First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

THE ASSOCIATION BETWEEN MEDITERRANEAN DIET ADHERENCE AND ALLOSTATIC LOAD IN OLDER ADULTS

Allostatic load (AL) is a multisystemic index of biological wear and tear which is associated with poor health outcomes. In recent years, researchers have examined the association between dietary pattern intake and AL; however, no studies to date have examined the relationship between AL and consumption of a Mediterranean diet. Blood and urine samples were collected from 201 community-dwelling older adults who completed a Food Frequency Questionnaire (FFQ). A Mediterranean Diet Score (MDS) was calculated based on previous recommendations and a sex-based AL index was calculated using a count-based approach for 16 biomarkers associated with neuroendocrine, immune, cardiovascular, or metabolic function. It was hypothesized that a higher MDS would associate with lower AL, and that this association would be particularly robust for the immune and metabolic subcomponents of the AL index. In support of the study hypotheses, generalized linear models revealed a significant inverse relationship between MDS and AL (ß = -0.03, P = 0.037). Furthermore, higher MDS was significantly associated with lower immune (ß = -0.06, P = 0.38) and metabolic (ß = -0.05, P = 0.039) subsystem scores, but was not associated with cardiovascular or neuroendocrine subsystem scores. Exploratory analyses further showed that the association was more robust in male than female participants. The current findings are interpreted with caution given the study design and sample characteristics. However, these findings contribute to the literature supporting the Mediterranean diet as an important lifestyle behavior that may support healthy aging.

The association between Mediterranean diet adherence and allostatic load in older adults

Allostatic load (AL) is a multisystemic index of biological wear and tear which is associated with poor health outcomes. In recent years, researchers have examined the association between dietary pattern intake and AL; however, no studies to date have examined the relationship between AL and consumption of a Mediterranean diet. Blood and urine samples were collected from 201 community-dwelling older adults who completed a Food Frequency Questionnaire (FFQ). A Mediterranean Diet Score (MDS) was calculated based on previous recommendations and a sex-based AL index was calculated using a count-based approach for 16 biomarkers associated with neuroendocrine, immune, cardiovascular, or metabolic function. It was hypothesized that a higher MDS would be associated with lower AL, and that this association would be particularly robust for the immune and metabolic subcomponents of the AL index. In support of the primary study hypotheses, generalized linear models revealed a significant inverse relationship between MDS and AL (ß = -0.03, P = 0.037). However, subcomponents of the AL model were not significantly associated with MDS. Exploratory sub-group analyses by sex suggested that the association between AL and MDS was more robust in male than in female participants. The current findings are interpreted with caution given the study design and sample characteristics. Nonetheless, these findings contribute to the literature supporting the Mediterranean diet as an important lifestyle behavior that may minimize AL, and therefore support healthy aging.