Nonsuicidal self-injury in an American Indian reservation community: results from the White Mountain Apache surveillance system, 2007-2008

J Am Acad Child Adolesc Psychiatry. 2011 Sep;50(9):860-9. doi: 10.1016/j.jaac.2011.06.007. Epub 2011 Aug 4.


Objective: To describe characteristics and correlates of nonsuicidal self-injury (NSSI) among the White Mountain Apache Tribe. NSSI has not been studied before in American Indian samples despite associated risks for suicide, which disproportionately affect American Indian youth.

Method: Apache case managers collected data through a tribally mandated surveillance system. Data from 2007 and 2008 (N = 182) were examined for rates, methods, precipitants, functions, past history of self-injury and service use, by age and gender.

Results: The rate of NSSI among all ages was 600 in 100,000, with individuals 10 to 14 years old disproportionately affected at a rate of 3,000 in 100,000. More females (65%) reported NSSI, and cutting was the preferred method (98%) for both genders combined. Most frequently reported precipitants were peer pressure/copying, conflict with boy/girlfriend and "depression." A substantial proportion (22%) was intoxicated/high at the time. More reported the function of NSSI was to "effect internal state" (45%) than "effect circumstances" (15%). More than one-third (39%) received ED treatment and referrals for aftercare (36%). Of those referred, only 30% followed up with services. Most (79%) reported past NSSI; 30% reported past suicidal ideation and 25% attempts.

Conclusions: NSSI is a significant, largely unaddressed mental health problem among the White Mountain Apache Tribe and likely other reservation communities, especially as NSSI could serve as a precursor to suicide in this population. Interestingly, another self-destructive behavior, severe substance use, was reported to the surveillance system by Apaches and described in terms similar to NSSI, an important preliminary finding worth further exploration.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arizona / epidemiology
  • Child
  • Female
  • Health Services / statistics & numerical data
  • Health Services / trends
  • Humans
  • Indians, North American*
  • Male
  • Population Surveillance*
  • Prevalence
  • Referral and Consultation / statistics & numerical data
  • Referral and Consultation / trends
  • Risk Factors
  • Self Mutilation / epidemiology*
  • Self Mutilation / etiology*
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / etiology*
  • Suicide, Attempted / trends
  • Young Adult