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Healey Akearok GK, Rana Z. Community perspectives on COVID-19 outbreak and public health: Inuit positive protective pathways and lessons for Indigenous public health theory. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:395-407. [PMID: 38653866 PMCID: PMC11133288 DOI: 10.17269/s41997-024-00863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/25/2024] [Indexed: 04/25/2024]
Abstract
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.
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Affiliation(s)
| | - Zoha Rana
- Qaujigiartiit Health Research Centre, Iqaluit, Nunavut, Canada
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Liu L, Batomen B, Pollock NJ, Contreras G, Jackson B, Pan S, Thompson W. Suicidality and protective factors among sexual and gender minority youth and adults in Canada: a cross-sectional, population-based study. BMC Public Health 2023; 23:1469. [PMID: 37528382 PMCID: PMC10394922 DOI: 10.1186/s12889-023-16285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Sexual and gender minority populations experience elevated risks for suicidality. This study aimed to assess prevalence and disparities in non-fatal suicidality and potential protective factors related to social support and health care access among sexual and gender minority youth and adults and their heterosexual and cisgender counterparts in Canada. The second objective was to examine changes in the prevalence of suicidal ideation and protective factors during the COVID-19 pandemic. METHODS Pooled data from the 2015, 2016 and 2019 Canadian Community Health Surveys were used to estimate pre-pandemic prevalence of suicidal ideation, plans and attempts, and protective factors. The study also estimated changes in the prevalence of recent suicidal ideation and protective factors in fall 2020, compared with the same period pre-pandemic. RESULTS The prevalence of suicidality was higher among the sexual minority populations compared with the heterosexual population, and the prevalence was highest among the bisexual population, regardless of sex or age group. The pre-pandemic prevalence of recent suicidal ideation was 14.0% for the bisexual population, 5.2% for the gay/lesbian population, and 2.4% for the heterosexual population. The prevalence of lifetime suicide attempts was 16.6%, 8.6%, and 2.8% respectively. More than 40% of sexual minority populations aged 15-44 years had lifetime suicidal ideation; 64.3% and 36.5% of the gender minority population had lifetime suicidal ideation and suicide attempts. Sexual and gender minority populations had a lower prevalence of protective factors related to social support and health care access. The prevalence of recent suicidal ideation among sexual and gender minority populations increased in fall 2020, and they tended to experience longer wait times for immediate care needed. CONCLUSIONS Sexual and gender minority populations had a higher prevalence of suicidality and less social support and health care access compared to the heterosexual and cisgender populations. The pandemic was associated with increased suicidal ideation and limited access to care for these groups. Public health interventions that target modifiable protective factors may help decrease suicidality and reduce health disparities.
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Affiliation(s)
- Li Liu
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Brice Batomen
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nathaniel J Pollock
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Gisèle Contreras
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Beth Jackson
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Saiyi Pan
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Wendy Thompson
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
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Mahinpey N, Pollock NJ, Liu L, Contreras G, Thompson W. Self-harm and rurality in Canada: an analysis of hospitalization data from 2015 to 2019. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1161-1170. [PMID: 37029322 PMCID: PMC10081931 DOI: 10.1007/s00127-023-02463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. METHODS Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. RESULTS Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10-19 and 20-34-year old age groups. Females aged 10-19 in very remote areas had the highest self-harm hospitalization rate. CONCLUSION The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts.
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Affiliation(s)
- Newsha Mahinpey
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, NL, Canada.
| | - Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
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Seidler IK, Tolstrup JS, Bjerregaard P, Crawford A, Larsen CVL. Time trends and geographical patterns in suicide among Greenland Inuit. BMC Psychiatry 2023; 23:187. [PMID: 36944963 PMCID: PMC10031872 DOI: 10.1186/s12888-023-04675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Between 1980 and 2018 Greenland has had one of the highest suicide rates in the world with an average rate of 96 suicides per 100,000 people annually. The aim of this study is to investigate suicide rates in Greenland according to age, birth cohort, period, sex, place of residence and suicide method from 1970 until 2018. METHODS Suicide rates were examined using register and census data from 1970-2018 among Greenland Inuit. Rates were calculated by Poisson regression in Stata and by use of Excel. In analyses of the period trends, rates were standardized according to the World Standard Population 2000-2025. RESULTS The suicide rate has been declining since a peak at 120 suicides per 100,000 people annually in the 1980s but remained high at a rate of 81.3 suicides per 100,000 people annually from 2015-2018. Descriptive analyses point to the decrease in male suicides as the primary factor for the overall decreasing rates while the rate among women has been increasing. Simultaneously, the proportion of women who used a violent suicide method increased from 60% in 1970-1979 to 90% in 2010-2018. The highest rates are seen among young people, especially young men aged 20-24 years and youth suicide rates increased with later birth cohorts. When the rates started to increase in the 1980s both the capital Nuuk and East Greenland had the highest rates. Since then, the rate in Nuuk has declined while the rate in East Greenland was three times the national rate from 2015-2018. CONCLUSIONS From 1970 to 1989 the suicide rate increased from 28.7 to 120.5 per 100,000 people mirroring a rapid societal transition in the post-colonial period. The rate has slowly declined from the peak in the 1980s but remains at a very high level. Young people in general are at risk, but the steady increase in the rate among women is worrying and there is a need to investigate underlying causes for this development.
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Affiliation(s)
- Ivalu Katajavaara Seidler
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
- Institute for Health and Nature, University of Greenland, Nuuk, Greenland.
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute for Health and Nature, University of Greenland, Nuuk, Greenland
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Smye V, Browne AJ, Josewski V, Keith B, Mussell W. Social Suffering: Indigenous Peoples' Experiences of Accessing Mental Health and Substance Use Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3288. [PMID: 36833982 PMCID: PMC9958899 DOI: 10.3390/ijerph20043288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
In this paper, we present findings from a qualitative study that explored Indigenous people's experiences of mental health and addictions care in the context of an inner-city area in Western Canada. Using an ethnographic design, a total of 39 clients accessing 5 community-based mental health care agencies were interviewed, including 18 in-depth individual interviews and 4 focus groups. Health care providers also were interviewed (n = 24). Data analysis identified four intersecting themes: normalization of social suffering; re-creation of trauma; the challenge of reconciling constrained lives with harm reduction; and mitigating suffering through relational practice. The results highlight the complexities of experiences of accessing systems of care for Indigenous people marginalized by poverty and other forms of social inequity, and the potential harms that arise from inattention to the intersecting social context(s) of peoples' lives. Service delivery that aims to address the mental health concerns of Indigenous people must be designed with awareness of, and responsiveness to, the impact of structural violence and social suffering on peoples' lived realities. A relational policy and policy lens is key to alleviate patterns of social suffering and counter the harms that are unwittingly created when social suffering is normalized.
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Affiliation(s)
- Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - Annette J. Browne
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Viviane Josewski
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | | | - William Mussell
- Sal’i’shan Institute, 800 Wellington Ave, Chilliwack, BC V2P 6H7, Canada
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Toombs E, Lund JI, Mushquash AR, Mushquash CJ. Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017. Front Public Health 2023; 10:1029139. [PMID: 36743177 PMCID: PMC9895934 DOI: 10.3389/fpubh.2022.1029139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Method Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Results Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. Discussion These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada,*Correspondence: Elaine Toombs ✉
| | - Jessie I. Lund
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Aislin R. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada,Northern Ontario School of Medicine (NOSM) University, Lakehead University, Thunder Bay, ON, Canada,Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada,Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
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Sjoblom E, Ghidei W, Leslie M, James A, Bartel R, Campbell S, Montesanti S. Centering Indigenous knowledge in suicide prevention: a critical scoping review. BMC Public Health 2022; 22:2377. [PMID: 36536345 PMCID: PMC9761945 DOI: 10.1186/s12889-022-14580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Erynne Sjoblom
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Winta Ghidei
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Marya Leslie
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Ashton James
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Reagan Bartel
- Métis Nation of Alberta, #100 Delia Gray Building, 11738 Kingsway Avenue NW, Edmonton, AB, T5G 0X5, Canada
| | - Sandra Campbell
- Librarian, Health Sciences, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Stephanie Montesanti
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada.
