exceeded those of other residents who were men. For suicide, Status Indian men ranked first and all other male residents of British Columbia ranked second.

Endemic tuberculosis (TB) was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada) before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research.Methods and analysisWe will search electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO), clinical trial registries, conference abstracts, and professional guidelines and recommendations from jurisdictions where MAID is legal, up to June 2017. Eligible report types will include technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies. We will include all descriptions of MAID provision (either euthanasia or assisted suicide) in adults who have provided informed consent for MAID, for any reason, including reports where patients have provided consent to MAID in advance of the development of incapacity (eg, dementia). We will exclude reports in which patients receive involuntary euthanasia (eg, capital punishment). Two independent investigators will screen and select retrieved reports using pilot-tested screening and eligibility forms, and collect data using standardised data collection forms. We will summarise extracted data in tabular format with accompanying descriptive statistics and use narrative format to describe their clinical relevance, identify knowledge gaps and suggest topics for future research.Ethics and disseminationThis scoping review will map the range and scope of the existing literature on the provision of MAID in jurisdictions where the practice has been decriminalised. The review will be disseminated through conference presentations and publication in a peer-reviewed journal. These results will be useful to clinicians, policy makers and researchers involved with MAID.

This paper reviews research progress and research priorities in the study of suicidal behaviour as a preliminary to implementing a community-based program of education and prevention of suicidal behaviours. Among the priorities for Canadian research and evaluation which this review has identified are better statistical base for Canadian suicidology; the study of regional and ecological variations in suicidal behaviour in Canada; the role of social stress, unemployment, and social change; family stability and disruption; the role of biological factors, mental illness, and alcoholism; the taxonomy of suicidal behaviours; the social meanings of suicide at the community level; and the increasing rates of suicidal behaviour in young people and associated age cohorts.

Introduction: Both active euthanasia and assisted suicide are legal in The Netherlands, Belgium, Luxemburg and, most recently, in Canada. Aim: Examination of national legislations of countries where both active euthanasia and assisted suicide are legal. The number of accomplished active euthanasia cases and that of assisted suicide cases. Method: Analysis of national statistical data. Comparison of statistical data before and after 2010. Comparison of the related practices in the surveyed countries. Results: The number of active euthanasia cases markedly predominates over the number of assisted suicide cases. Cancer is a main reason for active euthanasia, or assisted suicide. In countries with a larger population, the number of active euthanasia cases is higher than that in countries with a smaller population. Conclusions: Regarding the fact that the applicants for active euthanasia withdraw their requests in a smaller number than the applicants for assisted suicide, patients prefer the choice of active euthanasia. Since the related legislative product is too recent in Canada at present, it may be only presumed that a certain preference will also develop in the related practices in Canada. Orv. Hetil., 2016, 157(40), 1595–1600.

AimsThe frequency and burden of suicidality in obsessive-compulsive and related disorders have historically been under-reported, despite research pointing to a significant association between OCD and suicidality. Likewise, OCD is frequently undiagnosed or misdiagnosed. This study looks at coroners’ reports relating to suicides in UK, Australia and Canada in order to:Explore characteristics of suspected or confirmed cases of OCD in coroners’ reportsIdentify instances of possible undiagnosed or misdiagnosed OCDIdentify recurring themes in the reportsMethod1869 publicly available coroners’ reports were accessed from England (n = 200), Scotland (n = 128), Canada (n = 680) and Australia (n = 861). Reports were screened in order to identify individuals who had either a diagnosis of OCD (n = 16), a diagnosis of a related condition (n = 4), or indications of possible undiagnosed OCD (n = 12). Wherever possible, demographic and psychiatric characteristics were extracted for statistical analysis. Qualitative thematic analysis was carried out on selected reports.Result32 cases of interest were identified from analysis of coroners’ reports of suicides that took place between the years of 2000 and 2020. Breakdown by country was as follows:United Kingdom: n = 6 (1.8% of total reports analysed from United Kingdom)Canada n = 3 (0.4% of total reports analysed from Canada)Australia n = 23 (2.7% of total reports analysed from Australia)Among those with possible undiagnosed OCD, common experiences were fear of causing harm, intrusive thoughts of guilt and shame, and compulsive checking and/or reassurance seeking. Further themes included: misdiagnosis, failings in mental health care, stigma and discrimination.ConclusionIndividuals with OCD are thought to be up to ten times more likely to die by suicide, with this risk increasing in the presence of psychiatric comorbidities. However, OCD remains underdiagnosed, and this may be reflected in the relatively low number of suicides identified for this study where OCD was diagnosed before death. The low numbers may also point to a tendency among both coroners and healthcare professionals to underestimate the association between OCD and suicidality.Qualitative analysis of the coroners’ reports identified a theme of intolerable distress. This distress was documented most extensively in reports where OCD was strongly indicated but never diagnosed, highlighting the impact of missed, late or incorrect diagnosis.Notably, nearly all of the reports reveal repeated attempts by the individual to seek help. Despite this, many experienced stigma, mental health service failings and missed opportunities for help in the months preceding their deaths.

