The mental health of Aboriginal peoples: transformations of identity and community

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes

OBJECTIVE

This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness.

METHODS

Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health.

RESULTS

Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05).

CONCLUSION

Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional 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.

Cultural continuity, identity, and resilience among indigenous youth: Honoring the legacies of Michael Chandler and Christopher Lalonde

This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate the ways their innovative theory and methods have inspired decades of research, including the recent work presented in this issue, which addresses four broad themes: (1) the importance of a developmental perspective in mental health research; (2) the role of individual and collective continuity of identity in suicide prevention and mental health promotion; (3) Indigenous perspectives on trauma and resilience; and (4) Indigenous knowledge and values as a basis for culturally adapted and culturally grounded mental health services and interventions.

Community perspectives on COVID-19 outbreak and public health: Inuit positive protective pathways and lessons for Indigenous public health theory

OBJECTIVES

Indigenous public health theory and the voices of Canadian Indigenous communities remain under-represented in the literature despite the Canadian Truth and Reconciliation Calls to Action, and the perspectives of Inuit are further under-represented in this literature. The goal of this paper is to explore the perspectives of Iqalungmiut (people of Iqaluit), frontline staff, and decision-makers on the management of the COVID-19 outbreak in Iqaluit in April to June 2021 and to identify lessons learned and contributions to public health policy and practice specific to Inuit populations in Canada.

METHODS

This study used the Piliriqatigiinniq Community Health Research Model which was developed by Nunavummiut to guide community-based health and well-being research. Interviews were conducted with 44 individuals: 22 community members and shelter users; 17 frontline workers; and 5 decision-makers representing municipal and territorial government. Participants were asked about their experiences during the outbreak, sources of information, and strengths and challenges during outbreak management.

RESULTS

Challenges included overcrowding, physical disconnection from family members, and mental health and trauma. Community-identified strengths included strong interagency cooperation, food hamper and COVID-19 care kit deliveries, and travel restrictions. Several Inuit positive health-protective pathways were identified including Ilaginniq; Silativut; Inuuqatigiittiarniq; Piliriqatigiinniq; Ikajurniq; and Pijitsirniq.

CONCLUSION

Outbreaks of infectious illness are not new to Nunavut communities and Inuit protective pathways have and continue to be critical avenues to adapt to and mitigate such challenges. This exploratory study provides clear direction for Inuit public health policy and practice in Canada, while contributing to the body of literature on Indigenous public health theory.

Examining global Indigenous community wellness worker models: a rapid review

BACKGROUND

There is a growing interest in employing community wellness worker models in Indigenous populations to address inequities in healthcare access and outcomes, concerns about shortage in health and mental health human resources, and escalating burden of chronic and complex diseases driving significant increase in health services demand and costs. A thorough review of Indigenous community wellness worker models has yet to be conducted. This rapid review sought to outline the characteristics of a community wellness worker model in Indigenous contexts across the globe, detailing factors shaping implementation challenges and success.

METHODS

A rapid review of the international peer-reviewed and grey literature of OVID Medline, Global Index Medicus, Google, and Google Scholar was conducted from January to June 2022 for Indigenous community wellness/mental health worker models and comparative models. Articles were screened and assessed for eligibility. From eligible articles, data pertaining to study design and sample; description of the program, service, or intervention; model development and implementation; terminology used to describe workers; training features; job roles; funding considerations; facilitators and barriers to success; key findings; outcomes measured; and models or frameworks utilized were extracted. Data were synthesized by descriptive and pattern coding.

RESULTS

Twenty academic and eight grey literature articles were examined. Our findings resulted in four overarching and interconnected themes: (1) worker roles and responsibilities; (2) worker training, education, and experience; (3) decolonized approaches; and (4) structural supports.

CONCLUSION

Community wellness worker models present a promising means to begin to address the disproportionately elevated demand for mental wellness support in Indigenous communities worldwide. This model of care acts as a critical link between Indigenous communities and mainstream health and social service providers and workers fulfill distinctive roles in delivering heightened mental wellness supports to community members by leveraging strong ties to community and knowledge of Indigenous culture. They employ innovative structural solutions to bolster their efficacy and cultivate positive outcomes for service delivery and mental wellness. Barriers to the success of community wellness worker models endure, including power imbalances, lack of role clarity, lack of recognition, mental wellness needs of workers and Indigenous communities, and more.

Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework

BACKGROUND

Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada.

METHODS

A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research.

RESULTS

A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework.

CONCLUSIONS

The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.

An investigation into the relationship between community engagement and maternal mental health in Calgary, Alberta using the All Our Families cohort

INTRODUCTION

Existing literature shows that increased community engagement is associated with decreased depressive symptoms. To our knowledge, no existing studies have investigated the relationship between community engagement and adverse mental health among mothers in a Canadian context, nor has this relationship been studied over time. The current study aims to address these gaps by modelling the association between community engagement and anxiety and depression longitudinally using a cohort of prenatal and postnatal mothers living in Calgary, Alberta.

METHODS

We used data from the All our Families (AOF) study, a prospective cohort study of expectant and new mothers in Calgary, Alberta from 2008 to 2017 across seven timepoints. We used three-level latent growth curves to model the relationship between individual-level community engagement and maternal depression and anxiety scores, while adjusting for both individual and neighborhood-level characteristics.

RESULTS

The study sample consisted of 2129 mothers across 174 neighborhoods in Calgary. Adjusted latent growth curve models demonstrated that community engagement was associated with lower depression (b = - 0.28, 95% CI - 0.33, - 0.23) and anxiety (b = - 0.07, 95% CI - 0.12, - 0.02) scores among mothers over time.

DISCUSSION

Adjusted results show that community engagement has a protective effect against depression and anxiety amongst mothers. The results of this study are in line with existing evidence suggesting that social cohesion, civic participation, and community engagement are protective against adverse mental health outcomes.

