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Vance A, McGaw J, O'Meara A, Gone JP, Eades S. Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents. Aust N Z J Psychiatry 2024; 58:800-808. [PMID: 38642027 DOI: 10.1177/00048674241246441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people. METHODS A total of 132 Indigenous and 247 non-Indigenous young people aged 6-16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms. RESULTS The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms. CONCLUSIONS High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.
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Affiliation(s)
- Alasdair Vance
- Academic Child Psychiatry Unit and Developmental Neuropsychiatry Program, The Royal Children's Hospital, The University of Melbourne, Parkville, VIC, Australia
- Wadja Aboriginal Family Place, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Janet McGaw
- Faculty of Architecture, Building and Planning, The University of Melbourne, Parkville, VIC, Australia
| | - Angel O'Meara
- Wadja Aboriginal Family Place, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Joseph P Gone
- Department of Anthropology and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Sandra Eades
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, Parkville, VIC, Australia
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Engstrom T, Lobo EH, Watego K, Nelson C, Wang J, Wong H, Kim SL, Oh SI, Lawley M, Gorse AD, Ward J, Sullivan C. Indigenous data governance approaches applied in research using routinely collected health data: a scoping review. NPJ Digit Med 2024; 7:68. [PMID: 38491156 PMCID: PMC10943072 DOI: 10.1038/s41746-024-01070-3] [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: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Elton H Lobo
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Kristie Watego
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Jinxiang Wang
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Howard Wong
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sungkyung Linda Kim
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Soo In Oh
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | | | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Vance A, McGaw J, Winther J, White S, Gone JP, Eades S. Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescents. Aust N Z J Psychiatry 2023; 57:1538-1546. [PMID: 37480284 PMCID: PMC10666524 DOI: 10.1177/00048674231187315] [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] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way. METHODS A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups. RESULTS The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference. CONCLUSIONS It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed.
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Affiliation(s)
- Alasdair Vance
- Academic Child Psychiatry Unit and Developmental Neuropsychiatry Program, The Royal Children’s Hospital, The University of Melbourne, Parkville, VIC, Australia
- The Wadja Aboriginal Family Place, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Janet McGaw
- Faculty of Architecture, Building and Planning, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Winther
- Academic Child Psychiatry Unit and Developmental Neuropsychiatry Program, The Royal Children’s Hospital, The University of Melbourne, Parkville, VIC, Australia
- The Wadja Aboriginal Family Place, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Selena White
- The Wadja Aboriginal Family Place, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Joseph P Gone
- Department of Anthropology, Harvard University, Cambridge, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sandra Eades
- School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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Adane AA, Shepherd CCJ, Walker R, Bailey HD, Galbally M, Marriott R. Perinatal outcomes of Aboriginal women with mental health disorders. Aust N Z J Psychiatry 2023; 57:1331-1342. [PMID: 36927100 PMCID: PMC10517592 DOI: 10.1177/00048674231160986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. METHODS We used whole population-based linked data to conduct a retrospective cohort study (N = 38,592) using all Western Australia singleton Aboriginal births (1990-2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. RESULTS After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. CONCLUSIONS This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
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Affiliation(s)
- Akilew A Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Carrington CJ Shepherd
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Indigenous Studies, The University of Western Australia, Crawley, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Megan Galbally
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Clinical Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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Carlin E, Cox Z, Orazi K, Derry KL, Dudgeon P. Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1743. [PMID: 35162765 PMCID: PMC8835535 DOI: 10.3390/ijerph19031743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
The study aims to explore the role of mental health care in remote Aboriginal health services in the Kimberley region of Western Australia and provide a more nuanced understanding of the patients presenting for care, their needs, and the clinical response. Little is currently known about primary health care presentations for mental health, suicide, and self-harm for remote dwelling Aboriginal residents of the Kimberley region, despite high rates of psychological distress, self-harm, and suicide across the area. This study was progressed through a retrospective, cross-sectional audit of the electronic medical records system used by three remote clinics to explore the interactions recorded by the clinics about a patient's mental health. In addition, an in-depth file review was conducted on a stratified purposive sample of 30 patients identified through the audit. Mental ill-health and psychological distress were found to be prominent within clinical presentations. Psychosocial factors were frequently identified in relation to a patient's mental health presentation. Optimizing patients' recovery and wellness through service improvements, including an enhanced mental health model of care, is an important next step.
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Affiliation(s)
- Emma Carlin
- Kimberley Aboriginal Medical Services, Broome, WA 6725, Australia;
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA 6725, Australia;
| | - Zaccariah Cox
- Kimberley Aboriginal Medical Services, Broome, WA 6725, Australia;
| | - Kristen Orazi
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA 6725, Australia;
| | - Kate L. Derry
- School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia; (K.L.D.); (P.D.)
| | - Pat Dudgeon
- School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia; (K.L.D.); (P.D.)
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Risk and resilience: a mixed methods investigation of Aboriginal Australian women's perinatal mental health screening assessments. Soc Psychiatry Psychiatr Epidemiol 2021; 56:547-557. [PMID: 33226453 PMCID: PMC8053144 DOI: 10.1007/s00127-020-01986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women's Kimberley Mum's Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. METHODS We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into 'risk' and 'protective' factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. RESULTS Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11-33% high vs 61-100% no risk) and more commonly had risk factors (22-67% high vs 6-28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. CONCLUSION Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.
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