Suicide is a major public health issue in Canada. The quality of health care services, in addition to other individual and population factors, has been shown to affect suicide rates. In publicly managed care systems, such as systems in Canada and the United Kingdom, the quality of health care is manifested at the individual, program and system levels. Suicide audits are used to assess health care services in relation to the deaths by suicide at individual level and when aggregated at the program and system levels. Large health administrative databases comprise another data source used to inform population- based decisions at the system, program and individual levels regarding mental health services that may affect the risk of suicide. This status report paper describes a project we are conducting at the Institut national de santé publique du Québec (INSPQ) with the Quebec Integrated Chronic Disease Surveillance System (QICDSS) in collaboration with colleagues from Wales (United Kingdom) and the Norwegian Institute of Public Health. This study describes the development of quality of care indicators at three levels and the corresponding statistical analysis strategies designed. We propose 13 quality of care indicators, including system-level and several population-level determinants, primary care treatment, specialist care, the balance between care sectors, emergency room utilization, and mental health and addiction budgets, that may be drawn from a chronic disease surveillance system.

Summary: Suicide rates among inmate populations in prisons are considerably higher than in the general population. Suicide prevention is a common need among penal institutions around the world. Traditional approaches involving only correctional staff in suicide prevention efforts have proven to have their limitations. The involvement of inmates in peer prevention efforts seems to be a reasonable alternative approach. This study examines such a program, called SAMS in the Pen, operated jointly between the prison and the Samaritans of Southern Alberta. This service, the first of its kind in Canada, involved inmate volunteers, known as SAMS, who were trained in listening skills, suicide prevention, and risk assessment. Data was collected for the research from volunteers, correctional staff, general inmate population, and professional staff. However, given the low absolute number in the one institution where the study was carried out, statistical analyses were not practical. As with any new service, the SAMS in the Pen experienced some developmental problems but was perceived to be a worthwhile service to both inmates and staff of the prison.

Objective: To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants ( n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk–hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.

Abstract. Background: In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the distinction between nonsuicidal self-injury (NSSI) and suicide attempts (SA) is highlighted in the section of conditions for further study. Aims: The objective of this study was to examine the correlates of people who presented to emergency departments (ED) with NSSI compared with those who presented with SA and no self-harm or suicidal ideation (no SH or SI). Method: Data came from 4,772 presentations to ED of tertiary care hospitals in Manitoba, Canada, between January 2009 and June 2012. Chart reviews were conducted for presentations with NSSI ( n = 158), and a sample of SA ( n = 172) and no SH or SI ( n = 173). Results: NSSI was associated with borderline personality traits/disorders, previous history of SH, and aggression/impulsivity compared with no SH or SI. SA was associated with a lower likelihood of adjustment disorder ( OR = 0.58; 95 % CI [0.34, 0.99]) and previous history of NSSI ( OR = 0.30; 95 % CI [0.17, 0.53]) compared with NSSI. Limitations: A limitation of this study is its cross-sectional design. Conclusion: Given the distress associated with NSSI, the findings highlight the need for treatment plans that address all those who present to ED with SH regardless of intent.