Samis in the city. A qualitative study of mental health and well-being among Samis in Stockholm

Indigenous people globally suffer from poorer health than majority populations. For the Sami, the indigenous people living in the north of Norway, Sweden, Finland and Russia, physical health conditions seem to be comparable to the population in general, but there are concerns about mental health. Studies have shown a higher risk of suicide, especially for young men active in traditional reindeer herding in the north. There is less knowledge about the mental health of Samis that have migrated to the cities. In this study, we interviewed 25 Samis, recruited through convenience sampling in the Stockholm area, about their perceptions of health and well-being, the importance of the Sami background and culture, their views of mental health services and the need of adapting them to Sami needs. Throughout the process, the researchers collaborated closely with the Stockholm Sami Association, in an approach of participatory research. The interviews were analysed with thematic analysis. For the participants, a secure Sami identity and being treated with respect for their identity was seen as essential for mental health and well-being. Informants' emphasis on respect for their Sami identity and belonging can be seen as a call for restoration of basic human rights. Historical experiences, current harassments and political decisions affected their health. The informants wished caregivers to increase their knowledge of Sami history and traditions.

"In small places, close to home": Urban environmental impacts on child rights across four global cities

Urban environments influence child behaviours, exposures and experiences and may affect health, development, achievement and realization of fundamental human rights. We examined the status of eleven UN Convention on the Rights of the Child articles, in a multi-case study across four global cities. Within all study cities, children experienced unequal exposure to urban environmental risks and amenities. Many violations of child rights are related to car-based transportation systems and further challenged by pressures on urban systems from rapid population increases in the context of climate change. A child rights framework provides principles for a collective, multi-sectoral re-imagination of urban environments that support the human rights of all citizens.

Indigenous communities and the mental health impacts of land dispossession related to industrial resource development: a systematic review

Globally, many resource extraction projects such as mines and hydroelectric dams are developed on the territories of Indigenous Peoples. Recognising land as a determinant of Indigenous Peoples' health, our objective is to synthesise evidence about the mental health impacts on Indigenous communities who experience land dispossession due to industrial resource development (mining, hydroelectric, petroleum, and agricultural). We systematically reviewed studies that focused on Indigenous land dispossession in Australia, Aotearoa (New Zealand), North and South America, and the Circumpolar North. We searched Scopus, Medline, Embase, PsycINFO, and Global Health on OVID for peer-reviewed articles published in English from database inception to Dec 31, 2020. We also searched for books, research reports, and scholarly journals specialising in Indigenous health or Indigenous research. We included documents that reported on primary research, focused on Indigenous Peoples in settler colonial states, and reported on mental health and industrial resource development. Of the 29 included studies, 13 were related to hydroelectric dams, 11 to petroleum developments, nine to mining, and two to agriculture. Land dispossession due to industrial resource development had predominantly negative mental health impacts on Indigenous communities. The impacts were consequences of colonial relations that threatened Indigenous identities, resources, languages, traditions, spirituality, and ways of life. Health impact assessment processes in industrial resource development must expressly consider risks and potential impacts on mental health and respect Indigenous rights by making knowledge about mental health risks a central component to decisions about free, prior, and informed consent.

Social determination of alcohol consumption among Indigenous peoples in Colombia: a qualitative meta-synthesis

BACKGROUND

Alcohol consumption is a social phenomenon that involves society, groups, and individuals from different cultures around the world. Among some Indigenous groups located in Colombia, South America, alcohol consumption has been present in their lives, where contradictory processes occur and generate public health attention. We aimed to analyze qualitative research findings on alcohol consumption among Indigenous peoples in Colombia.

METHODS

This article used the qualitative meta-synthesis methodology, which included: (a) comprehensive search strategy, (b) appraisal of qualitative research reports, (c) findings classification, and (d) synthesis. Databases were searched for papers published from 2004 to 2019 in SCOPUS, LILACS, PROQUEST, and JSTOR, among other sources of information. A total of 2,159 papers were reviewed and finally, 13 studies were included in this meta-synthesis. The synthesis of findings included a constant comparative analysis and also aimed for the articulation of its findings to alternative perspectives in a predefined matrix.

RESULTS

Nine Indigenous ethnic groups of Colombia were represented in the 13 articles analyzed. From the analysis emerged the symbolic approach "Alcohol: a chameleon that unpredictable society colors" as the meta-theme of this research. This reflects four social processes that influence interaction with alcohol: Dynamic Systems Mergers (Indigenous system, influence of non-Indigenous system); Diverse Authority Spheres (parenting, Indigenous authority, school, university, religious and spiritual, traditional medicine); Between Transculturation and Interculturality (cultural crises effects and dynamism); and the Paradoxes of the Normalization of Alcohol (reasons, functions, and types of alcohol consumption). Likewise, these results support the social determination of health and sociocultural epidemiology perspectives, as being an adequate way of explaining a complex phenomenon.

CONCLUSION

Alcohol consumption among Indigenous peoples in Colombia is a social construction. Alcohol acts as an instrument, which is present in the changing relationships and tensions of social processes. This is reflected in harmonies, or disharmonies, in the life of Indigenous Colombians, which take place in a historical, sociocultural, economic, and political context. The results provide a reference point to guide practice and research but also reiterate the need to include the social determination of health perspective in public policies, as a path to the understanding of alcohol consumption.

Perspectives of Indigenous University Students in Canada on Mindfulness-Based Interventions and their Adaptation to Reduce Depression and Anxiety Symptoms

Objectives

Indigenous university students experience high rates of anxiety and depression due primarily to the pernicious and persistent effects of colonialism, racism, and discrimination. Mindfulness-based interventions (MBIs) hold promise, but likely require adaptation to make them culturally relevant for Indigenous peoples. We sought to gather Indigenous students' perspectives on the consistency and adaptability of MBIs for Indigenous students experiencing symptoms of depression and anxiety.

Method

This three-part longitudinal investigation employed a qualitative design mixed with Indigenous research methods to elicit feedback from students (n = 14; M _age = 28.92) on the acceptability of MBIs and ways to tailor MBIs to make them more consistent with Indigenous cultures and student lifestyles. We subsequently used this feedback to develop an outline for an adapted MBI that was then re-evaluated by the same participants for its cultural relevance and safety.

Results

Indigenous students emphasized the need for the adapted MBI to incorporate (a) traditional Indigenous practices; (b) Indigenous facilitators; (c) holistic conceptualizations of mental health that include spirituality; and (d) practices and methods that could improve flexibility and accessibility of the adapted intervention. Based on this feedback, we presented students with an outline of an adapted MBI tentatively titled Miyowâyâwin Mindful Wellbeing Program, which received favorable evaluations by students for cultural consistency and safety.

