Aboriginal and Torres Strait Islander Social and Emotional Wellbeing and Mental Health

Ethnic disparities in mental health problems in New Caledonia and French Polynesia

OBJECTIVES

Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors.

METHODS

We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income.

RESULTS

Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder.

CONCLUSION

We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents

OBJECTIVE

The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people.

METHODS

A total of 132 Indigenous and 247 non-Indigenous young people aged 6-16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms.

RESULTS

The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms.

CONCLUSIONS

High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.

The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

BACKGROUND

Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment.

METHODS

Participants included 1056 individuals aged 18-69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events.

RESULTS

Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83).

LIMITATIONS

The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses.

CONCLUSIONS

Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.

Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescents

OBJECTIVE

Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way.

METHODS

A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups.

RESULTS

The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference.

CONCLUSIONS

It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed.

Social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in Aboriginal controlled social housing

BACKGROUND

Little is known about the wellbeing and aspirations of Aboriginal and Torres Strait Islander peoples living in social housing. Aboriginal and Torres Strait Islander peoples living in social housing face common social housing challenges of low income, higher incidence of mental health issues and poorer health along with specific challenges due to the impacts of colonisation and its ongoing manifestations in racism and inequity. A greater understanding of social and emotional wellbeing needs and aspirations is essential in informing the provision of appropriate support.

METHODS

Surveys of social and emotional wellbeing (SEWB) were completed by 95 Aboriginal people aged 16 years and older living in Aboriginal Housing Victoria social housing in 2021. The survey addressed a range of domains reflecting social and emotional wellbeing, as defined by Aboriginal and Torres Strait Islander peoples.

RESULTS

Most respondents demonstrated a strong sense of identity and connection to family however 26% reported having 6 or more health conditions. Ill health and disability were reported to be employment barriers for almost a third of people (32%). Improving health and wellbeing (78%) was the most cited aspiration. Experiences of racism and ill health influenced engagement with organisations and correspondingly education and employment.

CONCLUSION

Strong connections to identity, family and culture in Aboriginal peoples living in social housing coexist along with disrupted connections to mind, body and community. Culturally safe and appropriate pathways to community services and facilities can enhance these connections. Research aimed at evaluating the impact of strengths-based interventions that focus on existing strong connections will be important in understanding whether this approach is effective in improving SEWB in this population.

TRIAL REGISTRATION

This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.

Integration of traditional therapies for first nations people within western healthcare: an integrative review

AIMS

To conduct an integrative literature review to reveal any evidence supportive of the integration of traditional therapies for First Nations peoples in Australia within a western healthcare model, and to identify which, if any, of these therapies have been linked to better health outcomes and culturally safe and appropriate care for First Nations peoples. If so, are there indications by First Nations peoples in Australia that these have been effective in providing culturally safe care or the decolonisation of western healthcare practices.

DESIGN

Integrative literature review of peer-reviewed literature.

DATA SOURCES

Online databases searched included CINAHL, Medline, Scopus, ScienceDirect InformitHealth, and ProQuest.

REVIEW METHODS

Databases were searched for papers with full text available and published in English with no date parameter set. The PRISMA guidelines were used during the literature review and the literature was critiqued using the Critical Appraisal Skills tool.

RESULTS

Seven articles met the inclusion criteria and were included in the review. Four articles selected were qualitative, two used a mixed method design, and one used a quantitative method. Six themes arose: (i) bush medicine, (ii) traditional healers, (iii) traditional healing practices, (iv) bush tucker, (v) spiritual healing, and (vi) therapies that connected to cultures such as yarning and storytelling.

CONCLUSION

There is limited literature discussing the use of traditional therapies in Western healthcare settings. A need exists to include traditional therapies within a Western healthcare system. Creating a culturally safer and appropriate healthcare experience for First Nations people in Australia and will contribute to advancement in the decolonisation of current healthcare models.

Factors that sustain indigenous youth mentoring programs: a qualitative systematic review

BACKGROUND

Indigenous youth worldwide continue to experience disproportional rates of poorer mental health and well-being compared to non-Indigenous youth. Mentoring has been known to establish favorable outcomes in many areas of health but is still in its early phases of research within Indigenous contexts. This paper explores the barriers and facilitators of Indigenous youth mentoring programs to improve mental health outcomes and provides evidence for governments' response to the United Nations Declaration on the Rights of Indigenous Peoples.

