Abstract
OBJECTIVES: Following the onset of intensive colonial intervention and rapid social change in the lives of Inuit people, youth in Nunavik have experienced high rates of mental health problems and suicide. Inuit people describe a broad range of contextual influences on mental wellness based on lived experience, but most epidemiological studies have focused on individual risk factors and pathologies. This study aimed to assess the influence of multiple determinants of mental wellness among Inuit youth in Nunavik, including culturally meaningful activities, housing and community social characteristics.
METHODS: Mental wellness was measured in the form of two primary outcomes: self-esteem and suicidal ideation. Using cross-sectional data from the 2004 Nunavik Inuit Health Survey and multilevel regression modelling, we estimated associations between these two outcomes and various independent individual- and community-level explanatory factors among Inuit youth. All variables were selected to reflect Inuit perspectives on determinants of mental wellness. The study design and interpretation of results were validated with Inuit community representatives.
RESULTS: Pride in Inuit identity, traditional activities, community-level social support and community-level socio-economic status were found to be protective. Barriers to participating in traditional activities, household crowding and high community rates of violence were risk factors.
CONCLUSION: These findings support Inuit perspectives, expand the scope of epidemiological analysis of Inuit mental wellness and reinforce the need for locally informed, community-wide approaches to mental wellness promotion for Inuit youth.
Key Words: Community psychiatry, Inuits, mental health, multilevel analysis, social conditions, social determinants of health
Résumé
OBJECTIFS : Après une intervention coloniale intensive et le changement social rapide de la vie des Inuits, les jeunes du Nunavik affichent des taux élevés de troubles de santé mentale et de suicide. Les Inuits décrivent un vaste éventail d’influences contextuelles sur leur bien-être mental d’après leur vécu, mais la plupart des études épidémiologiques mettent l’accent sur les facteurs de risque et les pathologies individuels. Dans notre étude, nous avons cherché à évaluer l’influence de plusieurs déterminants du bien-être mental chez les jeunes inuits du Nunavik: les activités culturellement significatives, le logement et les caractéristiques sociales de la communauté.
MÉTHODE : Nous avons mesuré le bien-être mental selon deux effets principaux: l’estime de soi et l’idéation suicidaire. À l’aide de données transversales de l’Enquête de santé auprès des Inuits du Nunavik de 2004 et d’un modèle de régression multiniveaux, nous avons estimé les associations entre ces deux effets et divers facteurs explicatifs individuels et collectifs indépendants chez les jeunes inuits. Les variables ont été sélectionnées pour refléter les perspectives inuites des déterminants du bien-être mental. Le protocole d’étude et l’interprétation des résultats ont été validés auprès de représentants des communautés inuites.
RÉSULTATS : La fierté liée à l’identité inuite, les activités traditionnelles, le soutien social communautaire et le statut socioéconomique communautaire sont des facteurs de protection. Les obstacles à la participation aux activités traditionnelles, les logements surpeuplés et les taux élevés de violence dans la communauté sont des facteurs de risque.
CONCLUSION : Ces constatations confirment les perspectives des Inuits, élargissent le périmètre de l’analyse épidémiologique du bien-être mental chez les Inuits et soulignent le besoin d’approches communautaires éclairées par les données locales pour favoriser le bien-être mental des jeunes inuits.
Mots Clés: psychiatrie communautaire, Inuits, santé mentale, analyse multiniveaux, conditions sociales, déterminants sociaux de la santé
Footnotes
Acknowledgements: We thank the people of Nunavik, particularly the Mental Health Promotion and Prevention Working Group of the Nunavik Regional Board of Health and Social Services, for invaluable insights regarding interpretation and recommendations; all those who planned, carried out or participated in the 2004 Nunavik Inuit Health Survey; and all those who work hard every day to support the wellness of the communities of Nunavik. We also thank Véronique Paradis and Isabelle Duguay, who provided helpful feedback on the article. AG and FR were supported by the Nunavik Regional Board of Health and Social Services to travel to Nunavik for meetings with community representatives. SH was supported by a Chercheurboursier Junior 2 award from the Fonds de recherche du Québec-Santé.
Conflict of Interest: None to declare.
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