The biggest study ever conducted into the risk factors for Nunavut's high suicides rates has revealed the depth of mental health problems in the territory.
"The rates of major psychiatric illness found in this study were higher than in the general Canadian population," said the report released Wednesday in Iqaluit. "The rates of major depressive disorder among Inuit in our study were higher than the national average."
The study analyzed the life history of 120 Inuit who killed themselves between 2003 and 2006 through interviews with surviving friends and family. Those "psychological autopsies" were compared with profiles of 120 demographically similar Inuit.
The result of 498 interviews and years of work by groups including the territorial government, the RCMP and McGill University, the study is an attempt to understand suicide risk factors in Nunavut.
"There's no one single cause for suicide," said Eduardo Chachamovich, the report's lead author. "What the study showed is that suicide is the outcome of a process that starts much earlier."
Suicide is one of the territory's most pressing public health issues. Nunavut's rate is 10 times the Canadian average and much higher than that for young men. It is difficult to find anyone in Nunavut who hasn't had a friend or family member commit suicide.
Last May, three people killed themselves in the community of Pangnirtung, including a grandmother distraught over the suicide of her granddaughter.
Chachamovich cautioned that the study can't answer why one person kills himself and another with a similar background doesn't.
"Protective factors are also very, very important and they're also part of the picture," he said. "Our study is not able to give precise answers because the data we collected could not identify the causes.
"But there's definitely a pattern there."
The study found that the deaths that were analyzed tended to be among single, unemployed males with relatively less education. The average age was 24. They had roughly double the rates of alcohol and cannabis abuse than control group members — who were themselves 22 times higher than average U.S. figures. There are no comparable figures for Canada.
Child abuse was a major risk factor. Almost half the people who killed themselves had been either sexually or physically abused as children compared with just over one-quarter of the comparison group.
The life histories suggested that those who went through with suicide tended to be much more impulsive and aggressive than others.
The study also found that severe depression was a problem for both groups.
Almost two-thirds of those who killed themselves had been diagnosed before their deaths with severe depression. That figure was 24 per cent in the control group.
That's three times the Canadian average for severe depression and higher than the national average for all mental illnesses combined.
The study also raised questions about the availability of mental health services in the North. It found only 17 per cent of those who committed suicide had ever been hospitalized for mental health problems. About the same percentage had been prescribed medication.
Chachamovich added that other factors are also likely to be in play.
"There's another layer of things," he said. "Only tackling the factors that we identified isn't enough."
One 2008 study correlated rising suicide rates among Inuit in Alaska, Nunavut and Greenland with the period when governments encouraged them to move into communities.
In all three countries, suicide rates began to rise among the first generation born in towns — the sons and daughters of those who had grown up on the land. That trend began in north Alaska in the 1960s, in Greenland in the 1970s and in Nunavut in the 1980s.
Chachamovich said the patterns his study found are good places to start.
"I don't think we could implement a suicide prevention strategy without tackling the mental health problems and substance abuse and childhood adversity," he said.
"This is a process that starts at some point early in life, which in a way tells us there's different windows of opportunity to intervene on suicide prevention."
Nunavut brought in a suicide prevention plan in 2011. Since then, the government and other partners have instituted public awareness and education campaigns and have sought to increase the availability of counsellors in Nunavut's tiny, isolated communities. Funding for such efforts has increased in the last two budgets.
Critics have criticized its implementation, pointing out that community meetings don't necessarily help someone struggling.
By Bob Weber in Edmonton