METHODS

A systematic search for published studies was conducted on PubMed, Embase, Scopus, CINAHL, and grey literature through Trove, OpenGrey, Indigenous HealthInfoNet, and Informit Indigenous Collection. All papers included in the search were peer-reviewed and published from 2007 to 2021. The Joanna Briggs Institute approaches to critical appraisal, data extraction, data synthesis, and confidence of findings were used.

RESULTS

A total of eight papers describing six mentoring programs were included in this review; six papers were from Canada, and two originated from Australia. Studies included mentor perspectives (n = 4) (incorporating views of parents, carers, Aboriginal assistant teachers, Indigenous program facilitators, young adult health leaders, and community Elders), mentee perspectives (n = 1), and both mentor and mentee perspectives (n = 3). Programs were conducted nationally (n = 3) or within specific local Indigenous communities (n = 3) with varying mentor styles and program focus. Five synthesized findings were identified from the data extraction process, each consisting of four categories. These synthesized findings were: establishing cultural relevancy, facilitating environments, building relationships, facilitating community engagement, and leadership responsibilities, which were discussed in the context of extant mentoring theoretical frameworks.

CONCLUSION

Mentoring is an appropriate strategy for improving general well-being. However, more research is needed to explore program sustainability and maintaining outcomes in the long term.

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic.

"I tried to get help about my addiction but he just gave me tablets:" male Aboriginal drug and alcohol rehabilitation clients' experiences and preferences speaking about substance use in primary care

BACKGROUND

Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use.

METHODS

Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group.

RESULTS

Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered.

CONCLUSION

This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.

The Availability, Appropriateness, and Integration of Services to Promote Indigenous Australian Youth Wellbeing and Mental Health: Indigenous Youth and Service Provider Perspectives

Concerns about the complexity, fragmentation and inefficiency of Australia's current youth mental health service systems have led policy makers to seek improvements through a shift to community-based solutions. However, there is little evidence of how communities can make this shift. This paper examines the efforts of one Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) community-Yarrabah in north Queensland-to develop strategies for mental health and wellbeing service system improvements for school-aged youth (5-18 years). The research was co-designed with Yarrabah's community-controlled health service and explores the perceptions of Yarrabah youth and service providers. Iterative grounded theory methods were used to collect and analyse data from 32 youth aged 11-24 years and 24 service providers. Youth were reluctant to seek help, and did so only if they felt a sense of safety, trust, relationality and consistency with providers. Young people's four suggestions for improvement were access to (1) information and awareness about mental health; (2) youth facilities, spaces and activities; (3) safe and available points of contact; and (4) support for recovery from mental illness. Service providers highlighted an appetite for youth-guided community change and recommended five improvement strategies: (1) listening to youth, (2) linking with community members, (3) providing wellbeing promotion programs, (4) intervening early, and (5) advocating to address the determinants of youth mental health. Overall, both groups realised a disjunct between youth need and service provision, but a willingness to work together for systems change. This study demonstrates the importance of community-driven efforts that harness both youth and service providers' perspectives, and suggests a need for ongoing dialogue as the basis for co-designing and implementing improvements to wellbeing supports and mental health services for Indigenous youth.

Partnering with Aboriginal and Torres Strait Islander Peoples: An Evaluation Study Protocol to Strengthen a Comprehensive Multi-Scale Evaluation Framework for Participatory Systems Modelling through Indigenous Paradigms and Methodologies

The social and emotional wellbeing of young Aboriginal and Torres Strait Islander peoples should be supported through an Indigenous-led and community empowering approach. Applying systems thinking via participatory approaches is aligned with Aboriginal and Torres Strait Islander research paradigms and can be an effective method to deliver a decision support tool for mental health systems planning for Indigenous communities. Evaluations are necessary to understand the effectiveness and value of such methods, uncover protective and healing factors of social and emotional wellbeing, as well as to promote Aboriginal and Torres Strait Islander self-determination over allocation of funding and resources. This paper presents modifications to a published evaluation protocol for participatory systems modelling to align with critical Aboriginal and Torres Strait Islander guidelines and recommendations to support the social and emotional wellbeing of young people. This paper also presents a culturally relevant participatory systems modelling evaluation framework. Recognizing the reciprocity, strengths, and expertise Aboriginal and Torres Strait Islander methodologies can offer to broader research and evaluation practices, the amended framework presented in this paper facilitates empowering evaluation practices that should be adopted when working with Aboriginal and Torres Strait Islander peoples as well as when working with other diverse, non-Indigenous communities.