- School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
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Lavoie JG, Clark W, McDonnell L, Nickel N, Dutton R, Kanayok J, Anawak J, Anawak C, Brown L, Clark GV, Evaluardjuk-Palmer M, Ford F, Fowler-Woods M, Wong S, Sanguins J, Katz A. Kivalliq Inuit women travelling to Manitoba for birthing: findings from the Qanuinngitsiarutiksait study. BMC Pregnancy Childbirth 2022; 22:870. [PMID: 36434515 PMCID: PMC9694830 DOI: 10.1186/s12884-022-05214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Qanuinngitsiarutiksait study aimed to develop detailed profiles of Inuit health service utilization in Manitoba, by Inuit living in Manitoba (approximately 1,500) and by Inuit from the Kivalliq region of Nunavut who travel to Manitoba to access care not available in Nunavut (approximately 16,000 per year). METHODS We used health administrative data routinely collected in Manitoba for all services provided and developed an algorithm to identify Inuit in the dataset. This paper focused on health services used by Inuit from the Kivalliq for prenatal care and birthing. RESULTS Our study found that approximately 80 percent of births to women from the Kivalliq region occur in Manitoba, primarily in Winnipeg. When perinatal care and birthing are combined, they constitute one third of all consults happening by Kivalliq residents in Manitoba. For scale, hospitalizations for childbirths to Kivalliq women about to only 5 percent of all childbirth-related hospitalizations in Manitoba. CONCLUSIONS The practice of evacuating women from the Kivalliq for perinatal care and birthing is rooted in colonialism, rationalized as ensuring that women whose pregnancy is at high risk have access to specialized care not available in Nunavut. While defendable, this practice is costly, and does not provide Inuit women a choice as to where to birth. Attempts at relocating birthing to the north have proven complex to operationalize. Given this, there is an urgent need to develop Inuit-centric and culturally appropriate perinatal and birthing care in Manitoba.
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Affiliation(s)
- Josée G. Lavoie
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | - Wayne Clark
- grid.17089.370000 0001 2190 316XUniversity of Alberta, Edmonton, AB Canada
| | - Leah McDonnell
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | - Nathan Nickel
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | | | | | | | | | | | | | | | | | | | - Sabrina Wong
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, BC Canada
| | | | - Alan Katz
- grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
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Okpalauwaekwe U, Ballantyne C, Tunison S, Ramsden VR. Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review. BMC Public Health 2022; 22:1630. [PMID: 36038858 PMCID: PMC9422134 DOI: 10.1186/s12889-022-14047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Udoka Okpalauwaekwe
- Health Sciences Program, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Clifford Ballantyne
- Sturgeon Lake Youth Center, Sturgeon Lake First Nation, Sturgeon Lake, Saskatchewan, S0J 2E1, Canada
| | - Scott Tunison
- University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0X1, Canada
| | - Vivian R Ramsden
- Research Division, Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7M 3Y5, Canada.
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Shafiee M, Mahboubi M, Shanbehzadeh M, Kazemi-Arpanahi H. Design, development, and evaluation of a surveillance system for suicidal behaviors in Iran. BMC Med Inform Decis Mak 2022; 22:180. [PMID: 35818024 PMCID: PMC9275034 DOI: 10.1186/s12911-022-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a serious cause of morbidity and mortality in Iran and worldwide. Although several organizations gather information on suicide and suicide attempts, there is substantial misperception regarding the description of the phenomenon. This study proposes the minimum data set (MDS) for suicidal behaviors surveillance. METHODS A literature review was first conducted to achieve a thorough overview of suicide-related items and map the existing evidence supporting the development of the MDS. The data items included in the literature review were then analyzed using a two-round Delphi technique with content validation by an expert panel. The suicidal behaviors surveillance system was then established based on the confirmed MDS, and ultimately, its performance was assessed by involving the end-users. RESULTS The panel of experts consisted of 50 experts who participated in the Delphi phase and validity content review. Of these, 46% were men, and their mean age and average work experience were (36.4, SD ± 6.4) and (12.32, SD ± 5.2) years, respectively. The final MDS platform of our study contained 108 items classified into eight main categories. A web-based system with a modular and layered architecture was developed based on the derived MDS. CONCLUSION The developed system provides a framework for recording suicidal behaviors' data. The integration of multiple suicide-related information systems at the regional and national levels makes it possible to assess the long-term outcomes and evolutions of suicide prevention interventions.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammad Mahboubi
