Risk factors and methods of NSSI and suicide attempts among American Indian and Alaska native adolescents and young adults: A systematic review protocol.

Abstract

Suicide is a leading cause of premature mortality worldwide and a major public health concern among adolescents and young adults. In the United States, American Indian and Alaska Native (AI/AN) populations have the highest suicide rates of any racial or ethnic group, with suicide among the leading causes of death in AI/AN youth. Suicide attempts are a clinically significant outcome and a strong predictor of subsequent suicide death. To our knowledge, no prior systematic review has simultaneously focused on AI/AN adolescents and young adults while examining risk factors, suicide attempt methods, and indicators of clinical severity or lethality. Addressing this gap is critical for informing equitable suicide prevention strategies. This protocol describes a systematic review that will synthesise evidence on demographic, psychological/psychiatric, social, cultural-historical, and structural risk factors associated with non-fatal self-harm and suicide attempts among AI/AN adolescents and young adults in the United States. It will also examine methods of suicide attempts and indicators of clinical severity or lethality. This systematic review protocol will follow PRISMA-P 2015 guidelines and the completed review will be reported according to PRISMA 2020. Electronic databases MEDLINE via PubMed, Embase, PsycINFO, CINAHL and Web of Science Core Collection will be searched from inception. Observational and epidemiological studies reporting non-fatal self-harm or suicide attempts among AI/AN youth will be eligible. Two reviewers (AS&YZ) will independently screen studies, extract data, and assess methodological quality using Joanna Briggs Institute critical appraisal tools. A narrative synthesis will be undertaken, and random-effects meta-analysis will be conducted where appropriate. Certainty of evidence will be evaluated using the GRADE approach. This systematic review protocol has been prospectively registered with the Open Science Framework (OSF) Registries (Registration ID: rjf2u; https://osf.io/rjf2u). This review will provide the first synthesis integrating multilevel risk factors with method-specific lethality and clinical severity patterns among AI/AN adolescents and young adults aged 10-25 years. The findings are expected to inform culturally responsive prevention strategies, guide Tribal and Indian Health Service planning, and strengthen equity-focused public health efforts aimed at reducing disparities in suicide attempts among AI/AN adolescents and young adults.