This study aimed to document the prevalence and factors associated with complete mental health (CMH) among Aboriginal peoples living in Canada. CMH is comprised of three parts: 1) the absence of major depressive episode, anxiety disorders, bipolar disorder, serious suicidal thoughts, and substance dependence in the past year as measured by the World Health Organization (WHO) versions of the Composite International Diagnostic Interview (WHO-CIDI), 2) happiness and/or satisfaction with life in the past month, and 3) psychological and social well-being. The method involved secondary analysis of Statistics Canada’s 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Responses from Aboriginal peoples living in Canada off-reserve ( n = 965) were examined to determine what percentage were in CMH and what characteristics are associated with being in CMH. Data analysis involved both bivariate and multivariate analytic techniques to examine factors associated with CMH among Aboriginal peoples. Overall, two-thirds of Aboriginal peoples (67.9%) living in Canada were in CMH. Those with a post-secondary degree, who had a confidant, and those who were free of disabling chronic pain were more likely to be in CMH. Additionally, the odds of CMH were higher among those without a history of suicidal ideation, major depression, alcohol dependence, drug dependence, anxiety disorder, or difficulty sleeping. Findings from this study provide indications of substantial resiliency among Aboriginal peoples in Canada.

Deaths from avoidable causes represent the largest component of deaths in young people in Canada and have a considerable social cost in relation to years of potential life lost. We evaluated social and demographic determinants of deaths in youth aged 12–24 years in Nova Scotia for the period 1995–2004. Youth most at risk of death were males, the more socially deprived, and those living in rural areas. There was a five-fold increase in suicides and a three-fold increase in injury deaths in males compared to females and a substantial component of these deaths were amongst males living in rural areas. Initiatives and prevention policies should be targeted towards specific at-risk groups, particularly males living in rural areas. Published vital statistics hide these important trends and thus provide only limited evidence with which to base-prevention initiatives.

Introduction. Information on the psychosocial distress and needs of sarcoma patients at diagnosis is sparse. The Canadian Problem Checklist (CPC) and Psychosocial Screen for Cancer-Revised (PSSCAN-R) are validated tools to identify cancer patients’ distress and are administered to all new patients referred to BC Cancer prior to their consultation. We used the CPC and PSSCAN-R to understand sarcoma patients’ needs at the initial oncology consultation in British Columbia, Canada. Materials and Methods. All sarcoma patients who completed the CPC and PSSCAN-R within 6 months of diagnosis between 2011 and 2016 were included. The retrospective chart review identified baseline demographics: age, performance status, disease location, resectability, and histology. Analysis was conducted using descriptive statistics, chi-squared test, Fisher’s exact test, and Kaplan–Meier method. Results. 413 sarcoma patients were identified. The majority of patients were over the age of 40 (83.3%) with ECOG performance status 0-1 (82.6%) and lower extremity tumors (55.4%). The most common diagnoses were liposarcoma 21.3%, undifferentiated pleomorphic sarcoma 12.1%, and myxofibrosarcoma 11.1%. At the initial consultation, 42.6% of patients were deemed resectable, 8.5% unresectable/metastatic, and 48.9% required further staging investigations. The top three patient-reported distress symptoms were feeling tense and unable to relax (50%), feeling nervous and shaky (48%), and experiencing repetitive and scary thoughts (42%). 38% of patients had subclinical/clinical anxiety symptoms, and 21% of patients had subclinical/clinical depression symptoms. 5% of patients expressed suicidal ideation. The top three concerns/needs were understanding of illness/treatment (45.5%), fear/worries (45.3%), and worry about family (23%). No differences in overall survival were identified for patients displaying symptoms of depression or anxiety versus no symptoms. Discussion. Up to 45% of sarcoma patients experience some form of psychological distress at disease presentation. Patients desire information about their diagnosis and treatment. Tailored interventions to individual psychological comorbidity and improved patient education resources would be beneficial.