YArnhem: Co-designing a model of social and emotional wellbeing stepped care for young people of the north east Arnhem region: A development study protocol

INTRODUCTION

More Aboriginal and Torres Strait Islander young people experience high or very high levels of psychological distress compared to their non-Indigenous counterparts. This may be partly attributed to systemic barriers resulting in lower rates of help-seeking, sub-optimal identification of psychological challenges, and undertreatment. Reducing these barriers within health systems is an important factor in reducing the Social and Emotional Wellbeing (SEWB) health burden on young Aboriginal and Torres Strait Islander people.

OBJECTIVES

In partnership with Miwatj Health Aboriginal Corporation (Miwatj), this project will co-design an integrated youth Social and Emotional Wellbeing (SEWB) and mental health stepped care model for remote Aboriginal communities in the north east Arnhem region of the Northern Territory.

DESIGN

A collaborative research approach using co-design methods will underpin a community-centric stepped care allocation method, to which culturally appropriate SEWB and mental health interventions and treatments are assigned. These components of the project will inform a digital platform which will facilitate access to SEWB care for young people in north east Arnhem land. This concept was co-developed in a partnership between researchers and Miwatj and builds on Miwatj's previous work to map the stepped needs of young people. The co-design of the content and features of these outputs will be facilitated through community participation and overseen by community, health, and cultural governance structures. This will ensure the solutions developed by the project are culturally responsive, fit for purpose, and will enhance self-determination while reducing systemic barriers to care.

Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations

OBJECTIVE

To assess the effects of psychological, psychosocial, educational and alternative interventions on mental health outcomes of Indigenous adult populations in Australia, Canada, New Zealand and the United States and the Indigenous involvement and content in each study.

METHODS

We systematically searched databases, key journals and gray literature, for records until June 2020. Eligible studies were in English or French and examined the impact of interventions on mental health outcomes including anxiety disorders, posttraumatic stress disorder, depression, psychological distress or stress for Indigenous adults (⩾16 years). Data were extracted using a modified Cochrane Data Extraction Form and the Template for Intervention Description and Replication. Quality was evaluated using the Effective Public Health Practice Project quality assessment form.

RESULTS

In total, 21 studies were eligible, comprising 8 randomized controlled trials, 10 single-group pre-post studies and 3 pre-post studies with comparison groups. Twenty studies had Indigenous individuals or organizations involved in some decision-making capacity, though extent of involvement varied widely. In total, 9 studies were rated moderate and 12 weak in the Effective Public Health Practice Project quality assessment. Eight studies measuring depression, three measuring posttraumatic stress disorder, three measuring psychological distress and two measuring stress showed statistically significant improvements following the intervention.

CONCLUSION

A wide range of interventions demonstrated mental health improvements. However, it is difficult to draw generalizable conclusions on intervention effectiveness, given heterogeneity among studies. Studies should employ a thorough assessment of the Indigenous involvement and content of their interventions for reporting and for critical consideration of the implications of their research and whether they address Indigenous determinants of mental health.

Building evidence to reduce inequities in management of pain for Indigenous Australian people

OBJECTIVES

Pain is a universal experience which each person encounters differently, guided by the psycho-socio-environmental context in which it occurs. Although more research is underway yet very little is known about pain from Indigenous Australian perspective. Therefore, this study aims to examine, experience of pain and coping, and utility of three measures: Brief Pain Inventory short form, McGill Pain Questionnaire and Numerical rating scale, from Indigenous South Australian people perspective.

METHODS

Thirteen in-person interviews were conducted which lasted around 90 min and were audio-recorded. The transcripts were coded and analysed thematically with NVivo.

RESULTS

Six key themes were identified; 1: Spiritual conceptualisation of pain; 2: Frequent experience of trauma and injury; 3: Influence of familial history of pain; 4: Acceptance of pain as normal; 5: Outlook on biomedical management of pain; 6: Preference for non-pharmacological management of pain. Also, the three measures did not fully capture pain from an Indigenous Australian perspective which is more deeply rooted in a bio-psycho-socio-spiritual context which is cardinal to conceptualization of health and wellbeing in Indigenous Australian communities.

