Abstract
BACKGROUND: Indigenous peoples in Canada have high rates of psychological distress and suicide. We sought to assess the socioeconomic inequalities in psychological distress and suicidal behaviours, and the factors that explain them within Indigenous peoples living off-reserve. METHODS: Using the nationally representative 2012 Aboriginal Peoples Survey collected from Indigenous adults living off-reserve in Canada, we measured income-related inequalities in psychological distress (measured on the 10-item Kessler Psychological Distress Scale) and suicidal behaviours (suicidal ideation and suicide attempt) and identified factors contributing to these inequalities using the concentration index (C) approach. RESULTS: Among 14410 individuals representing 600 750 Indigenous adults (aged ≥18 yr) living off-reserve in Canada, the mean score of psychological distress was 16.1; 19.4% reported lifetime suicidal ideation and 2.2% reported a lifetime suicide attempt. Women had higher psychological distress scores (mean score 16.7 v. 15.2, p < 0.001), and prevalence of suicidal ideation (21.9% v. 16.1%, p < 0.001) and suicide attempts (2.3% v. 2.0%, p = 0.002) than men. Poorer individuals disproportionately experienced higher psychological distress (C= –0.054, 95% confidence interval [CI] –0.057 to –0.050), suicidal ideation (Cn = –0.218, 95% CI –0.242 to –0.194) and suicide attempts (Cn = –0.327, 95% CI –0.391 to –0.263). Food insecurity and income, respectively, accounted for 40.2% and 13.7% of the psychological distress, 26.7% and 18.2% of the suicidal ideation and 13.4% and 7.8% of the suicide attempts concentrated among low-income Indigenous peoples. INTERPRETATION: Substantial income-related inequalities in psychological distress and suicidal behaviours exist among Indigenous peoples living off-reserve in Canada. Policies designed to address major contributing factors such as food insecurity and income may help reduce these inequalities.
| Original language | English |
|---|---|
| Pages (from-to) | E325-E336 |
| Journal | CMAJ |
| Volume | 191 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Mar 25 2019 |
Bibliographical note
Funding Information:The analyses presented in this paper were conducted at the Statistics Canada’s Atlantic Research Data Centre at Dalhousie University, which is part of the Canadian Research Data Centre Network. The authors thank the Canadian Research Data Centre Network for facilitating the access to the Aboriginal Peoples Survey and the Atlantic Research Data Centre analyst Heather Hobson for her support and assistance. The authors also thank participants at the 52nd Annual Conference of the Canadian Economics Association, the 12th European Conference on Health Economics and the 2018 Canadian Association for Health Services and Policy Research for their comments and suggestions. Funding for this research was provided by the Nova Scotia Health Research Foundation Establishment Grant program (grant no. 1017).
Funding Information:
Funding: Funding for this research was provided by the Nova Scotia Health Research Foundation Establishment Grant program (grant no. 1017).
Funding Information:
Competing interests: Mohammad Hajizadeh, Amy Bombay and Yukiko Asada report grants from the Nova Scotia Health Research Foundation.
Publisher Copyright:
© 2019 Joule Inc.
ASJC Scopus Subject Areas
- General Medicine