Objective The objective of this research was to evaluate the impact of federal, public health and social support programs on national suicide rates in Canada. Design Cross-sectional study. Setting Canadian National Database (i.e., Statistics Canada) and Statista. Participants Population-level data, and economic and consumer market data. Main Outcome Measures Suicide mortality data, population data and unemployment data were obtained from available statistical databases (e.g. Statistics Canada). We quantified suicide rate by dividing the total number of suicide deaths by the national population expressed as a rate per 100,000 population. Results Overall suicide mortality rate decreased in Canada from 10.82 deaths per 100,000 in the March 2019 - February 2020 period to 7.34 per 100,000 (i.e. absolute difference of 1300 deaths) in the March 2020 - February 2021 period. The overall Canadian unemployment rate changed from an average monthly rate of 5.7% in 2019 to 9.5% in 2020. Conclusion Our results indicate that for the first post-pandemic interval evaluated (i.e., March 2020 - February 2021), suicide rates in Canada decreased against a background of extraordinary public health measures intended to mitigate community spread of COVID-19. An externality of public health measures was a significant rise in national unemployment rates in population measures of distress. Our results suggest that government interventions that broadly aim to reduce measures of insecurity (i.e., economic, housing, health), and timely psychiatric services, should be prioritised as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic.

Objectives: Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group. Methods: We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis. Results: The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1. Conclusion: The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada.

Abstract Background The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. Methods We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. Results From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide. Conclusions The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide.

Objective: Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey. Method: The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2—Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 ( N = 5,155) were reinterviewed in 2018 ( n = 2,941). The World Mental Health Survey–Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition ( DSM-IV) criteria. Results: The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information. Conclusions: The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.

Context Assessing temporal changes in the recorded diagnostic rates, incidence proportions, and health outcomes of substance-related disorders (SRD) can inform public health policymakers in reducing harms associated with alcohol and other drugs. Objective To report the annual and cumulative recorded diagnostic rates and incidence proportions of SRD, as well as mortality rate ratios (MRRs) by cause of death among this group in Canada, according to their province of residence. Methods Analyses were performed on linked administrative health databases (AHD; physician claims, hospitalizations, and vital statistics) in five Canadian provinces (Alberta, Manitoba, Ontario, Québec, and Nova Scotia). Canadians 12 years and older and registered for their provincial healthcare coverage were included. The International Classification of Diseases (ICD-9 or ICD-10 codes) was used for case identification of SRD from April 2001 to March 2018. Results During the study period, the annual recorded SRD diagnostic rates increased in Alberta (2001–2002: 8.0‰; 2017–2018: 12.8‰), Ontario (2001–2002: 11.5‰; 2017–2018: 14.4‰), and Nova Scotia (2001–2002: 6.4‰; 2017–2018: 12.7‰), but remained stable in Manitoba (2001–2002: 5.5‰; 2017–2018: 5.4‰) and Québec (2001–2002 and 2017–2018: 7.5‰). Cumulative recorded SRD diagnostic rates increased steadily for all provinces. Recorded incidence proportions increased significantly in Alberta (2001–2002: 4.5‰; 2017–2018: 5.0‰) and Nova Scotia (2001–2002: 3.3‰; 2017–2018: 3.8‰), but significantly decreased in Ontario (2001–2002: 6.2‰; 2017–2018: 4.7‰), Québec (2001–2002: 4.1‰; 2017–2018: 3.2‰) and Manitoba (2001–2002: 2.7‰; 2017–2018: 2.0‰). For almost all causes of death, a higher MRR was found among individuals with recorded SRD than in the general population. The causes of death in 2015–2016 with the highest MRR for SRD individuals were SRD, suicide, and non-suicide trauma in Alberta, Ontario, Manitoba, and Québec. Discussion Linked AHD covering almost the entire population can be useful to monitor the medical service trends of SRD and, therefore, guide health services planning in Canadian provinces.

