*4.5. Future Research*

Beyond identifying very high suicide rates in young men in Greenland, the studies we identified in our review covered only a very narrow period, providing little detail on how and when age group transitions occurred, or specific suicide risk factors. There is a clear need for studies describing fine-grained temporal changes by age and gender, using appropriate statistical tests, and charting patterns beyond 2011. There is also a need for studies investigating specific risk factors for suicide in young men in Greenland, as those for all age groups and genders are of limited utility in understanding young men. This relies on improved recording of the clinical and socio-demographic characteristics of all suicide cases, with testing for age and gender variation. However, the problem of a lack of power will continue to be an issue in answering specific research questions at the country level. This has been an issue in studies investigating whether there is a differential effect of seasonality in young people in Greenland, where even combining genders was not felt to have overcome the issue of power [20,45]. Seasonality is of interest because of the potential impact of ambient light on sleep patterns, as well as associations with social behavior and working patterns.

Population registers present a valuable opportunity to conduct population-based analysis including routine clinical data, and to describe how risk factors for suicide are distributed demographically. One such study found that young Greenlandic men are more likely than the general Greenlandic population to be diagnosed with a psychiatric disorder [36]. Using suicide data available for the years following 2011, and the potential for linkage with Danish health registers, there is scope to investigate the contribution of psychiatric disorder to suicide risk in different age groups. Primary data collection will be needed to investigate whether seasonal affective disorder, acculturative stress

through rapid modernisation, or imitative suicide [46] are contributory factors, as these have not ye<sup>t</sup> been investigated in young men in Greenland. The association between ambient light and suicide rates, the effects of colonial relationships [47] and of climate change, and the influence of the media reporting of suicide on young people in Greenland are also important areas for investigation.
