https://doi.org/10.9778/cmajo.20200177

Indigenous people around the globe have suffered from the impacts of colonization to various extents and often share similar historical and ongoing collective adversities that negatively affect well-being.1^,2 Of particular concern is the disproportionate burden of mental health issues among Indigenous people.3^–5 A growing number of studies demonstrate the extent of inequality in physical health and mental health between non-Indigenous and Indigenous populations. 6^–10 For example, just under one-quarter of Inuit (23.5%) and First Nations adults living off-reserve (24.0%) and 1 in 5 Métis (19.6%) reported lifetime suicidal ideation, compared with just over 1 in 10 non-Indigenous adults.11 Furthermore, a recent study12 shows inequalities in mental health outcomes within Indigenous populations in Canada.

To assist effective policy-making based on the emerging evidence of the extent of inequalities, it is critical to understand what explains these inequalities. Recent studies12^,13 highlighted the importance of social determinants of health in inequalities in health and mental health outcomes within Indigenous populations in Canada. These studies show, for example, that policies designed to address food insecurity may help reduce mental health issues among Indigenous people living off-reserve in Canada. Our study objective was to quantify the extent of, and explain various demographic, socioeconomic and geographical factors that account for, inequalities in psychological distress, suicidal ideation and suicide plans between non-Indigenous and Indigenous populations living off-reserve in Canada.

https://doi.org/10.1503/cmaj.181374

Worldwide, Indigenous populations have high rates of suicide and psychological distress, the latter characterized by psychological and physiologic symptoms of anxiety and depression.1^–3 Suicide is a major cause of death among First Nations, Métis and Inuit peoples,4 the 3 distinct Indigenous groups in Canada. Suicide rates among Indigenous peoples, when considered collectively, are 2 to 3 times higher than among non-Indigenous Canadians.5 Rates of suicide and distress vary considerably across the Indigenous groups. During the period between 1991 and 2001, the Indigenous to non-Indigenous suicide mortality rate ratio was 1.60 for Métis men, 0.85 for Métis women, 1.66 for status First Nations men and 1.86 for status First Nations women.6 Suicide rates among the Inuit, which are among the highest in the world, are up to 10 times higher than the overall rate for Canada.5^,7^,8 Suicide led to life expectancy losses of 4.8 years for men and 1.2 years for women in Inuit Nunangat in 1999–2003.9 Suicide rates are higher among First Nations peoples living on-reserve than among Indigenous peoples living off-reserve. 10 The rate ratios for potential years of life lost owing to suicide among status First Nation men living on- and off-reserve compared with non-Indigenous men (women) were 2.88 (3.71) and 1.11 (0.76), respectively.11 Furthermore, except for Métis men, suicidal thoughts among Indigenous peoples are more common than among non-Indigenous Canadians.12

Historical and ongoing experiences associated with colonization accompanied by inequities in income, employment opportunities, housing and food security, among other factors, have resulted in pervasive health problems among Indigenous peoples.4^,13^–21 Indigenous populations have the poorest health outcomes in Canada, often similar to those of populations in developing countries.18

Income has been shown to be a main determinant of health among both Indigenous22 and the general Canadian populations. 23 Recent evidence points to a particularly strong income-related gradient in mental health outcomes compared with most other health outcomes.24 The role of income may be especially important given persistently lower incomes among Indigenous populations compared with non-Indigenous populations, with a gap of 25% in 2015 and little improvement since 2005.25 There is scant literature on socioeconomic inequalities in mental health within Indigenous peoples in Canada, despite considerable variations in collective histories, present-day circumstances and cultures.

Using data from the 2012 Aboriginal Peoples Survey, we quantified the extent of and factors accounting for income-related inequalities in psychological distress and suicidal behaviours among status First Nations, non-status First Nations, Métis and Inuit peoples living off-reserve in Canada.

https://doi.org/10.1016/j.healthpol.2018.06.011

https://doi.org/10.1016/S2215-0366(15)00352-1

Indigenous people worldwide are likely to share collective experiences of being exploited, marginalised, disenfranchised from lands, and having had their cultures attacked. In several countries—including Canada, the USA, and Australia—Indigenous children were targets of abusive and violent assimilation tactics. In Canada, this tactic was based on the rationale that as children, Indigenous people would be particularly suitable for “complete transformation”. To this end, the government’s policy of forcibly removing Indigenous children from their parents to attend church-run residential schools was implemented in the mid-1800s. In addition to the trauma of being taken from their communities, these children experienced chronic neglect and many experienced various forms of abuse. More than 4000 children died, and observational nutritional studies were done to note the effects of malnutrition and starvation. These schools operated during several generations until the 1990s, and coincided with many other forms of government imposed control. On the basis of a representative sample of adults living in First Nations’ communities (the largest of Canada’s three distinct Aboriginal groups [First Nations, Métis, and Inuit]) in Canada during 2008–10, 20% reported having attended one of these residential schools, 52·5% had at least one parent who attended, and 46·2% had one or more grandparents who were survivors.