- Department of Public Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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Heid O, Khalid M, Smith H, Kim K, Smith S, Wekerle C, Bomberry T, Hill LD, General DA, Green TJ, Harris C, Jacobs B, Jacobs N, Kim K, Horse ML, Martin-Hill D, McQueen KCD, Miller TF, Noronha N, Smith S, Thomasen K, Wekerle C. Indigenous Youth and Resilience in Canada and the USA: a Scoping Review. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:113-147. [PMID: 35733443 PMCID: PMC9206629 DOI: 10.1007/s42844-022-00060-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Relative to non-Indigenous youth, Indigenous youth have been under-represented when studying pathways to mental wellness. Yet, a broad range of adversity is acknowledged, from intergenerational and ongoing trauma arising from colonial policies. This scoping review explores resilience definitions, measures, key stressors, and what Indigenous youth identify as pathways to their wellness, based on quantitative and qualitative peer-reviewed literature in Canada and the Continental United States. Eight databases (EBSCO, PsycINFO, Science Direct, Social Science Citation Index, Web of Science, PsycARTICLES, and EMBASE) and hand searches of 7 relevant journals were conducted to ensure literature coverage. Two independent reviewers screened each article, with one Indigenous screener per article. The final scoping review analysis included 44 articles. In articles, no Indigenous term for resilience was found, but related concepts were identified (“walking a good path,” “good mind,” Grandfathers’ teachings on 7 values, decision-making for 7 generations into the future, etc.). Few Indigenous-specific measures of resilience exist, with studies relying on Western measures of psychological resilience. Qualitative approaches supporting youth-led resilience definitions yielded important insights. Youth stressors included the following: substance use, family instability, and loss of cultural identity. Youth resilience strategies included the following: having a future orientation, cultural pride, learning from the natural world, and interacting with community members (e.g., relationship with Elders, being in community and on the land). Indigenous traditional knowledge and cultural continuity serve as prominent pathways to Indigenous youth resilience. More research is needed to yield a holistic, youth-centered measure of resilience that includes traditional practices.
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Affiliation(s)
- Olivia Heid
- Health Sciences, Faculty of Health Science, McMaster University, Hamilton, Ontario Canada
| | - Marria Khalid
- Life Sciences, Faculty of Science, University of Waterloo, Waterloo, Ontario Canada
| | - Hailey Smith
- Social Work, School of Social Work, Dalhousie University, Halifax, Nova Scotia Canada
| | - Katherine Kim
- Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario Canada
| | - Savannah Smith
- Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario Canada
| | - Christine Wekerle
- Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario Canada
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Clark W, Lavoie JG, Mcdonnell L, Nickel N, Anawak J, Brown L, Clark G, Evaluardjuk-Palmer M, Ford F, Dutton R, Wong S, Sanguins J, Katz A. Trends in Inuit health services utilisation in Manitoba: findings from the Qanuinngitsiarutiksait study. Int J Circumpolar Health 2022; 81:2073069. [PMID: 35543481 PMCID: PMC9103522 DOI: 10.1080/22423982.2022.2073069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a notable lack of research related to trends in Inuit accessing health services throughout the land known as Canada. Given Nunavut’s reliance on specialised services provided in the Northwest Territories, Alberta, Manitoba, and Ontario, this gap is particularly problematic, making it more difficult for Nunangat to proactively plan new programs for emerging needs, and for provinces to respond to those needs. The Qanuinngitsiarutiksait study aimed to address this gap by developing detailed profiles of Inuit accessing health services in Manitoba. We used administrative data routinely collected by Manitoba agencies, to support the development of Inuit-centric services. It was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut Canada and Manitoba. We focused on two interrelated cohorts: Kivallirmiut (Inuit from the Kivalliq region of Nunavut) who come to Winnipeg to access specialised services; and Manitobamiut (Inuit already living in Manitoba). Findings show that health services are primarily accessed in Winnipeg. Half of health services accessed by Kivallirmiut are for in-patient care at facilities with the Winnipeg Regional Health Authority. The other half are for advanced out-patient care including specialist consults. For Kivallirmiut, hospitalisation for pregnancy and birth are the most prevalent reasons for hospitalisation, followed by diseases of the respiratory system. Noteworthy, rates of hospitalisation for conditions treatable in primary healthcare for Kivallirmiut are considerably lower than those for Manitobans living in the northern part of the province (where comparable constraints exist). For Inuit adults, rates of hospitalisation for these conditions are comparable to those of Manitobans living in small communities. Inuit living in Manitoba are most often hospitalised for mental health reasons, although other reasons are nearly as prevalent. Our results support the need for more Inuit-centric health programming in Winnipeg.