CONCLUSIONS

Findings highlight some commonalities as well as unique differences between Indigenous experiences of pain as compared to non-Indigenous. Factors such as spiritual connection with pain, grief and loss, history of trauma and injury, fear of addiction to pain medication and exposure to pain from early childhood had important implications for how participants viewed pain.

Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach

Background

Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population.

Methods

We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB.

Results

Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region.

Conclusions

Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07682-3.

'First tonight, the contentious new code telling nurses to say, 'sorry for being white': Mental health nurses' beliefs about their Code of Conduct and cultural safety for Aboriginal and Torres Strait Islander Peoples

The Nursing and Midwifery Board of Australia's Code of Conduct for Nurses sets out the professional behaviour and conduct expectations for nurses in all practice settings. The publication of a revised version in 2018, which included expectations related to culturally safe and respectful practice and Aboriginal and Torres Strait Islander Peoples' health, caused reverberations beyond the profession of nursing. A controversy that the changes required nurses to verbally apologize for being white before their interactions with Aboriginal and Torres Strait Islander people gained the attention of the mainstream media. This interpretation, which came from outside nursing, was disputed by the Board. Challenged by these events, the authors were interested in understanding the actual impacts of the changes from the perspectives of nurses in practice. This research, carried out nearly three years after publication, has focused specifically on the speciality of mental health nurses in this context. The objective of this research was to undertake a social analysis focused on the impact that changes in the Code have had on the culture of mental health nursing utilizing a qualitative methodology. Eight mental health nurses were interviewed. The research found that there was little evidence of any impact on mental health nursing practice. Many of the participants were unaware of the amendments to the Code, whilst those nurses who were aware did not perceive that it had led to any real change within mental health nursing or service delivery.

Development of a Maternal and Child mHealth Intervention with Aboriginal and Torres Strait Islander Mothers: A Co-Design Approach (Preprint)

Background

Objective

Methods

Results

Conclusions

Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives

PROBLEM

Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context.

BACKGROUND

Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist.

AIM

This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives.

METHODS

Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives.

FINDINGS

Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool.

DISCUSSION

In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate micro-processes in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles.

CONCLUSION

This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.

Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.

Mental health nursing practice and Aboriginal and Torres Strait Islander people: an integrative review

Background: For nearly thirty years, significant concerns have been raised about the public-provided mental health services for Aboriginal and Torres Strait Islander peoples. Staff have been identified as having little understanding of Indigenous culture, and this had resulted in inappropriate treatment. In attempting to understand what specialist knowledge exists to guide mental health nursing practice with Aboriginal and Torres Strait Islander peoples, the authors have turned to published peer-reviewed literature.Methods: The approach chosen to explore this area was an integrative review. This provided a method to identify, analyse, and synthesise a wide range of literature.Results: The available evidence points to the need that treatment planning must be focused on the promotion of social and emotional wellbeing and not simply the treatment of symptoms. It also emphasises the importance of cultural safety informed by awareness and understanding of social, cultural and historical factors that can impact the health and treatment of Aboriginal and Torres Strait Islander peoples. Within the literature, staff reported difficulty in understanding how knowledge about social and emotional wellbeing could translate into practice. Nurses working in mental health contexts reported not feeling adequately prepared for, or confident in this area of practice.Conclusions: There is a paucity of current literature on mental health nursing practice for Aboriginal and Torres Strait Islander peoples, with the literature available not providing clear guidance for effective and meaningful practice.

Patterns of child protection service involvement by Aboriginal children associated with a higher risk of self-harm in adolescence: A retrospective population cohort study using linked administrative data

BACKGROUND

A history of child maltreatment is known to elevate the risk of self-harm in adolescence. However, this link has not been investigated for Aboriginal children who experience a greater burden of both.

OBJECTIVE

Identify patterns of involvement with child protection services by Aboriginal children associated with a higher risk of self-harm in adolescence.

PARTICIPANTS AND SETTING

A cohort study was established using linked administrative records of Aboriginal children born in the Northern Territory (NT) of Australia.

METHODS

Survival analysis techniques were used to determine the risk of self-harm in adolescence associated with different levels and timing of child protection involvement throughout childhood.