Introduction Many anthropologists and other academics have attempted to argue that the spread of technology is a global homogenising force, socialising the remaining indigenous groups across the planet into an indistinct Western "monoculture" focussed on consumption, where they are rapidly losing their cultural distinctiveness. In many cases, these intellectuals -– people such as Jerry Mander -- often blame the diffusion of television (particularly through new innovations that are allowing it to penetrate further into rural areas, such as satellite and cable) as a key force in the effort to "assimilate" indigenous groups and eradicate their unique identities. Such writers suggest that indigenous groups can do nothing to resist the onslaught of the technologically, economically, and aesthetically superior power of Western television. Ironically, while often protesting the plight of indigenous groups and heralding their need for cultural survival, these authors often fail to recognise these groups’ abilities to fend for themselves and preserve their cultural integrity. On the other side of the debate are visual anthropologists and others who are arguing that indigenous groups are quickly becoming savvy to Western technologies, and that they are now using them for cultural revitalisation, linguistic revival, and the creation of outlets for the indigenous voice. In this school of thought, technology is seen not so much as a threat to indigenous groups, but instead as a remarkable opportunity to reverse the misfortunes of these groups at the hands of colonisation and national programmes of attempted assimilation. From this perspective, the rush of indigenous groups to adopt new technologies comes hand-in-hand with recent efforts to assert their tribal sovereignty and their independence. Technology has become a "weapon" in their struggle for technological autonomy. As a result, many are starting their own television stations and networks, and thus transforming the way television operates in their societies -– away from global monocultures and toward local interests. I hypothesise that in fact there is no correlation between television viewing and acculturation, and that, in fact, the more familiar people are with the technology of television and the current way the technology is utilised, the more likely they are to be interested in using it to revive and promote their own culture. Whatever slight negative effect exists depends on the degree to which local people can understand and redirect how that technology is used within their own cultural context. However, it should be stated that for terms of this investigation, I consider the technologies of "video" and "television" to be identical. One is the recording aspect, and the other the distribution aspect, of the same technology. Once people become aware that they can control what is on the television screen through the instrumentality of video, they immediately begin attempting to assert cultural values through it. And this is precisely what is going on on the Cheyenne River Reservation. This project is significant because the phenomenon of globalisation is real and Western technologies such as video, radio, and PCs are spreading throughout the world, including the "Fourth World" of the planet’s indigenous peoples. However, in order to deal with the phenomenon of globalisation, anthropologists and others may need to deal more realistically with the phenomenon of technological diffusion, which operates far less simply than they might assume. Well-meaning anthropologists seeking to "protect" indigenous groups from the "invasion" of technologies which will change their way of life may be doing these groups a disservice. If they turned some of their effort away from fending off these technologies and toward teaching indigenous groups how to use them, perhaps they might have a better result in creating a better future for them. I hope this study will show a more productive model for dealing with technological diffusion and what effects it has on cultural change in indigenous societies. There have been very few authors that have dealt with this topic head-on. One of the first to do so was Pace (1993), who suggested that some Brazilian Indians were acculturating more quickly as a result of television finally coming to their remote villages in the 1960s. Molohon (1984) looked at two Cree communities, and found that the one which had more heavy television viewing was culturally closer to its neighboring white towns. Zimmerman (1996) fingered television as one of the key elements in causing Indian teenagers to lose their sense of identity, thus putting them at higher risk for suicide. Gillespie (1995) argued that television is actually a ‘weapon’ of national states everywhere in their efforts to assimilate and socialise indigenous and other ethnic minority groups. In contrast, authors like Weiner (1997), Straubhaar (1991), and Graburn (1982) have all critiqued these approaches, suggesting that they deny subjectivity and critical thinking to indigenous TV audiences. Each of these researchers suggest, based on their field work, that indigenous people are no more likely than anybody else to believe that the things they see on television are true, and no more likely to adopt the values or worldviews promoted by Western TV programmers and advertisers. In fact, Graburn has observed that the Inuit became so disgusted with what they saw on Canadian national television, that they went out and started their own TV network in an effort to provide their people with meaningful alternatives on their screens. Bell (1995) sounds a cautionary