The current study found that young Sami experienced a higher prevalence of suicidal expressions and suicide in significant others but not a higher prevalence of suicide attempts compared to young Swedes. Reindeer herders, Sami with experience of ethnicity-related maltreatment, those living in Västerbotten/Jamtland/Västernorrland and Sami women reported a markedly higher prevalence of suicide plans. Likewise reindeer herders and women had a about 3-fold higher odds of attempting suicide. A more positive attitude toward possibilities to act against suicidal problems was indicated in the Sami group.
The representativeness of the sample requires some explanation. The young Sami were found through different registers and by their connections to Sami organizations. The identity is based on self-identification (24
). As no ethnic registers are allowed in Sweden and most Sami are assimilated into the Swedish society, this is the only way to locate Sami participants in a study.
The response rate (59%) is deemed satisfactory considering the problem of finding young persons who in many cases have not settled down. Under these circumstances, the sample is deemed representative for young persons with an explicit Sami identity. ATTS is used to indicate factors that contribute to the understanding of suicide and suicidal behaviour, but is not expected to illuminate the entire phenomenon. We have used a selection of attitude items from ATTS, as the intention was to keep the number of items low.
The Sami is a small indigenous group with strong family relations and coherence, which means that as soon as a suicide occurs many will be affected. This could be a reason for the higher prevalence of young Sami reporting completed suicide in significant others. A number of studies have shown an association between the experience of suicidal behaviour in significant others and own suicidal behaviour which thus constitute an important risk factor for suicidal behaviour (25
It is interesting to see that there is a substantial number of missing data in both groups regarding suicidal problems in the family. This might indicate that the issue is sensitive or that the respondents are uncertain and do not know the answer.
A high proportion of both Sami and Swedes reported own suicidal expressions. However, the Sami more frequently reported life weariness, death wishes and suicidal ideation. This might be seen as part of an existential complex which can have different sources, for example an individual's desire to contribute to saving the Sami language and culture from extinction and a response to external attacks on Sami culture as an obstacle to social development (1
Experience of racial discrimination is consistently found to be associated with a range of negative mental health measures (26
). This is supported by findings in a recent study by Omma et al. (28
) where young Sami experiencing ethnicity-related maltreatment by others were less prone to feel calm and more prone to have worries. Furthermore, those who had perceived ethnicity-related maltreatment by teacher more often felt sad and depressed.
One possible way to understand these elevated risks is the severe circumstances and existential demands that these young Sami are facing. Reindeer herding is under pressure in many ways, especially in the southern part of the Sapmi. There are severe and persistent conflicts about land use and the Sami have lost herding areas. Therefore, the Sami is suffering from both a historical loss of land, which can mean a negative impact on moods and mental health (29
) and an on-going loss of land (30
). Other distressing factors could be the low economic standards of the reindeer herders because of the strained conditions. However, herding is merely seen as a way of living and not as an occupation, and those engaged often feel it important to continue despite the hardships (20
). According to William's and Pollack, suicide can be conceptualized as a “cry of pain”, the response to a situation that has 3 components: defeat, no escape and no rescue. If the possibility to escape (e.g., from painful self-perception) is arrested and/or there is no hope about rescue, the situation can be impossible to bear (31
). However, the concept of suicide as an “Act of Pain” as opposed to a “Cry of pain” seems more reasonable. As there is no indication of an elevated prevalence of mental illness or drinking problems in this Sami population (4
), we believe there is an accumulation of distressing, negative circumstances that really could be life threatening especially for the reindeer herders.
The Sami women reported more suicide attempts and plans, and women in both groups reported more suicidal expressions than men. Women, especially in Western societies, report a higher occurrence of depression (33
), suicidal thoughts and plans, and they also report more suicidal attempts than men, whilst men in Western societies more often die from completed suicides (13
). This gender differences are sometimes discussed as a gender paradox. One possible explanation is a higher and perhaps genetically caused vulnerability in women, but also perhaps due to the effect of socio-culturally determined gender roles. Another possibility is differences in affective/cognitive style, with men more likely to act out. Women perceive and reflect about feelings, thoughts and experience before communicating them. This is perhaps a protective strategy, which helps to understand and regulate feelings and behaviour and which might increase the possibilities to handle negative experiences and might even function as a protective force against completed suicide. This is in contrast to men, who maybe do not allow themselves to think about this issue and to communicate with others. The man's tendency to act instead of communicating perceived problems and threats might make them more vulnerable to active suicide behaviour.
There has been a concern for several years about suicide-related problems and this has been highlighted in meetings amongst different groups and organizations of Sami. This might have had an impact on attitudes to suicide and contributed to the finding that even though the Sami youth report a higher experience of suicide in significant others and higher prevalence of own suicidal expressions, they report no more plans and attempts than the majority group. In a qualitative study, the author found that suicide is a common topic amongst young Sami, making them more aware of the problem and the need to reduce the suicidal risk in the group (35
Silviken et al. found an increased risk of suicide mortality in a Norwegian Sami cohort compared to a reference population in the study period 1970–1998 (9
). In a follow up study, no ethnic differences of suicide attempts were found between Sami adolescents (mean age 16.9) and their non-Sami peers (8
). The prevalence of suicide attempts was 10.5% in the Norwegian Sami adolescent population compared to 5.5% in this study. The prevalence of suicide ideation was 19% for women and 14% for men in this population, compared to 53% and 35%, respectively in the present study (36
). Differences in age, time for the assessment, and the posing of questions make comparisons difficult between studies.
In the SLiCA project (the Survey of Living Conditions in the Arctic) amongst indigenous people age 15–34 years, suicidal thoughts were present in 5% (men) and 12% (women) among Swedish Sami, and 9% (men) and 31% (women) among Norwegian Sami (37
). Those proportions are low compared to the findings in this study and could be due to methodological differences. The SLiCA study used face-to-face interviews.
We found an increased awareness of the suicide problem in the Sami community and there are on-going attempts to deal with this. For example, the SSR (the Swedish Sami organization) is organizing seminars on lifestyle issues with young male Sami. We have been invited to discuss and inform about research results at several meetings with different Sami groups who consider mental health in the Sami population to be important.
It is important that problems for the Sami culture are addressed by the majority community. The need for culturally adapted health care for the Sami should be met and the issue of discrimination and negative treatment of the Sami should be addressed. Suicidal behaviour is not necessarily primarily an expression of a wish to die, but part of an internal existential dialogue contributing to building a human identity. It is thus important not only to consider different risk factors for suicidal behaviour, but also to discuss possible protective factors. Strong family ties and a positive ethnic group identity might be of particular importance for this group.