Conclusions

We confirmed the perceived acceptability and consistency of mindfulness and mindfulness programs with Indigenous cultures. The need for a flexible MBI that centers Indigenous elements and Indigenous facilitators was highlighted by Indigenous participants. This study paves the way for latter steps of the development and subsequent evaluation of the Miyowâyâwin Mindful Wellbeing Program.

Preregistration

This study is not preregistered.

Imposing calculations: The visibility and invisibility of harm in the Mackenzie Gas Project environmental assessment

Environmental assessment is an institutional apparatus through which proponents concede harm associated with extractive projects. Within these processes proponents define the nature and scope of harm, which is made visible through the production of indicators and measurements and made manageable through mitigation measures or economic compensation. That the activities of extractive industries may have effects on surrounding ecologies is rarely in question; proponents of extractive projects regularly concede that their activities will result in negative (but also positive) changes to environments and communities. What is often contested in the course of environmental assessment and regulatory processes is the "significance" of the impacts identified, the nature of the harm caused, and whether or not it is possible or acceptable to accommodate it. Drawing from ethnographic fieldwork conducted in the Sahtu Settlement Area, NWT during the Mackenzie Gas Project environmental assessment, along with regulatory documents and transcripts, this paper examines how proponents and regulatory regimes work to make the impacts of extractive industries visible, and how these logics deviate discursively and materially from many Indigenous peoples' understandings of appropriate relationships between human beings and nature.

The association between suicidal behaviour and violence, sexual abuse, and parental substance abuse among Sami and Greenlandic adolescents: the WBYG study and the NAAHS

Background

For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed, as suicidal behaviour predicts later death by suicide. The aim of this study was to investigate associations between suicidal thoughts and suicide attempts and negative life events, including violence, sexual abuse, and parental substance abuse, in Sami and Greenlandic adolescents, within and between groups and gender.

Method

Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in The Norwegian Arctic Adolescent Health Study (NAAHS) and the Well-Being among Youth in Greenland (WBYG) study. Multivariable logistic regression explored associations between suicidal behaviour and violence, sexual abuse, and parental substance abuse.

Results

Across Indigenous groups, suicidal thoughts and attempts were significantly associated with violence and sexual abuse. The association between suicidal behaviour; especially suicidal thoughts, and sexual abuse was significant and strong among Sami females. Sami and Inuit adolescents with a history of childhood violence reported significantly more suicide attempts; the strongest association was found among Sami males.

Conclusion

To Sami and Greenlandic Inuit, the experiences of negative life events, such as violence or sexual abuse are significant risk factors for suicidal behaviour. Public health programmes and prevention strategies targeting youth mental health and suicide should be culturally sensitive and sensitive to gender differences in the association between negative life events and suicidal behaviour.

The Wet’suwet’en Nation’s Mobilization of Indigenous Focusing Oriented Therapy: An Exploratory Study

Indigenous mental health research is beginning to address colonization, however, Indigenous approaches to wellness have largely been overlooked. There is a paucity of research exploring psychological trauma interventions with Indigenous peoples. The Wet’suwet’en hereditary chiefs recognize the profound impacts of historical trauma among their people and are utilizing Indigenous focusing oriented therapy (IFOT), a trauma model that is collective, land-based, and intergenerational, as a part of their wellness framework. This collaborative research study explored the question: How is IFOT shaped by Wet’suwet’en ways of knowing and mobilized by individuals, families, house groups, and the Nation? Wet’suwet’en IFOT practitioners participated in sharing circles for data collection and interpretation. The exploratory findings revealed that the strategic application of IFOT by Wet’suwet’en hereditary chiefs created a culturally relevant model for land-based healing wherein Wet’suwet’en people were able to experience greater connection with their own yintah (land) and c’idede’ (history).

Centering Indigenous knowledge in suicide prevention: a critical scoping review

BACKGROUND

Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention-typically involving individual-level efforts for behavioural change via mental health professional intervention-by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations.

METHODS

A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings.

RESULTS

Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches.

CONCLUSIONS

Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.

Exploring sex-specific time trends in drinking patterns in the Greenlandic population from 1993 to 2014 - a large Arctic Indigenous population

A drinking pattern characterised by occasional excessive drinking is a key challenge for public health in Greenland. The objective was to examine sex-specific time trends in drinking patterns among Greenland Inuit. Cross-sectional and cohort data from geographically representative health surveys in 1993, 2005–2010 and 2014 were included (n = 4,938). Drinking patterns were defined as abstainer, non-problematic and occasional binge drinking. Patterns were analysed by sex-specific crude proportions and logistical analyses according to age, birth cohort and calendar time, accounting for region and settlement type. More than half of the men and one-third of the women had an occasional binge drinking pattern, while 22.6% of females and 15.1% of men were abstainers. Abstention increased with increasing age, while occasional binge drinking decreased among men. Younger male birth cohorts were less likely to have an occasional binge drinking pattern, while the youngest females had the highest odds ratio. A drinking pattern characterised by occasional excessive use remains a key challenge for public health in Greenland with age as a strong predictor. A high prevalence of abstainers co-exists with a high prevalence of occasional binge drinking. The increased odds ratio for occasional binge drinking among younger females should be addressed further.

Aspects of Wellbeing for Indigenous Youth in CANZUS Countries: A Systematic Review

Indigenous children and young people (hereafter youth) across CANZUS nations embody a rich diversity of cultures and traditions. Despite the immense challenges facing these youth, many harness cultural and personal strengths to protect and promote their wellbeing. To support this for all youth, it is critical to understand what contributes to their wellbeing. This review aims to identify components contributing to wellbeing for Indigenous youth in CANZUS nations. Five databases were searched from inception to August 2022. Papers were eligible if they: focused on Indigenous youth in CANZUS nations; included views of youth or proxies; and focused on at least one aspect of wellbeing. We identified 105 articles for inclusion (Canada n = 42, Australia n = 27, Aotearoa New Zealand n = 8, USA n = 28) and our analysis revealed a range of thematic areas within each nation that impact wellbeing for Indigenous youth. Findings highlight the unique challenges facing Indigenous youth, as well as their immense capacity to harness cultural and personal strengths to navigate into an uncertain future. The commonalities of Indigenous youth wellbeing across these nations provide valuable insights into how information and approaches can be shared across borders to the benefit of all Indigenous youth and future generations.