note against studies like Graburn’s, noting that the efforts of indigenous New Zealanders to create their own TV programming for local markets failed, largely because they were crowded out by the "media imperialism" of outside international television. Although the indigenous groups there tried to put their own faces on the screen, many local viewers preferred to see the faces of J.R. Ewing and company, and lowered the ratings share of these efforts. Salween (1991) thinks that global media "cultural imperialism" is real -– that it is an objective pursued by international television marketers -– and suggests a media effects approach might be the best way to see whether it works. Woll (1987) notes that historically many ethnic groups have formed their self-images based on the way they have been portrayed onscreen, and that so far these portrayals have been far from sympathetic. In fact, even once these groups started their own cinemas or TV programmes, they unconsciously perpetuated stereotypes first foisted on them by other people. This study tends to side with those who have observed that indigenous people do not tend to "roll over" in the wake of the onslaught of Western television. Although cautionary studies need to be examined carefully, this research will posit that although the dominant forces controlling TV are antithetical to indigenous groups and their goals, the efforts of indigenous people to take control of their TV screens and their own "media literacy" are also increasing. Thus, this study should contribute to the viewpoint that perhaps the best way to save indigenous groups from cultural eradication is to give them access to television and show them how to set up their own stations and distribute their own video programming. In fact, it appears to be the case that TV, the Internet, and electronic 'new media' are helping to foster a process of cultural renewal, not just among the Lakota, but also among the Inuit, the Australian aborigines, and other indigenous groups. These new technologies are helping them renew their native languages, cultural values, and ceremonial traditions, sometimes by giving them new vehicles and forms. Methods The research for this project was conducted on the Cheyenne River Sioux Reservation headquartered in Eagle Butte, South Dakota. Participants chosen for this project were Lakota Sioux who were of the age of consent (18 or older) and who were tribal members living on the reservation. They were given a survey which consisted of five components: a demographic question section identifying their age, gender, and individual data; a technology question section identifying what technologies they had in their home; a TV question section measuring the amount of television they watched; an acculturation question section determining their comparative level of acculturation; and a cultural knowledge question section determining their knowledge of Lakota history. This questionnaire was often followed up by unstructured ethnographic interviews. Thirty-three people of mixed age and gender were given this questionnaire, and for the purposes of this research paper, I focussed primarily on their responses dealing with television and acculturation. These people were chosen through strictly random sampling based on picking addresses at random from the phone book and visiting their houses. The television section asked specifically how many hours of TV they watched per day and per week, what shows they watched, what kinds of shows they preferred, and what rooms in their home had TVs. The acculturation section asked them questions such as how much they used the Lakota language, how close their values were to Lakota values, and how much participation they had in traditional indigenous rituals and customs. To assure open and honest responses, each participant filled out a consent form, and was promised anonymity of their answers. To avoid data contamination, I remained with each person until they completed the questionnaire. For my data analysis, I attempted to determine if there was any correlation (Pearson’s coefficient r of correlation) between such things as hours of TV viewed per week or years of TV ownership with such things as the number of traditional ceremonies they attended in the past year, the number of non-traditional Lakota values they had, their fluency in the Lakota language, their level of cultural knowledge, or the number of traditional practices and customs they had engaged in in their lives. Through simple statistical tests, I determined whether television viewing had any impact on these variables which were reasonable proxies for level of acculturation. Findings Having chosen two independent variables, hours of TV watched per week, and years of TV ownership, I tested if there was any significant correlation between them and the dependent variables of Lakota peoples’ level of cultural knowledge, participation in traditional practices, conformity of values to non-Lakota or non-traditional values, fluency in Lakota, and participation in traditional ceremonies (Table 1). These variables all seemed like reasonable proxies for acculturation since acculturated Lakota would know less of their own culture, go to fewer ceremonies, and so on. The cultural knowledge score was based on how many complete answers the respondents knew to ‘fill in the blank’ questions regarding Lakota history, historical figures, and important events. Participation in traditional practices was based on how many items they marked in a survey of whether or not they had ever raised a tipi, used traditional medicine, etc. The score for conformity to