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Abstract
The colonisation of Australia has led to persistent inequity and disadvantage for Aboriginal and Torres Strait Islander peoples (herein referred to as Indigenous Australians) and has had a devastating impact on their health and wellbeing. Multiple barriers to appropriate care continue to contribute to significant disparities in health outcomes for Indigenous Australians compared to other Australians. Suicide among Indigenous Australians was a rare phenomenon until the 1980s, however some communities now record rates among the highest in the world, particularly among young people. Despite the need, there is a dearth of evidence around what is effective in Indigenous youth suicide prevention. This thesis was driven by community need and the courage of Yawuru community members to innovate with haste in a painful, grief-laden and political space. Trusted working relationships between stakeholders were imperative to conduct the work described herein.
This thesis includes eight papers over four chapters. Chapter 2 provides context around remote Indigenous suicide and reviews the limited Indigenous suicide prevention evidence. Chapter 3 highlights the promise of technology and describes the protocol for a randomised controlled trial of "IBobbly"; an app featuring acceptance-based therapeutic activities. Chapter 4 employs mixed-methods to present the results of the trial including an analysis of app usage and acceptability. Finally, Chapter 5 systematically reviews the efficacy of acceptance and commitment therapy for suicidal ideation and self-harm. This chapter also focuses on knowledge translation, particularly dissemination of results through online video.
The trial indicated that the app reduced depression and psychological distress but neither suicidal ideation nor impulsivity. Community members regarded the app as acceptable, culturally appropriate and of therapeutic value. The three per cent attrition rate was a stand-out aspect of the trial. Finally, the use of accessible mediums such as community reports and online video aided the understanding and promotion of research in Indigenous communities.
To conclude, a co-designed app in the challenging space of youth suicide can be adopted and acceptable to Indigenous communities and can improve emotional wellbeing. This thesis demonstrates that studies built on trusted relationships can potentially maintain participant engagement and enhance the likelihood of meaningful future collaborations.