The problem of suicide in autochthonous populations is not new [4–16], but it is neglected [11]. This is the first epidemiological study on suicide in the population of the Camopi-Trois Sauts district. It shows a gradual increase of suicide events between 2008 and 2015. It is difficult to say whether this trend is stable or whether it reflects an transient phenomenon [17], a Werther effect [18, 19], suggested by the frequency of suicidal events in the close family [20]. The present study had several limitations: case ascertainment, questionnaire development and administration and outcome ascertainment were potential limitations; even though at the scale of a small village suicide was a major problem, the absolute overall number of events per year was “small”, which may lead to wide fluctuations and more extreme rates; some of the data was declarative, which may have biased responses towards more socially desirable answers; and finally the study period may have been too short to witness long term trends. However, despite broad confidence intervals in the annual estimates, even the lower boundary of the 95% confidence interval in Camopi-Trois Sauts was still higher than estimates in France (36 vs. 16 per 100,000, respectively).

Elders in the village reported that, in the past, it was not exceptional for persons to want to end their life, but that it was not as frequent as in recent years [21]. Thus there seemed to be a real increase of suicide. This trend has also been observed in other indigenous populations. The observed suicide rate observed in Camopi-Trois Sauts is close to what was reported on the upper Maroni in 2006 (280 per 100,000) [3] with similar characteristics in terms of age and gender. Although age categorization differences made it impossible to standardize suicide rates by age, the crude comparison with mainland France is still quite striking: 172/100000 versus 16/100000 (2015), hence over 10 times more [22, 23]. In practice, this means that for the 2008–2015 period 1.4% (95% CI = 0.9–2.1) of the population of Camopi-Trois Sauts committed suicide, more specifically 3% of the 15–29 year-old age group; it also means that 3.2% (95% CI = 2.4–4.2) of the same population, and 6.5% (1 in 15 persons) of the 15–29 year-old age group, had attempted suicide. The small size of the villages implies that nearly everyone has seen or felt the impact of this trauma. The epidemiologic studies of different autochthonous populations usually observe high suicide rates, with a similar epidemiological profile in terms of age but they often report a male predominance, which was not the case in Camopi-Trois Sauts. Despite similarities, the incidence observed in French Guiana seems particularly high relative to these studies (51.7/100000 in young men in Alaska [16, 24, 25]). It is possible that this very high rate is a peak value measured on a small sample at the apex of a transient phenomenon, which may subsequently drop to pre-episode levels. However, it underscores the considerable intensity of the phenomenon.

Apart from the sole quantitative aspect, there were also specific differences with mainland France, with a very young age at the time of the suicidal act in Camopi-Trois Sauts (71% were less than 25 years) whereas, in France the incidence of suicide was 6.4/100000 for the 15–24 year-old age group and 40.3/100000 for the 85–94 year-old age group.

The average yearly suicide attempt rate was 396 per 100,000 inhabitants for Camopi-Trois Sauts, a rate over twice greater than the crude rate observed in mainland France (177 per 100,000 inhabitants).

In addition, the lethality rate of 30.4%, which is about four times higher than in mainland France (8.2%), shows the radical nature of suicidal acts in Camopi-Trois Sauts, where most suicide attempts were by hanging.

The principal life events preceding suicide were the death of someone close, interpersonal conflicts, professional or financial problems, an interruption of school or unemployment, and finally health problems. This is relatively similar to the literature. It is of note that persons often cumulated several difficult life events, and nearly all reported at least one.

It is not easy to intervene on the occurrence of these first life events. However, the prevention and support provided aim at reducing suicidal events.

Concerning the prevention and management of interpersonal conflicts, traditional leaders and traditional modes of regulation must be rehabilitated [26] in partnership with the municipality (https://www.interieur.gouv.fr/SG-CIPDR/Outils-et-initiatives/Les-outils-du-Maire/Le-guide-d-installation-du-CDDF). The chronic problem of illegal gold mining, which is very real in these remote areas, adds stress and division in the community. The acknowledgement of psychological suffering and mental health and addiction issues by psychiatry professionals assisted by local mediators seems important [5, 6, 27, 28]. Childhood abuse is a known risk factor for suicide [29], it was reported in a non-negligible number of cases. The creation of the regional cell for the well-being of populations of the interior (CeRMEPI) has an important coordinating role for actions that aim at preventing the life events triggering suicide.

The frequency of conflicts, the fear of gossip, and the resonance of life events may be linked to the small size of the villages and the geographic and family proximity of suicides and suicide attempts. Thus 61% of those surveyed revealed a suicidal event of a family member, 45% of whom were first degree relatives. These percentages are the proof a serial phenomenon that must be contained.

As elsewhere suicide was closely associated with alcohol [30, 31]. Most persons who were drunk during their suicide attempt were addicted to alcohol. The repetition of a suicide attempt was significantly linked to the consumption of marijuana, a potentially interesting information for prevention [27]. Recent studies of a different design seemed to suggest that alcohol and marijuana consumption were greater than in the general population [32, 33]. Psychiatric risk factors have a clear influence on suicidal acts. Untreated depression is considered as the first cause of suicide [27, 28].

The unusually high lethality rate could raise the question of ascertainment bias and the underestimation of suicide attempts relative to suicides. However, given the size of the villages, underestimation seemed less likely than at the scale of larger territories. Therefore, the high lethality rate, and the lethal methods used in suicide attempts seem more indicative of the acuity of lethal intent in attempted suicides. The balanced sex ratio, which is unusual, could suggest particularities regarding gender relations with particular psychological distress among young women. We did not have any data to further explore this hypothesis but previous studies showed 11% of women experiencing forced first intercourse [33]. The absence of secondary schools, leads to separation between youths and their family as they move to other towns to continue studying. This presumably leads them to grow apart from traditional culture and fuels intergenerational conflicts, situations that may exacerbate psychological suffering when they come back to their village, isolated, torn between traditional and modern cultures in a context where suicide is omnipresent [34]. The regional cell for the well-being of populations of the interior (CeRMEPI), trained local mediators and educators to assist those with mental health problems, and prevent suicide, rapid response psychiatric teams may have an important role to relieve psychological suffering among youths in these areas. The above interventions (CeRMEPI, on site schools, trained educators and mediators, psychiatric teams to implement an emergency medico-psychologic response in less than 24 h) may help alleviate psychological suffering and suicidality. The interviewed persons were favorable to the idea of psychiatric help. However, these interventions should be prospectively evaluated and the present efforts to quantify the problem of suicide should be pursued in order to see if there is any progress following the interventions. A recent parliamentary mission published a report on the subject of suicide in this area [35]. The report detailed 37 propositions to improve well being and reduce suicidality in these territories, notably the presence of a permanent psychiatric facility in Camopi, and emergency medico-psychological task force able to respond within 24 h, and the creation of an observatory of suicide, which definitely would be useful to follow future trends.