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Affiliation(s)
- Wayne Clark
- Indigenous Health Initiatives, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Josée G Lavoie
- Director of Ongomiizwin Research, Professor, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Leah Mcdonnell
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
| | - Nathan Nickel
- Director of Ongomiizwin Research, Professor, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | | | | | - Sabrina Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Julianne Sanguins
- Health & Wellness Department, Manitoba Métis Federation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Troya M, Spittal MJ, Pendrous R, Crowley G, Gorton HC, Russell K, Byrne S, Musgrove R, Hannah-Swain S, Kapur N, Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101399. [PMID: 35518122 PMCID: PMC9065636 DOI: 10.1016/j.eclinm.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. METHODS Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. FINDINGS A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. INTERPRETATION The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations. FUNDING No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- M.Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, 4.07 Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Grace Crowley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kirsten Russell
- School of Psychological Sciences and Health, Graham Hills Building, 40 George Street, Glasgow, UK
| | - Sadhbh Byrne
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Musgrove
- Centre for Mental Health and Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Navneet Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Corresponding author.
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Scarth B, Pavlova A, Hetrick SE, Witt KG, Hawton K, Fortune S. Service users’ experiences of emergency care following an episode of self-harm: a mixed evidence synthesis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Bonnie Scarth
- WellSouth, Primary Care Organisation; Dunedin New Zealand
| | - Alina Pavlova
- Psychological Medicine; University of Otago; Dunedin New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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15
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First responder, clinician, and non‐clinical support staff knowledge, attitudes, and behaviours towards people presenting for emergency care following self‐harm: a mixed evidence synthesis. Cochrane Database Syst Rev 2021; 2021:CD014939. [PMCID: PMC8668017 DOI: 10.1002/14651858.cd014939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: The objectives of this review are threefold, as follows. Firstly, to assess the content of knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff towards service users with SH presentations. Secondly, to understand how service user and staff characteristics (e.g. age, gender, sociodemographic background), type of SH presentation (e.g. method, repetition), and contextual factors (e.g. hospital environment, presence of bystanders) affect the knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff in providing acute care. Thirdly, to assess whether clinicians' knowledge, attitudes, and behaviours have evolved over time.
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16
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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17
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Pollock NJ, Liu L, Wilson MM, Reccord C, Power ND, Mulay S, Karaivanov Y, Tonmyr L. Suicide in Newfoundland and Labrador, Canada: a time trend analysis from 1981 to 2018. BMC Public Health 2021; 21:1291. [PMID: 34215242 PMCID: PMC8252247 DOI: 10.1186/s12889-021-11293-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. METHODS We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. RESULTS From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide. CONCLUSIONS The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide.
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Affiliation(s)
- Nathaniel J Pollock
- School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada. .,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada. .,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Li Liu
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margo M Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Charlene Reccord
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole D Power
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine, Discipline of Family Medicine, Faculty of Medicine, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Lil Tonmyr
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Pollock N, Wilson M, Karaivanov Y, Power N, Reccord C. Codesigning a public health approach to preventing firearm-related suicide deaths with rural communities. CMAJ 2021; 192:E1811. [PMID: 33318094 DOI: 10.1503/cmaj.77311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nathaniel Pollock
- Postdoctoral fellow, School of Public Health, University of Alberta, Edmonton, Alta
| | - Margo Wilson
- Emergency physician, Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, NL
| | - Yordan Karaivanov
- Family physician and chief of staff, Labrador Health Centre, Labrador-Grenfell Health, Happy Valley-Goose Bay, NL
| | - Nicole Power
- Policy, planning and research analyst, Department of Research and Innovation, Eastern Health, St. John's, NL
| | - Charlene Reccord
- Clinical research scientist, Department of Research and Innovation, Eastern Health, St. John's, NL