Systematic Review and Meta-analysis: First Nations, Inuit, and Métis Youth Mental Health

OBJECTIVE

The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada.

METHOD

Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates.

CONCLUSION

Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges.

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.

Intimate-partner violence and its association with symptoms of depression, perceived health, and quality of life in the Himalayan Mountain Villages of Gilgit Baltistan

Study objectives

We aimed to estimate the prevalence of intimate partner violence (IPV) and associated risk factors in married women in rural villages of Gilgit Baltistan in Pakistan.

Methods

A cross-sectional design to assess the magnitude and factors associated with IPV in a random sample of 789 married women aged 18–49 years. A World Health Organization screening instrument was used to assess the presence of IPV in the previous 12 months. A locally validated instrument was adopted to identify self-reported symptoms of major depression according to the DSM IV. Trained nurses obtained socio-demographic and reproductive history through structured interviews. Bivariate and multivariable logistic regression analyses were used to estimate prevalence and identify significant predictors of IPV.

Results

The mean age of the participants was 38.3 years (SD: ±12.8). The prevalence of IPV in women was 22.8% (95% Confidence Interval: 20.0–25.9), 18.5% in pregnant women (95% CI: 11.7–27.9) and significantly associated with depression in 55.1% of IPV cases. Husband education level (college/higher) (Adjusted Odds Ratio: 0.40; 95%CI: 0.22–0.70) and high household income (AOR: 0.44; 95% CI: 0.29–0.68) were protective against IPV. Increase in age (AOR;1.02; 95% CI: 1.01–1.02) and poor relationship with mother-in-law increased the risk of IPV (AOR = 2.85; 95% CI: 1.90–4.28). IPV was positively associated with symptoms of depression (AOR = 1.97; 95% CI:1.39–2.77), poor perceived quality of life (AOR = 3.54; 95% CI: 1.90–6.58) and poor health (AOR = 2.74; 95% CI: 1.92–3.92).

Conclusion

IPV is substantial public health burden significantly associated with depressive symptoms, poor perceived health and the quality of life.

Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review

BACKGROUND

Indigenous youth in Canada face profound health inequities which are shaped by the rippling effects of intergenerational trauma, caused by the historical and contemporary colonial policies that reinforce negative stereotypes regarding them. Moreover, wellness promotion strategies for these youth are replete with individualistic Western concepts that excludes avenues for them to access holistic practices grounded in their culture. Our scoping review explored strategies, approaches, and ways health and wellness can be enhanced by, for, and with Indigenous youth in Canada by identifying barriers/roadblocks and facilitators/strengths to enhancing wellness among Indigenous youth in Canada.

METHODS

We applied a systematic approach to searching and critically reviewing peer-reviewed literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] as a reporting guideline. Our search strategy focused on specific keywords and MeSH terms for three major areas: Indigenous youth, health, and Canada. We used these keywords, to systematically search the following electronic databases published in English between January 01, 2017, to May 22, 2021: Medline [Ovid], PubMed, ERIC, Web of Science, Scopus, and iportal. We also used hand-searching and snowballing methods to identify relevant articles. Data collected were analysed for contents and themes.

RESULTS

From an initial 1695 articles collated, 20 articles met inclusion criteria for this review. Key facilitators/strengths to enhancing health and wellness by, for, and with Indigenous youth that emerged from our review included: promoting culturally appropriate interventions to engage Indigenous youth; using strength-based approaches; reliance on the wisdom of community Elders; taking responsibility; and providing access to wellness supports. Key barriers/roadblocks included: lack of community support for wellness promotion activities among Indigenous youth; structural/organizational issues within Indigenous communities; discrimination and social exclusion; cultural illiteracy among youth; cultural discordance with mainstream health systems and services; and addictions and risky behaviours.

CONCLUSION

This scoping review extracted 20 relevant articles about ways to engage Indigenous youth in health and wellness enhancement. Our findings demonstrate the importance of promoting health by, and with Indigenous youth, by engaging them in activities reflexive of their cultural norms, rather than imposing control measures that are incompatible with their value systems.

Protective Factors against Self-Harm and Suicidality among Australian Indigenous Adolescents: A Strengths-Based Analysis of the Longitudinal Study of Indigenous Children

Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time—The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31−26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.

Shifting Safeties and Mobilities on the Land in Arctic North America: A Systematic Approach to Identifying the Root Causes of Disaster

Amid the surge in research on mobility and migration in the context of environmental change, little research has focused on the experiences of people for whom travel is cyclical and a part of daily, weekly, or seasonal life. For Inuit in Arctic North America, the land is the heart of cultural and community life. Disruption to time spent on the land is reported to impact the emotional health and well-being of individuals and communities. There is concern that environmental change is creating barriers to safe travel, constituting a creeping disaster. We systematically review and evaluate the literature for discussion of barriers to travel for Inuit in Arctic North America, using an approach from the field of disaster anthropology to identify root causes of constraints to mobility. We identify root causes of risk and barriers to time spent on the land. These emerge from historic and contemporary colonial policy and inequality, as opposed to environmental hazards per se, impacting people’s mobility in profound ways and enacting a form of slow violence. These results suggest a need to understand the underlying processes and institutions that put people at risk.

Mind the Gap: What Factors Determine the Worse Health Status of Indigenous Women Relative to Men Living Off-Reserve in Canada?

BACKGROUND

Indigenous populations have the poorest health outcomes in Canada. In addition, some studies report notable gender health gaps among Indigenous populations of Canada, with greater disadvantages for Indigenous women. To date, the driving factors behind the health gaps between Indigenous women and men are poorly understood.

METHOD

Using the four available Aboriginal People Surveys (APS) (2001, 2006, 2012, and 2017), we measure gender gaps in good general health (GGH) (i.e. good/very good/excellent self-rated health) among Indigenous adults (age 18 and above) living off-reserve in Canada. We apply the Oaxaca-Blinder (OB) decomposition method to identify the relative contribution of health endowments and the return to these endowments to the gender health gaps among Indigenous peoples.