non-Lakota values was based on how many items they marked with a contrary answer to the emic Lakota value system ("the seven Ws".) Lakota fluency was based on how well they could speak, write, or use the Lakota language. And ceremonial attendance was based on the number of traditional ceremonies they had attended in the past year. There were no significant correlations between either of these TV-related variables and these indexes of acculturation. Table 1. R-Scores (Pearson’s Coefficient of Correlation) between Variables Representing Television and Acculturation R-SCORES Cultural Knowledge Traditional Practices Modern Values Lakota Fluency Ceremonial Attendance Years Owning TV 0.1399 -0.0445 -0.4646 -0.0660 0.1465 Hours of TV/Week -0.3414 -0.2640 -0.2798 -0.3349 0.2048 The strongest correlation was between the number of years the Lakota person owned a television, and the number of non-Lakota (or ‘modern Western’) values they held in their value system. But even that correlation was pretty weak, and nowhere near the r-score of other linear correlations, such as between their age and the number of children they had. How much television Lakota people watched did not seem to have any influence on how much cultural knowledge they knew, how many traditional practices they had participated in, how many non-Lakota values they held, how well they spoke or used the Lakota language, or how many ceremonies they attended. Even though there does not appear to be anything unusual about their television preferences, and in general they are watching the same shows as other non-Lakota people on the reservation, they are not becoming more acculturated as a result of their exposure to television. Although the Lakota people may be losing aspects of their culture, language, and traditions, other causes seem to be at the forefront than television. I also found that people who were very interested in television production as well as consumption saw this as a tool for putting more Lakota-oriented programs on the air. The more they knew about how television worked, the more they were interested in using it as a tool in their own community. And where I was working at the Cultural Center, there was an effort to videotape many community and cultural events. The Center had a massive archive of videotaped material, but unfortunately while they had faithfully recorded all kinds of cultural events, many of them were not quite "broadcast ready". There was more focus on showing these video programmes, especially oral history interviews with elders, on VCRs in the school system, and in integrating them into various kinds of multimedia and hypermedia. While the Cultural Center had begun broadcasting (remotely through a radio modem) a weekly radio show, ‘Wakpa Waste’ (Good Morning CRST), on the radio station to the north, KLND-Standing Rock, there had never been any forays into TV broadcasting. The Cultural Center director had looked into the feasibility of putting up a television signal transmission tower, and had applied for a grant to erect one, but that grant was denied. The local cable system in Eagle Butte unfortunately lacked the technology to carry true "local access" programming; although the Channel 8 of the system carried CRST News and text announcements, there was no open channel available to carry locally produced public access programming. The way the cable system was set up, it was purely a "relay" or feed from news and channels from elsewhere. Also, people were investing heavily in satellite systems, especially the new DBS (direct broadcast satellite) receivers, and would not be able to pick up local access programmes anyway. The main problem hindering the Lakotas’ efforts to preserve their culture through TV and video was lack of access to broadcast distribution technology. They had the interest, the means, and the stock of programming to put on the air. They had the production and editing equipment, although not the studios to do a "live" show. Were they able to have more local access to and control over TV distribution technology, they would have a potent "arsenal" for resisting the drastic acculturation their community is undergoing. TV has the potential to be a tool for great cultural revitalisation, but because the technology and know-how for producing it was located elsewhere, the Lakotas could not benefit from it. Discussion I hypothesised that the effects if TV viewing on levels of indigenous acculturation would be negligible. The data support my hypothesis that TV does not seem to have a major correlation with other indices of acculturation. Previous studies by anthropologists such as Pace and Molohon suggested that TV was a key determinant in the acculturation of indigenous people in Brazil and the U.S. -– this being the theory of cultural imperialism. However, this research suggests that TV’s effect on the decline of indigenous culture is weak and inconclusive. In fact, the qualitative data suggest that the Lakota most familiar with TV are also the most interested in using it as a tool for cultural preservation. Although the CRST Lakota currently lack the means for mass broadcast of cultural programming, there is great interest in it, and new technologies such as the Internet and micro-broadcast may give them the means. There are other examples of this phenomenon worldwide, which suggest that the Lakota experience is not unique. In recent years, Australian Aborigines, Canadian Inuit, and Brazilian Kayapo have each begun ambitious efforts in creating satellite-based television networks that allow them to reach their far-flung populations with programming in their own