RESULT

The relative risk of self-harm was greatest for children with substantiated maltreatment in both early and middle childhood had nine times higher risk for self-harm (aHR: 9.11, 95% CI: 3.39-24.46,p < 0.001) and six times higher for children who experienced notifications in early childhood and substantiated maltreatment in middle childhood (aHR: 6.72, 95% CI:2.16-20.90, p < 0.001). Other patterns of child protection involvement observed in middle childhood alone also conferred a higher relative risk of self-harm in adolescence.

CONCLUSION

This study confirms a higher risk of self-harm in adolescence is associated with child maltreatment, especially in middle childhood. Addressing the intergenerational trauma in Aboriginal families is crucial to preventing child maltreatment and informing reforms to child protection responses that can better identify and address the culturally-specific unmet needs of Aboriginal families. This would go some way to fostering the healthy growth and development of Aboriginal children and reduce self-harm risk.

"It's hard for me to tell my story" the experiences of Aboriginal and Torres Strait Islander male clients at a residential drug and alcohol rehabilitation centre using primary health care

ISSUE ADDRESSED

Aboriginal males who use drug and alcohol may experience unique barriers accessing primary health care. This study explores the perceptions of Aboriginal males in treatment for drug and alcohol use around their experiences accessing primary health care, and barriers to access.

METHODS

Twenty male Aboriginal clients at a fee-paying residential drug and alcohol rehabilitation centre completed semi-structured interviews about their primary health care experiences before their stay. Interpretative phenomenological analysis was used to inductively develop themes.

RESULTS

About half the males had regular General Practitioners at a mainstream primary health care service or Aboriginal Medical Service. Positive experiences included having medical needs met or understanding the health information provided; and negative experiences included inefficient health service or system processes or experiencing cultural bias or racism. Barriers included limited access to appointments or to the same GP regularly, long wait times, lack of access to transport, worry or fear about their health or the visit or their complex lives taking priority.

CONCLUSION

This research showed that the participants sought out health care and identified barriers to accessing care and potential improvements. SO WHAT?: Access to a regular General Practitioner, continuity of care and culturally appropriate and comprehensive communication techniques are important to facilitate access to primary health care by Aboriginal males. Efforts to enhance access may focus on inherent strengths within Aboriginal communities including focusing on relationships between clinicians and families, providing a welcoming environment and encouraging clients to bring a trusted family member to appointments.

Usage and Acceptability of the iBobbly App: Pilot Trial for Suicide Prevention in Aboriginal and Torres Strait Islander Youth

BACKGROUND

The proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers.

OBJECTIVE

This paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial.

METHODS

Aboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015.

RESULTS

Regression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed.

CONCLUSIONS

There is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers.

Connecting with social and emotional well-being in rural Australia: An evaluation of 'We-Yarn', an Aboriginal gatekeeper suicide prevention workshop

OBJECTIVE

This evaluation considered the potential of We-Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales.

DESIGN

A mixed methods approach included surveys, in-depth interviews and workshop observations.

SETTING

Aboriginal suicide prevention training in rural New South Wales, Australia.

PARTICIPANTS

Attendees at We-Yarn training.

INTERVENTION

We-Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non-Aboriginal facilitator. We-Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness.

MAIN OUTCOME MEASURES

Pre and post-workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content.

RESULTS

We-Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training.

CONCLUSION

We-Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre-existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important.

Trauma and Violence Informed Care Through Decolonising Interagency Partnerships: A Complexity Case Study of Waminda's Model of Systemic Decolonisation

Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women’s Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: (1) Yarning interviews with the workforce from four partner health services (n = 24); (2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14); (3) Semi-structured interviews with a facilitator of Waminda’s Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda’s innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated individual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.

Developing best practice guidelines for the psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts

OBJECTIVE

To develop guidelines for the culturally responsive psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts.

METHOD

The Delphi method was used to establish expert consensus. A systematic search and review of relevant research literature, existing guidelines and grey literature was undertaken to develop a 286-item questionnaire. The questionnaire contained best practice statements to guide clinicians undertaking psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. An expert panel comprising 28 individuals with clinical, community-based and lived experience in Aboriginal and Torres Strait Islander mental health and/or suicide prevention were recruited and independently rated the items over three rounds. Statements endorsed as essential or important by 90% or more of the expert panel were then synthesised into recommendations for the best practice guideline document.