RESULTS

Indigenous men are found to have a higher rate of GGH than their female counterparts. The gender health gap among Indigenous people has somewhat widened over the period 2001 to 2017. The widening of the gender health gap was observed in all four Indigenous identity groups, viz. registered First Nations, non-registered First Nations, Métis, and Inuit. The OB decomposition suggests that differences in endowments such as employment status and income between men and women explain between 30 to 60% of the gender health gap among Indigenous populations in Canada over the study period.

CONCLUSION

The social determinants of health appear to be the main factor explaining the gender health gap within the Indigenous peoples living in Canada. Policies improving employment opportunities and income among Indigenous women may potentially reduce the gender health gap within Indigenous population in Canada.

Mental health experiences with COVID-19 public health measures in an Alberta First Nations Community

BACKGROUND

First Nations (FN) people of Canada experience health, social, and systemic inequities due to colonization. Consequently, COVID-19 has placed further mental health stress on people related to personal finances, employment security and worry over infection, resulting in exacerbated effects of unresolved past medical and physical traumas. This study aims to understand the experiences related to mental health in an Alberta FN community during the early stages of the pandemic.

METHODS

In partnership with FN leadership, the study implemented an online cross-sectional survey. Adults from a large FN community in Alberta, Canada, were asked to complete a survey, including two mental health-related screening questionnaires: (1) Generalized Anxiety Disorder-2 item; and (2) Patient Health Questionnaire-2 item. In addition, respondents could provide responses to open-ended questions about their experiences.

RESULTS

Among 106 respondents, 95 (89.6%) finished the survey; 18% of adults screened positive for depressive symptoms (score of 3 or greater) and reported difficulty following public health advice for using hand sanitizer, maintaining social distancing, or self-isolating. 21% of adults screened positive for symptoms of anxiety (score of 3 or greater) and reported difficulty maintaining social distance, self-isolating, obtaining food and clothing, or meeting other basic living requirements.

CONCLUSIONS

FN communities may be disproportionately affected by COVID-19, and may experience exacerbated symptoms of anxiety, depression and overall poor mental health and well-being. Additional supports and services, including for mental health, should be considered for FN in the context of COVID-19 public health measures.

HIGHLIGHTS

The COVID-19 pandemic has brought upon increased stress and accompanying symptoms of anxiety and depression for a First Nations community in Alberta. Studies, such as this one, that characterize the influence of the COVID-19 pandemic on mental health among First Nations people, are urgently needed because of increasing demands on healthcare systems due to the pandemic and potential delays in the care of patients living with pre-existing mental health conditions. There is an opportunity to capitalize on First Nations people's experiences of post-traumatic growth proactively supporting/maintaining their well-being and possibly the development of community-based mental health interventions and supports.

Modelling Maternal Depression: An Agent-Based Model to Examine the Complex Relationship between Relative Income and Depression

Depression is a major public health concern among expectant mothers in Canada. Income inequality has been linked to depression, so interventions for reducing income inequality may reduce the prevalence of maternal depression. The current study aims to simulate the effects of government transfers and increases to minimum wage on depression in mothers. We used agent-based modelling techniques to identify the predicted effects of income inequality reducing programs on maternal depression. Model parameters were identified using the All Our Families cohort dataset and the existing literature. The mean age of our sample was 30 years. The sample was also predominantly white (78.6%) and had at least some post-secondary education (89.1%). When income was increased by just simulating an increase in minimum wage, the proportion of depressed mothers decreased by 2.9% (p < 0.005). Likewise, simulating the Canada Child Benefit resulted in a 5.0% decrease in the prevalence of depression (p < 0.001) and Ontario’s Universal Basic Income pilot project resulted in a simulated 5.6% decrease in the prevalence of depression (p < 0.001). We also assessed simulated changes to the mother’s social networks. Progressive income policies and increasing social networks are predicted to decrease the probability of depression.

Mental health of indigenous people: is Bangladesh paying enough attention?

Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers.

How Key Psychological Theories Can Enrich Our Understanding of Our Ancestors and Help Improve Mental Health for Present and Future Generations: A Family Historian’s Perspective

Family historians could increase their understanding of their ancestors and themselves and improve the mental health of living and future generations if they consider the psychological history of their forebears. Genealogists could then begin to recognize their family’s unique psychological inheritance that can appear as a result of trauma, depression, or addiction. The author explores three generations of a Parker family branch from Huntingdon/Norfolk, England, to show family historians how such considerations can shed light on their family’s psychological legacy. The author does this by introducing us to her great-grandmother Ann grandfather Walter, and mother Doreen through the lens of attachment theory, and their adverse childhood experiences (ACEs) such as poverty, bereavement, and addiction. Attachment matters because it affects not only how safe we feel, our ability to regulate our emotions and stress, our adaptability, resilience, and lifelong mental and physical health, but attachment style can also be passed on. In addition, this paper utilizes attachment theory to speculate on the likely attachment styles for the three generations of the Parker family and looks at the possible parenting behavior in the first two, the effect of alcoholism and the intergenerational impact of trauma and depression.

The associations of dispositional mindfulness, self-compassion, and reappraisal with symptoms of depression and anxiety among a sample of Indigenous students in Canada

ObjectiveDepression and anxiety are major concerns among students. Unfortunately, there are disparities between the mental health of majority culture students (White; Judeo-Christian) and that of Indigenous students. Although mindfulness, self-compassion, and reappraisal are correlated with symptoms of psychopathology among White students, these relationships have never been examined among Indigenous students. Participants: Undergraduate Indigenous students recruited from a Canadian institution. Methods: We administered self-report measures of depression, anxiety, dispositional mindfulness, self-compassion, and emotion regulation strategies (cognitive reappraisal and emotional suppression). Results: 37.5% (n = 33) and 40.9% (n = 36) reported significant symptoms of depression or anxiety, respectively. Dispositional mindfulness and self-compassion were negatively and strongly associated with depression symptoms (r = -.58 and r = -.58, respectively). Further, both constructs were also negatively and strongly associated with anxiety symptoms (r = -.55 and r = -.53, respectively). We also found a negative correlation between reappraisal and depression and anxiety symptoms. Conclusions: Mindfulness, self-compassion, and reappraisal are associated with depression and anxiety symptoms among this sample of Indigenous students.

Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien'kéha (Mohawk) and Inuit in Quebec

PURPOSE

We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.

METHODS

We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information.

RESULTS

The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner.

CONCLUSION

This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.

Narrative frames as choice over structure of American Indian sexual and reproductive health consequences of historical trauma

Emerging evidence suggests that the historical trauma associated with settler colonialism affects the sexual and reproductive health (SRH) of American Indian (AI) communities today. This article examines how one AI community narratively frames the influence of historical trauma within the context of community-based participatory research (CBPR) and the implications of this framing for health behaviours, internalized oppression, SRH outcomes, and future CBPR interventions. We found that AIs framed the SRH consequences of historical trauma with renderings that favoured personal choice over structural explanations. Our findings suggest future interventions could: (1) include educational components on historical trauma and the continued role settler colonialism plays in structural violence against AI bodies and communities; and (2) recognize the role that the individualized logic of westernized/white culture may play in the erasure of traditional collectivist AI culture, internalized oppression, and SRH.

Anxiety and depression in two indigenous communities in Bangladesh

BACKGROUND

The mental health status of indigenous people in Bangladesh has attracted little or no attention. The objective of the present study is to determine the extent of symptoms of anxiety and depression in the two largest indigenous communities in Bangladesh.

METHODS

In total, 240 participants were recruited, 120 from each of the Marma and Chakma communities with an overall mean age of 44.09 years (s.d. 15.73). Marma people were older (mean ages 48.92 v. 39.25, p < 0.001). Participants completed the Anxiety Scale (AS) and Depression Scale (DS) that have been developed and standardised in Bangladesh in the Bangla (Bengali) language.

RESULTS

Results indicated that anxiety and depression scores were elevated in both communities, 59.2% of the participants scoring above the cut-off for clinical significance on AS and 58.8% of the participants scoring above the cut-off for clinical significance on DS. Marma people compared to Chakma people were more anxious (M = 59.49 v. 43.00, p < 0.001) and more depressed (M = 106.78 v. 82.30, p < 0.001). The demographic variables of age, sex and socioeconomic status were weakly or inconsistently related to scores. In the Marma people, females scored higher on both AS and DS, but in the Chakma community, males scored higher on AS and the same on DS.

CONCLUSION

The finding of significant anxiety and depression in communities with such limited mental health services is a matter of concern and emphasises the need to formulate and implement appropriate mental health policies for indigenous people in Bangladesh and other parts of the world.

Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review

Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.

Mental health and well-being of indigenous people during the COVID-19 pandemic in Bangladesh

BACKGROUND

The ongoing pandemic caused by the novel coronavirus and the subsequent containment strategies has taken a heavy toll on the mental health of people irrespective of age, gender, race, ethnicity, and geographical location. Studies have documented the mental health status of non-indigenous Bangladeshi people, but little attention has been paid during the pandemic to the investigation of the mental health status of indigenous people living in remote hilly areas. To address this gap the present study aimed at investigating the prevalence and accompanying risk factors of depression, anxiety, stress, and compromised well-being among indigenous people during the pandemic.

METHODS

A cross-sectional survey was conducted on 422 indigenous people aged between 16 and 90 using the 21-item Bangla Depression Anxiety Stress Scale (BDASS-21) and the Bangla version of the WHO-5 Well-being Index from January 30 to April 10, 2021. Data were collected by trained research assistants from three remote hilly areas namely Bandarban, Rangamati, and Khagracchari in the Chattogram Hill Tracts (CHT). Chi-squares, logistic regression, and ANOVA were performed to examine the association of variables.

RESULTS

The prevalence of moderate to extremely severe depression, anxiety, stress, and low well-being among the indigenous population during the pandemic was found to be 49.3%, 47.2%, 36.7%, and 50.9%, respectively. Risk predictors for depression, anxiety, and stress included age, ethnicity, geographical locations, educational attainment, occupation, and marital status.

CONCLUSIONS

The results suggest that the ongoing pandemic has led to the rise of common mental health problems among indigenous people during the pandemic. The results can contribute to the formation of mental health policy for indigenous people and the development of suitable mental health intervention strategies especially during and after the COVID-19 pandemic.

Psychopathology in the Offspring of Indigenous Parents with Mental Health Challenges: A Systematic Review: Psychopathologie des descendants de parents autochtones ayant des problèmes de santé mentale: Une revue systématique

OBJECTIVE

Parental psychopathology is a significant risk factor for mental health challenges in offspring, but the nature and magnitude of this link in Indigenous Peoples is not well understood. This systematic review examined the emotional and behavioral functioning of the offspring of Indigenous parents with mental health challenges.

METHOD

We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until April 2020. Studies were included if they included assessments of emotional, behavioral, or other psychological outcomes in the offspring of Indigenous parents with a mental health challenge.

RESULTS

The 14 studies eligible for review were focused on parental substance misuse (n = 8), maternal internalizing (i.e., depression, anxiety) issues (n = 5), and poor overall parental mental health (n = 4). In 11 studies, parental substance misuse, depression, and/or overall mental health challenges were associated with 2 to 4 times the odds of offspring externalizing and internalizing behaviors as compared to offspring of Indigenous parents without mental health challenges.

CONCLUSION

The findings suggest higher risks of mental health challenges among offspring of Indigenous parents with psychiatric difficulties than among Indigenous children of parents without similar difficulties. Knowledge of these phenomena would be improved by the use of larger, more representative samples, culturally appropriate measures, and the engagement of Indigenous communities. Future studies should be focused on both risk and resilience mechanisms so that cycles of transmission can be interrupted and resources aimed at detection, prevention, and treatment optimally allocated.

Caliata: An Indigenous Community in Ecuador Offers Lessons on Food Sovereignty and Sustainable Diets

BACKGROUND

To achieve a healthy sustainable food system globally, it is imperative to understand how local food systems can provide healthy and sustainable conditions.