indigenous language. In Australia, Aboriginal activists have created music television programming which has helped them assert their position in land claims disputes with the Australian government (Michaels 1994), and also to educate the Europeans of Australia about the aboriginal way of life. In Canada, the Inuit have also created satellite TV networks which are indigenous-owned and operated and carry traditional cultural programming (Valaskakis 1992). Like the Aborigines and the Inuit, the Lakota through their HVJ Lakota Cultural Center are beginning to create their own radio and video programming on a smaller scale, but are beginning to examine using the reservation's cable network to carry some of this material. Since my quantitative survey included only 33 respondents, the data are not as robust as would be determined from a larger sample. However, ethnographic interviews focussing on how people approach TV, as well as other qualitative data, support the inferences of the quantitative research. It is not clear that my work with the Lakota is necessarily generalisable to other populations. Practically, it does suggest that anthropologists interested in cultural and linguistic preservation should strive to increase indigenous access to, and control of, TV production technology. ‘Protecting’ indigenous groups from new technologies may cause more harm than good. Future applied anthropologists should work with the ‘natives’ and help teach them how to adopt and adapt this technology for their own purposes. Although this is a matter that I deal with more intensively in my dissertation, it also appears to me to be the case that, contrary to the warnings of Mander, many indigenous cultures are not being culturally assimilated by media technology, but instead are assimilating the technology into their own particular cultural contexts. The technology is part of a process of revitalisation or renewal -- although there is a definite process of change and adaptation underway, this actually represents an 'updating' of old cultural practices for new situations in an attempt to make them viable for the modern situation. Indeed, I think that the Internet, globally, is allowing indigenous people to reassert themselves as a Fourth World "power bloc" on the world stage, as linkages are being formed between Saami, Maya, Lakota, Kayapo, Inuit, and Aborigines. Further research should focus on: why TV seems to have a greater acculturative influence on certain indigenous groups rather than others; whether indigenous people can truly compete equally in the broadcast "marketplace" with Western cultural programming; and whether attempts to quantify the success of TV/video technology in cultural preservation and revival can truly demonstrate that this technology plays a positive role. In conclusion, social scientists may need to take a sidelong look at why precisely they have been such strong critics of introducing new technologies into indigenous societies. There is a better role that they can play –- that of technology ‘broker’. They can cooperate with indigenous groups, serving to facilitate the exchange of knowledge, expertise, and technology between them and the majority society. References Bell, Avril. "'An Endangered Species’: Local Programming in the New Zealand Television Market." Media, Culture & Society 17.1 (1995): 182-202. Gillespie, Marie. Television, Ethnicity, and Cultural Change. New York: Routledge, 1995. Graburn, Nelson. "Television and the Canadian Inuit". Inuit Etudes 6.2 (1982): 7-24. Michaels, Eric. Bad Aboriginal Art: Tradition, Media, and Technological Horizons. Minneapolis: U of Minnesota P, 1994. Molohon, K.T. "Responses to Television in Two Swampy Cree Communities on the West James Bay." Kroeber Anthropology Society Papers 63/64 (1982): 95-103. Pace, Richard. "First-Time Televiewing in Amazonia: Television Acculturation in Gurupa, Brazil." Ethnology 32.1 (1993): 187-206. Salween, Michael. "Cultural Imperialism: A Media Effects Approach." Critical Studies in Mass Communication 8.2 (1991): 29-39. Straubhaar, J. "Beyond Media Imperialism: Asymmetrical Interdependence and Cultural Proximity". Critical Studies in Mass Communication 8.1 (1991): 39-70. Valaskakis, Gail. "Communication, Culture, and Technology: Satellites and Northern Native Broadcasting in Canada". Ethnic Minority Media: An International Perspective. Newbury Park: Sage Publications, 1992. Weiner, J. "Televisualist Anthropology: Representation, Aesthetics, Politics." Current Anthropology 38.3 (1997): 197-236. Woll, Allen. Ethnic and Racial Images in American Film and Television: Historical Essays and Bibliography. New York: Garland Press, 1987. Zimmerman, M. "The Development of a Measure of Enculturation for Native American Youth." American Journal of Community Psychology 24.1 (1996): 295-311. Citation reference for this article MLA style: Steven Mizrach. "Natives on the Electronic Frontier: Television and Cultural Change on the Cheyenne River Sioux Reservation." M/C: A Journal of Media and Culture 3.6 (2000). [your date of access] <http://www.api-network.com/mc/0012/natives.php>. Chicago style: Steven Mizrach, "Natives on the Electronic Frontier: Television and Cultural Change on the Cheyenne River Sioux Reservation," M/C: A Journal of Media and Culture 3, no. 6 (2000), <http://www.api-network.com/mc/0012/natives.php> ([your date of access]). APA style: Steven Mizrach. (2000) Natives on the electronic frontier: television and cultural change on the Cheyenne River Sioux Reservation. M/C: A Journal of Media and Culture 3(6). <http://www.api-network.com/mc/0012/natives.php> ([your date of access]).