This article examines the Western academic explanations for suicide epidemics among adolescents and young adults documented in many Pacific Island nations beginning in the early 1970s. These explanatory accounts draw heavily from Émile Durkheim's theory of social change and suicide, developed in the late nineteenth century. Durkheim argued that suicide epidemics are more likely in the context of modernizing social change either because of increased social disequilibrium (anomie) or social disintegration (egoism). These traditional Western explanations are rarely empirically assessed for their appropriateness in Pacific Island contexts. Therefore, this article uses selected empirical evidence to assess the major claims found in these explanations, focusing on Sāmoa and the Micronesian region as the best documented examples. Finding that the data do not support well the major Western-derived explanations for these suicide epidemics, alternative explanations are explored. These alternatives suggest that Pacific Island young people's vulnerability to suicide is partly a result of how globalizing commodity flows, development policies, and the selective appropriation of these by local actors inform local social relations and the tensions in them. This view supports well recent advocacy for a shift in perspectives toward those that draw on indigenous Oceanic understandings of the vā or wā as relational spaces that are central for the quality of health and well-being in Pacific Island communities.