Community-Led Native American Suicide Prevention Research

As a member of the Cherokee and Seminole Nations of Oklahoma, Victoria O’Keefe knew about the problem of Native American suicide long before entering a graduate program in clinical psychology. But during a summer program placement at a tribal behavioral health clinic, she met a young man who’d just lost a loved one to suicide. He told her, “There isn’t anyone around here who hasn’t lost a family member or friend to suicide.” His words instantly clarified her focus and career path. 

O’Keefe joined the Bloomberg School faculty in October 2017 as an assistant professor in International Health and the Center for American Indian Health. In this Q&A, she talks about what brought her to the School and the results she hopes to achieve going forward.

Did you always intend to work in public health?

I decided to go to graduate school in clinical psychology to understand mental health and suicide from a clinical perspective and through research. I wasn’t as familiar with public health research, except from my independent reading—and especially reading about what the Center was doing. However, I really feel that all of our diverse approaches are necessary to bring solutions to suicide prevention. In a comprehensive public health approach, a clinical intervention might be one piece of the larger public health solution. 

What brought you to the School? 

At conferences, I met researchers from Baltimore as well as members of the White Mountain Apache Tribe who also work for the Center. 

I was inspired when I saw their presentations and learned about their academic and tribal community partnerships, which I think is the appropriate way of conducting research with a Native community. The Center is nationally recognized for making significant strides in suicide prevention in Native communities and doing it in a way that allows the community to take the lead. I wanted to be part of that.

Can you tell me more about that approach?

Indigenous communities have solutions. They may not always tell the world because they may be very protected by the community, and for good reason. There’s a history of researchers going into communities and trying to learn everything and then publishing it without the community’s informed consent. However, I think there are ways we can harness some of those cultural strengths in prevention programs with the community’s approval and involvement, especially for health disparities and mental health disparities. 

By involving communities, we’re partnering with them—and also empowering them. They may feel like in the past they’ve had researchers conduct research on them; but when they are part of the research, they are working collaboratively with researchers as opposed to being researched. 

What are you working on now? 

I’ve joined some ongoing research studies and programs. Our mental health team received a grant from the National Institute of Mental Health for a project called the Southwest Hub for American Indian Youth Suicide Prevention Research. We’re one of three hubs across the U.S. working with tribal communities to reduce high suicide rates among American Indian and Alaska Native communities and harness strengths and resiliency. One aspect of our grant includes a sequential multiple assignment randomized trial of two culturally tailored interventions that the White Mountain Apache community has developed with the Center. Overall, the tribe has seen a reduction in suicide rates, but we are trying to better understand whether certain interventions are driving the effect and for which groups. 

Another project we’re working on involves consulting with Native communities who have received Zero Suicide grants to implement this approach in their health system. We assist with completing formative work about how to discuss suicide in a culturally appropriate way and then work with health care staff to train them in identifying and treating those who may experience suicidal ideation or behavior. 

Do you have plans to lead any research projects in the near future?

I’m working with one community that has anecdotal evidence and limited electronic health data about the burden of suicide, but they don’t know the full scope of the problem. I’m writing a K Award, an early career mentored research grant, to work with this community to truly understand the causes of suicide and what the community members see as strengths and potential solutions. My goal is to obtain strong qualitative and quantitative data to inform future culturally appropriate suicide prevention and intervention programs.

What are some of the challenges to that research? 

One challenge is community stigma, whether that stems from cultural beliefs about death or suicide or whether that stems from stigma about mental health issues in general. We have to be very sensitive to communities that have certain cultural beliefs around death and suicide. For example, some tribes have taboos related to talking about death or suicide. It can be very challenging to try to remedy an issue when it’s a traditional value in the community not to talk about it at all. We conduct formative qualitative work with community members, and we are grateful to learn about their beliefs and culture prior to conducting further research or developing programs. 

Besides research, what else do you hope to accomplish?

I’m dedicated to training the next generation of Native scholars and health professionals because we are underrepresented in higher education and in these careers. I am at this point in my career thanks to guidance from academic mentors and colleagues, as well as the support of my family and friends. This community has helped me get to where I am. I fully intend to provide that same level of support to the next generation of Native scholars. 

This is an important reason I was drawn to the Center for American Indian Health—we have our own training program for Native scholars at various academic levels. I’m humbled to be part of a Center that is committed to increasing Native representation among the scholars and professionals working to eliminate health inequities in American Indian and Alaska Native communities.