OBJECTIVE

To explore, through the indigenous community of Caliata in the Ecuadorian highlands, the factors that support or hinder sustainable Andean food systems.

METHODS

We designed a participatory mixed-methods study in Caliata (Chimborazo, Ecuador) and an inclusive and transdisciplinary research process with constant member checking. The study combined culturally validated qualitative methods (n = 49), agroecology-based site analysis, and household surveys (n = 57), including a modified 48-h recall. We used the NOVA food classification system to categorize the diet according to levels of processing and analyzed categorical and numeric data to understand the interplay of parcel size, agrodiversity, and diet diversity.

RESULTS

First, the agroecological space is defined by the stewardship of Pachamama (Mother Nature), a central role in Andean cosmovision, leading to trophic interactions and cycles characterized by a diversity of heterarchical social organizations and agroecologically useful species. Second, consistency was found in dietary patterns; all respondents consume their produce, fruits being the most popular snack (in a 24-h period, 70% reported an average of 2.2 servings), and two-thirds of households' consumption represent unprocessed or minimally processed foods. Third, gendered agriculture and population aging represent demographic challenges, while chronic health problems remain relatively infrequent compared with the general population. Fourth, food sovereignty is an ecocentric concept based on production, exchanges of seeds and produce, consumption of produce, and knowledge of how agroecological space is treated. This system represents a nutrient loop tied to a system of knowledge about how to care for soil, land, and the ecological community.

CONCLUSIONS

Caliata provides important perspectives on linkages between diet, biodiversity, use of agroecological space, and rural-urban dynamics. This small indigenous community offers lessons for achieving both healthy ecosystems and food security.

Intergenerational Trauma and Its Relationship to Mental Health Care: A Qualitative Inquiry

Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are passed across generations without exposure to the original event. This qualitative study aimed to explore how psychiatrists understand intergenerational trauma in respect to their practice, for the purposes of identifying interventions for addressing intergenerational trauma in public mental health services. Findings revealed that psychiatrists observe intergenerational trauma frequently in their roles and try to opportunistically promote awareness of trauma with adults, and refer families to external services for supportive interventions. They feel powerless when faced with directly intervening with intergenerational trauma and required restructuring of their roles to adequately address it in public settings. Findings have implications for training, advocacy and research on the relationship between trauma and mental illness. Alongside this, there is an indicated need for examination of how systems can ensure access to appropriate services once organisations become trauma-informed.

Vogt-Koyanagi-Harada Syndrome in a Canadian First Nations Population

Purpose: To characterize presentations, characteristics and outcomes of uveitis in Vogt-Koyanagi-Harada (VKH) syndrome in a North American First Nations (FN) population.Methods: Charts of 27 Canadian FN patients with VKH uveitis were retrospectively reviewed to characterize demographics, disease characteristics, management, complications and visual outcomes.Results: Average age at uveitis onset was 30.9 ± 13.8 years. Twenty-six patients 10 (96.3%) were female. Nine patients (33.3%) demonstrated complete VKH, 8 (29.6%) incomplete, and 10 (37%) probable VKH. Systemic associations included integumentary (19 patients, 70%), neurologic (17 patients, 63%), and auditory (13 patients, 48%) findings. Initial rates of mild, moderate and severe vision loss were 19 eyes (35.2%), 12 eyes (22.2%), and 23 eyes (42.6%), respectively, compared with final rates of 19 eyes (35.2%), 14 eyes (25.6%) and 21 eyes (38.9%), respectively. Average change in visual acuity was 15 0.1 ± 6.3 Snellen lines. Rates of immunomodulatory therapy (IMT) use (10 patients, 37%) fell short of targets.Conclusions: VKH may cause potentially severe uveitis in this population. Comorbidities including tuberculosis and diabetes, in addition to unique cultural, linguistic and geographic factors, may necessitate complex, individualized management strategies.

The Social Gradient in Mental Health and Well-Being for Indigenous Older Adults Living in Rural Areas: A Cross-Sectional Comparison With Rural Non-indigenous Population in Chile

Objectives: To compare differences in depression, loneliness and personal well-being in a sample made up of indigenous (Aymara and Mapuche) and non-indigenous older people resident in original rural territories. Methods: A cross-sectional study involving 800 older adults living in a rural context in Chile, of whom 201 were Aymara, 368 Mapuche and 231 non-indigenous. Validated instruments were included for depression, loneliness and personal well-being (outcome variables). Ordinary least squares regression analyses were performed. Results: Membership of an indigenous group was significantly associated with lower scores for depression and loneliness and higher scores for personal well-being. The interactions of severe deprivation and housing deprivation with indigenous group membership were significantly associated with lower loneliness scores and higher personal well-being scores for Aymara and Mapuche participants. Discussion: Native rural settings and territories may offer a degree of protection to indigenous peoples. Cultural continuity enhanced by rural areas would produce a culturally constructed resilience against deprivation.

Historical trauma and social support as predictors of psychological stress responses in American Indian adults during the COVID-19 pandemic

BACKGROUND

American Indians (AIs) live with historical trauma, or the cumulative emotional and psychological wounding that is passed from one generation to the next in response to the loss of lives and culture. Psychological consequences of historical trauma may contribute to health disparities.

PURPOSE

Here, we investigate whether historical trauma predicts changes in psychological stress associated with the onset of the COVID-19 pandemic in AI adults. Based on the stress-sensitization theory, we hypothesize that greater historical trauma will predict greater increases in levels of psychological stress from before the onset of the pandemic to after.

METHOD

Our analytic sample consisted of 205 AI adults. We measured historical trauma and levels of psychological stress before and after the onset of the pandemic.

RESULTS

Using hierarchical regression models controlling for age, biological sex, income, symptoms of depression and anxiety, psychological stress at Time 1, COVID-19 specific stress, and childhood trauma, we found that greater historical trauma preceding the pandemic predicted greater increases in psychological stress (β = 0.38, t = 5.17 p < .01, ΔR² = 0.12), and levels of social support interacted with historical trauma to predict changes in psychological stress (β = -0.19, t = -3.34, p = .001, ΔR² = 0.04). The relationship between historical trauma and changes in stress was significant for individuals with low levels of social support.

CONCLUSIONS

Historical trauma may contribute to AI mental health disparities, through heightened psychological stress responses to life stressors and social support appears to moderate this relationship.