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A rapid review of Irish Traveller mental health and suicide: a psychosocial and anthropological perspective. Ir J Psychol Med 2020; 39:223-233. [PMID: 33054886 DOI: 10.1017/ipm.2020.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Irish Travellers are an indigenous ethnic minority (IEM) with poor health outcomes. Whilst they constitute less than 1% of the Irish population, they account for 10% of national young adult male suicide statistics. METHODS A rapid review of scientific publications related to mental health and suicide in Irish Travellers was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches of PubMed, PsycINFO and Google Scholar were performed. Eligibility criteria included: (i) Irish Travellers/Gypsy Travellers; (ii) information on mental health/suicide/self-harm; (iii) psychosocial anthropological perspectives of mental health; (iv) publications in english. Data on studies including design, methods, participants and key findings were extracted using a spreadsheet template. RESULTS From 5160 scientific references over the past 20 years, 19 papers made reference to Traveller mental health, and only 5 papers made specific data-based reference to suicide in Travellers. It was only when we qualified Travellers as being 'Irish Travellers' in our scientific review did we detect meaningful references to their existence as an IEM, and their health and well-being. Due to sample sizes and heterogeneity in design, results were synthesised narratively. DISCUSSION This paper draws together strands from the disciplines of psycho/socio/anthropological perspectives to gain deeper insights into mental health and suicide in Irish Travellers. In a knowledge vacuum, it behoves the scientific community to explain the value of scientific research and rigour to both policymakers as well as Travellers, shifting the existing discourse towards new knowledge and understanding around mental health and suicide in Travellers.
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Basham CA. Regional variation in multimorbidity prevalence in British Columbia, Canada: a cross-sectional analysis of Canadian Community Health Survey data, 2015/16. Health Promot Chronic Dis Prev Can 2020; 40:225-234. [PMID: 32667879 PMCID: PMC7450904 DOI: 10.24095/hpcdp.40.7/8.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Multimorbidity represents a major concern for population health and service delivery planners. Information about the population prevalence (absolute numbers and proportions) of multimorbidity among regional health service delivery populations is needed for planning for multimorbidity care. In Canada, health region-specific estimates of multimorbidity prevalence are not routinely presented. The Canadian Community Health Survey (CCHS) is a potentially valuable source of data for these estimates. METHODS Data from the 2015/16 cycle of the CCHS for British Columbia (BC) were used to estimate and compare multimorbidity prevalence (3+ chronic conditions) through survey-weighted analyses. Crude frequencies and proportions of multimorbidity prevalence were calculated by BC Health Service Delivery Area (HSDA). Logistic regression was used to estimate differences in multimorbidity prevalence by HSDA, adjusting for known confounders. Multiple imputation using chained equations was performed for missing covariate values as a sensitivity analysis. The definition of multimorbidity was also altered as an additional sensitivity analysis. RESULTS A total of 681 921 people were estimated to have multimorbidity in BC (16.9% of the population) in 2015/16. Vancouver (adj-OR = 0.65; 95% CI: 0.44-0.97) and Richmond (adj-OR = 0.55; 95% CI: 0.37-0.82) had much lower prevalence of multimorbidity than Fraser South (reference HSDA). Missing data analysis and sensitivity analysis showed results consistent with the main analysis. CONCLUSION Multimorbidity prevalence estimates varied across BC health regions, and were lowest in Vancouver and Richmond after controlling for multiple potential confounders. There is a need for provincial and regional multimorbidity care policy development and priority setting. In this context, the CCHS represents a valuable source of information for regional multimorbidity analyses in Canada.
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Affiliation(s)
- C Andrew Basham
- University of British Columbia, Vancouver, British Columbia, Canada
- Provincial TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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21
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Lavoie JG, Phillips-Beck W, Kinew KA, Katz A. Manitoba First Nation peoples' use of hospital-based mental health services: trends and solutions. Canadian Journal of Public Health 2020; 112:231-239. [PMID: 32720215 DOI: 10.17269/s41997-020-00328-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this article is to document patterns and trends of in-hospital mental health service use by First Nations (FN) living in rural and remote communities in the province of Manitoba. METHODS Our sample included all Manitoba residents eligible under the Manitoba Health Services Insurance Plan living on FN reserves and those living in rural and remote communities from 1986 to 2014. Using administrative claims data, we developed multi-level models that describe hospitalization for mental health conditions shown responsive to primary healthcare interventions. We aggregated the results by First Nation Tribal Councils and remoteness to derive rates of hospitalization episodes, length of stay and readmission rates. RESULTS Rates of hospitalization for mental health are increasing for FN males and females. This is particularly evident for those affiliated with the Island Lake and Keewatin Tribal Councils. The length of stay has increased. Changes in rates of readmissions were not statistically significant. FNs are admitted for mental health conditions at a younger age when compared with other Manitobans, and trends show that the FNs' average age at admission is decreasing. CONCLUSIONS Our results raise serious concerns about the responsiveness of community-based mental health services for FNs in Manitoba, because of both increasing rates of episodes of hospitalization and decreasing age of admission. Given the documented lack of mental health services accessible on-reserve, levels of social distress associated with a history of oppressive policies, and continued lack of infrastructure, current trends are alarming.