RESULTS

A total of 226 statements across all relevant areas of clinical practice were endorsed. No statements covering the use of structured assessment tools were endorsed. The endorsed statements informed the development of a set of underlying principles of culturally competent practice and recommendations for processes of effective and appropriate engagement; risks, needs and strengths to be assessed; formulation of psychosocial assessment; and recommendations specific to children and young people.

CONCLUSION

The guidelines are based on recommendations endorsed across a range of expertise to address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings. Further work is needed to develop an implementation strategy and evaluate the recommendations in practice.

Enhancing Social and Emotional Wellbeing of Aboriginal Boarding Students: Evaluation of a Social and Emotional Learning Pilot Program

Boarding schools can provide quality secondary education for Aboriginal students from remote Aboriginal Australian communities. However, transition into boarding school is commonly challenging for Aboriginal students as they need to negotiate unfamiliar cultural, social and learning environments whilst being separated from family and community support. Accordingly, it is critical for boarding schools to provide programs that enhance the social and emotional skills needed to meet the challenges. This study evaluated a 10-session social and emotional learning (SEL) program for Aboriginal boarders and identified contextual factors influencing its effectiveness. The study combined a pre-post quantitative evaluation using diverse social and emotional wellbeing measures with 28 students between 13-15 years (10 female, 11 male, 7 unidentified) and qualitative post focus groups with 10 students and episodic interviews with four staff delivering the program. Students' social and emotional skills significantly improved. The qualitative findings revealed improvements in students seeking and giving help, working in groups, managing conflict, being assertive and discussing cultural issues. The focus groups and interviews also identified program elements that worked best and that need improvement. Secure relationships with staff delivering the program and participation in single sex groups stood out as critical enablers. The findings lend evidence to the critical importance of collaborative design, provision and evaluation of SEL programs with Aboriginal peoples.

A police-led community response to Child abuse and Youth Sexual Violence and Abuse in Indigenous communities in Far North Queensland: "Speak Up. Be strong. Be Heard."

BACKGROUND

Child abuse and Youth Sexual Violence and Abuse (YSVA) are persistent social issues across the globe. The development and implementation of effective prevention strategies are a common focus for those working at the coalface. The Cairns Child Protection Investigation Unit of the Queensland Police Service (QPS) developed and implemented the "Speak Up. Be Strong. Be Heard." (SUBSBH) initiative. This police-led multi-component child abuse prevention initiative has been implemented in 26 Aboriginal and Torres Strait Islander communities across the Far North Queensland Police District since June 2016.

OBJECTIVE

The aim of this research was to evaluate the success of the SUBSBH initiative.

PARTICIPANTS AND SETTING

Existing data held by QPS were examined. These data include statistics on reporting of YSVA offences, internal program documents and reports, and evaluation feedback forms completed prior to this evaluation study. Information collected via these sources pertained to 26 Indigenous communities within the Far North Queensland Police District. The above-mentioned feedback forms were completed by 307 participants, of whom approximately 90% are Indigenous.

METHODS

This study adopted desktop analysis and triangulation through a range of qualitative and quantitative data to ensure robust and rigorous evaluation of the SUBSBH initiative.

RESULTS

The study found that the initiative was successful in meeting basic accepted practice for child abuse and YSVA prevention programs, receiving positive participant feedback on the educational program, achieving the initiative's objective to increase reporting of YSVA, and achieving cost-efficiency in meeting outcomes. Importantly, the increase in reporting of YSVA was statistically significant.

CONCLUSION

This study contributes to current understanding regarding the implementation of multi-component child abuse prevention initiatives and provides an example of a cost-efficient police-led community response to child abuse and YSVA in Indigenous communities. The findings may guide responses in other communities which grapple with this critical social issue.

Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia

While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.

A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

Social and emotional developmental vulnerability at age five in Aboriginal and non-Aboriginal children in New South Wales: a population data linkage study

Background

Early childhood social and emotional development underpins later social, emotional, academic and other outcomes. The first aim of this study was to explore the association between child, family and area-level characteristics associated with developmental vulnerability, amongst Aboriginal and non-Aboriginal children in their first year of school. The second aim was to quantify the magnitude of the social and emotional developmental inequalities between Aboriginal and non-Aboriginal children and the extent to which differences in socioeconomic disadvantage and perinatal characteristics explained this inequality.