Sewing and Inuit women's health in the Canadian Arctic

Traditional Inuit cultural values and practices are integral to an Inuit understanding of health. We examine the role of sewing in Inuit women's health in the Canadian Arctic in a case study of Ulukhaktok, Northwest Territories, Canada. An analysis of data collected using semi-structured interviews with 30 Inuit women reveals that sewing contributes to participant's health and the collective health of the community in several ways including: pride and sense of accomplishment; cultural identity; relaxation, decompression, and socialization; and spirituality and healing. As a cultural practice, sewing is about older generations teaching younger generations about their identity, who they are and where they come from. For some participants, sewing is a way through which they express their culture. Sewing brings people together at a time when social isolation is becoming more apparent, and gives women the chance to learn vital, tangible skills that continue to have social, economic, and cultural importance. Sewing is also a form of healing that helps women ease their minds and focus on a challenging and productive task that brings them satisfaction, self-worth, and value. We conclude that sewing is important for cultural continuity, enabling Inuit to both practice and carryon their culture, and contributing positively to individual and the collective health of the community.

Harvest Programs in First Nations of Subarctic Canada: The Benefits Go Beyond Addressing Food Security and Environmental Sustainability Issues

By breaking down barriers that impacted the ability of subarctic First Nations people to harvest waterfowl, the Sharing-the-Harvest program provided a safe, nutritious, and culturally appropriate food (i.e., geese) to James Bay Cree communities while also helping to protect the environment by harvesting overabundant geese. However, the impacts extend beyond those described above. Thus, the objectives of the present paper are twofold: to document the food sharing networks of the Sharing-the-Harvest program; and to examine the benefits associated with the harvest program beyond food security and environmental sustainability issues, as revealed through semi-directed interviews. In the regional initiative, harvested geese were shared with all James Bay communities; sharing is an important part of Cree culture. Where detailed information was collected, the goose-sharing network reached 76% of the homes in one of the communities. Likewise, in the local initiative, the goose-sharing network had a 76% coverage rate of the homes in the community. Although decreasing food insecurity was an important focus of the harvest-sharing programs, there were other benefits, from an Indigenous perspective, of being on the land, as identified by the Cree harvesters through semi-directed interviews (e.g., the transmission of Indigenous knowledge, the strengthening of social networks, and the feeling of wellness while out on-the-land). Thus, by participating in the on-the-land harvest programs, the Cree gained benefits beyond those solely related to strengthening food security and contributing in part to environmental sustainability. The Sharing-the-Harvest protocol has the potential to be adapted and employed by other Indigenous (or marginalized) groups worldwide, to help improve health and wellness, while, also protecting the environment from overabundant and/or invasive species.

Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples: a meta-analysis to identify sources of heterogeneity

BACKGROUND AND AIMS

To reduce health and social inequities, it is important to understand how drinking patterns vary within and between Indigenous peoples. We aimed to assess variability in estimates of Indigenous Australian drinking patterns and to identify demographic and methodological factors associated with this.

DESIGN

A three-level meta-analysis of Australian Aboriginal and Torres Strait Islander ('Indigenous') drinking patterns [International Prospective Register of Systematic Reviews (PROSPERO) no. CRD42018103209].

SETTING

Australia.

PARTICIPANTS

Indigenous Australians.

MEASUREMENTS

The primary outcomes extracted were drinking status, single-occasion risk and life-time risk. Moderation analysis was performed to identify potential sources of heterogeneity. Moderators included gender, age, socio-economic status, local alcohol restrictions, sample population, remoteness, Australian state or territory, publication year, Indigenous involvement in survey design or delivery and cultural adaptations.

FINDINGS

A systematic review of the literature revealed 41 eligible studies. For all primary outcomes, considerable heterogeneity was identified within ( I22 = 51.39-68.80%) and between ( I32 = 29.27-47.36%) samples. The pooled proportions (P) of current drinkers [P = 0.59, 95% confidence interval (CI) = 0.53-0.65], single-occasion (P = 0.34, 95% CI = 0.24-0.44) and life-time (P = 0.21, 95% CI = 0.15-0.29) risk were all moderated by gender, age, remoteness and measurement tool. Reference period moderated proportions of participants at single-occasion risk.

CONCLUSIONS

Indigenous Australian drinking patterns vary within and between communities. Initiatives to reduce high-risk drinking should take account of this variability.

What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review

BACKGROUND

Alcohol affects Indigenous communities globally that have been colonised. These effects are physical, psychological, financial and cultural. This systematic review aims to describe the prevalence of current (12-month) alcohol dependence in Indigenous Peoples in Australia, New Zealand, Canada and the United States of America, to identify how it is measured, and if tools have been validated in Indigenous communities. Such information can help inform estimates of likely treatment need.

METHODS

A systematic search of the literature was completed in six electronic databases for reports on current alcohol dependence (moderate to severe alcohol use disorder) published between 1 January 1989-9 July 2020. The following data were extracted: (1) the Indigenous population studied; country, (2) prevalence of dependence, (3) tools used to screen, assess or diagnose current dependence, (4) tools that have been validated in Indigenous populations to screen, assess or diagnose dependence, and (5) quality of the study, assessed using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

A total of 11 studies met eligibility criteria. Eight were cross-sectional surveys, one cohort study, and two were validation studies. Nine studies reported on the prevalence of current (12-month) alcohol dependence, and the range varied widely (3.8-33.3% [all participants], 3-32.8% [males only], 1.3-7.6% [females only]). Eight different tools were used and none were Indigenous-specific. Two tools have been validated in Indigenous (Native American) populations.

CONCLUSION

Few studies report on prevalence of current alcohol dependence in community or household samples of Indigenous populations in these four countries. Prevalence varies according to sampling method and site (for example, specific community versus national). Prior work has generally not used tools validated in Indigenous contexts. Collaborations with local Indigenous people may help in the development of culturally appropriate ways of measuring alcohol dependence, incorporating local customs and values. Tools used need to be validated in Indigenous communities, or Indigenous-specific tools developed, validated and used. Prevalence findings can inform health promotion and treatment needs, including funding for primary health care and specialist treatment services.