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Affiliation(s)
- Josée Gabrielle Lavoie
- Department of Community Health Science, University of Manitoba, Winnipeg, R3E 3P4, Canada. .,Ongomiizwin Research, 715 John Buhler Research Centre, University of Manitoba, Winnipeg, R3E 3P4, Canada.
| | | | - Kathi Avery Kinew
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.,Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Pollock NJ, Apok C, Concepcion T, Delgado RA, Rasmus S, Chatwood S, Collins PY. Global goals and suicide prevention in the Circumpolar North. Indian J Psychiatry 2020; 62:7-14. [PMID: 32001925 PMCID: PMC6964448 DOI: 10.4103/psychiatry.indianjpsychiatry_717_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/18/2019] [Indexed: 01/11/2023] Open
Abstract
The purpose of this selective narrative review is to provide an overview of suicide and suicide prevention in the Circumpolar North and the relevance of global strategies and policies to these themes. We conducted a selective review of the English language literature on Arctic Indigenous mental health, suicide, and suicide prevention. We briefly present the social context, epidemiology, and risk and protective factors for suicide in the Arctic, with a focus on Indigenous peoples. We highlight a recent collaborative, intergovernmental response to elevated suicide rates in this region, the Reducing the Incidence of Suicide in Indigenous Groups - Strengths United through Networks Initiative, which used a consensus methodology to identify key outcomes for evaluating suicide prevention interventions in the circumpolar context. In relation to the Sustainable Development Goals, we examine recent policy developments in Indigenous-led suicide prevention and identify opportunities for strengthening policy, community interventions, and research. Globally, suicide prevention is a public health priority, and reducing the number of suicide deaths is a key target for sustainable development. Although overall and country-specific suicide rates have decreased since 1990, there remains wide variation at the regional and local level. This is particularly evident in the Arctic region known as the Circumpolar North, where Indigenous peoples experience marked disparities in suicide risk and suicide deaths compared to non-Indigenous populations. The factors that influence these variations are complex and often rooted in the social and economic consequences of colonization. The integration of science, community-based and Indigenous knowledge, and policies that address upstream risks for suicide will play an important role in suicide prevention alongside the growing number of Indigenous suicide prevention strategies tailored for specific populations.
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Affiliation(s)
| | - Charlene Apok
- Indigenous Studies, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Roberto A Delgado
- Office of Polar Programs, National Science Foundation, Alexandria, Virginia, USA
| | - Stacy Rasmus
- Center for Alaska Native Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Susan Chatwood
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Pamela Y Collins
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Re-Thinking Ethics and Politics in Suicide Prevention: Bringing Narrative Ideas into Dialogue with Critical Suicide Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183236. [PMID: 31487801 PMCID: PMC6766026 DOI: 10.3390/ijerph16183236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 01/14/2023]
Abstract
The purpose of this paper is to explore the conviviality between practices of narrative therapy and the emerging field of critical suicide studies. Bringing together ideas from narrative therapy and critical suicide studies allows us to analyze current suicide prevention practices from a new vantage point and offers us the chance to consider how narrative therapy might be applied in new and different contexts, thus extending narrative therapy’s potential and possibilities. We expose some of the thin, singular, biomedical descriptions of the problem of suicide that are currently in circulation and attend to the potential effects on distressed persons, communities, and therapists/practitioners who are all operating under the influence of these dominant understandings. We identify some cracks in the dominant storyline to enable alternative descriptions and subjugated knowledges to emerge in order to bring our suicide prevention practices more into alignment with a de-colonizing, social justice orientation.
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