*4.4. Policy Implications*

Although the studies we identified sugges<sup>t</sup> that from the mid-1970s to 2011 young men were the demographic group of most concern in Greenland, and that their high rates may have stabilised in 1995 [24], data on suicide rates subsequent to 2011 are lacking. Apart from suicide data published by Statistics Greenland reporting 24 suicides among men aged 15–24 in 2012–2013 [5] we lack clear risk estimates enabling temporal trends to be charted. To ensure that current Greenlandic suicide prevention efforts target the groups at highest risk, there is a clear need for updated mortality indicators to be made available so that up-to-date surveillance is directly linked to suicide prevention activity.

Young people were a major focus of Greenland's 2004 plans for suicide prevention [9], which proposed interventions to improve resilience throughout the education system, and national helplines and radio programmes to overcome barriers such as access to psychological support in remote areas [21,40]. They also proposed strengthening the research base [21], a need reinforced by the findings of this review. The multi-level approaches suggested have been shown to have synergistic benefits [41], but Greenlandic suicide prevention interventions have never been evaluated [42]. Future versions should consider including means restriction, generally understood to be the most effective suicide prevention intervention [43]. The high proportion of violent suicides in Greenland [20], and the historical predominance of hunting/fishing jobs in men who die by suicide [22], sugges<sup>t</sup> a role for gun control interventions such as limiting access to firearms outside working hours. Other issues to address include the impact of labour market changes [10], given qualitative accounts of hopelessness among young men about their opportunities [44]. Evidence from other Arctic Indigenous communities suggests that reform of alcohol policies may not reduce suicides as much as hoped [34]. International collaborations such as the RISING SUN project are likely to be important to Greenland in terms of research infrastructure, and intervention implementation. Implementation of the Canadian Inuit Suicide Prevention Strategy will also be of interest to Greenland, where any successes in Inuit-specific approaches might be emulated [2].