Methods

This retrospective cohort study used cross-sectoral data linkage to identify and follow participants from birth to school age. In this way, social and emotional development was examined in 7,384 Aboriginal and 95,104 non-Aboriginal children who were included in the Australian Early Development Census in their first year of full-time school in New South Wales (NSW) in 2009 or 2012 and had a birth registration and/or perinatal record in NSW. The primary outcome measures were teacher-reported social competence and emotional maturity as measured using the Australian version of the Early Development Instrument.

Results

The mean age at the start of the school year for children in the study sample was 5.2 years (SD = 0.36 years). While 84% of Aboriginal children scored favourably - above the vulnerability threshold – for social competence and 88% for emotional maturity, Aboriginal children were twice as likely as non-Aboriginal children to be vulnerable on measures of social development (RR = 2.00; 95%CI, 1.89–2.12) and had 89% more risk of emotional vulnerability (RR = 1.89; 95%CI, 1.77–2.02). The inequality between Aboriginal and non-Aboriginal children was largely explained by differences in the socioeconomic and perinatal health characteristics of children and families. Thus, after adjusting for differences in measures of socioeconomic advantage and disadvantage (Model 2), the relative risk was attenuated to 1.31 (95% CI: 1.23–1.40) on the social competence domain and 1.24 (95% CI, 1.15–1.33) on the emotional maturity domain. Child, family and area-level characteristics associated with vulnerability were identified.

Conclusions

Most of the gap in early childhood social and emotional development between Aboriginal and non-Aboriginal children can be attributed to socioeconomic and early life health disadvantage. Culturally safe health and social policies addressing the socioeconomic and health inequalities experienced by Aboriginal children are urgently required.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-1019-x) contains supplementary material, which is available to authorized users.

Aboriginal and Torres Strait Islander people's domains of wellbeing: A comprehensive literature review

There are significant health and social disparities between the world's Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians' QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians' wellbeing.

Hair cortisol, allostatic load, and depressive symptoms in Australian Aboriginal and Torres Strait Islander people

Chronic stress and adversity are associated with poor mental health and are thought to contribute to the existing mental health gap between Aboriginal and Torres Strait Islander people and other Australians. Hair cortisol and allostatic load (AL) are indices of sustained stress and may be mediators of the effects of stress on health. The aim of this study was to examine the relationship between hair cortisol, AL, and depressive symptoms. This cross-sectional study comprised 329 Aboriginal and Torres Strait Islander adolescents and adults recruited at two health screening programs operating in three communities in north Queensland. We measured hair cortisol and calculated an AL index from 10 biomarkers. We assessed depressive symptoms with a version of the Patient Health Questionnaire-9 adapted for Aboriginal and Torres Strait Islander people (aPHQ-9). We found differences in cortisol and AL between the screening programs and communities, which were not explained by depressive symptoms. Overall aPHQ-9 scores were unrelated to hair cortisol (p = .25 and p = .94) and AL (p = .30 and p = .88) when age, gender and smoking were taken into account. However, anhedonia (p = .007) and insomnia (p = .006) sub-scores were each significantly associated with AL in one study site. Our present data did not demonstrate overall associations of stress biomarkers and multisystem dysregulation with depressive symptoms, which suggests that the relationship between cumulative stress and depression may be better explained by other factors in this population. The specific association between anhedonia and insomnia with AL indicates that chronic multisystem dysregulation plays a role in these features of depression in this population. Lay summary Our study investigated the relationship between symptoms of depression and two biological pathways thought to mediate depression risk - the stress hormone cortisol and allostatic load (AL) - in an Australian Aboriginal and Torres Strait Islander population. Overall, cortisol and AL were unrelated to depression. However, AL was selectively associated with anhedonia (lack of motivation or drive) and sleep disturbances. These results suggest that metabolic dysregulation measured as AL may be relevant to the depression risk in this population.

Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing

OBJECTIVE

To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison.

METHODS

Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers.

RESULTS

Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1).

CONCLUSIONS

Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.

Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH

OBJECTIVES

The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.

SETTING

Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.

PARTICIPANTS

1476 Aboriginal children aged 0-17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.

PRIMARY OUTCOME MEASURES

ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.

RESULTS

Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).

CONCLUSIONS

Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.