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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2015 Sep 1;106(6):e375–e381. doi: 10.17269/CJPH.106.4923

Mental health and substance use in an urban First Nations population in Hamilton, Ontario

Michelle Firestone 17,✉, Janet Smylie 17,27, Sylvia Maracle 37, Constance McKnight 47, Michael Spiller 47,57, Patricia O’Campo 67
PMCID: PMC6972211  PMID: 26680428

Abstract

OBJECTIVES: Mental health and substance use have been identified as health priorities currently facing Indigenous peoples in Canada; however, accessible and culturally relevant population health data for this group are almost non-existent. The aim of the Our Health Counts study was to generate First Nations adult population health data in partnership with the De dwa da dehs ney>s Aboriginal Health Access Centre in Hamilton, Ontario.

METHODS: Analysis involved data gathered through respondent-driven sampling. Prevalence estimates and 95% confidence intervals were generated for diagnosis and treatment of a psychological disorder or mental illness, depression, anxiety, post-traumatic stress disorder (PTSD) and suicide, alcohol and substance use, and access to emotional support.

RESULTS: Of the 554 First Nations adults who participated in the Our Health Counts study in Hamilton, 42% had been told by a health care worker that they had a psychological and/or mental health disorder. High rates of depression (39%) and PTSD (34%), as well as suicide ideation (41%) and attempts (51%) were reported. Half of the sample reported marijuana use in the previous 12 months, and 19% reported the use of cocaine and opiates.

CONCLUSION: First Nations adults living in Hamilton experience a disproportionate burden of mental health and addictions. By working in partnership with urban Aboriginal organizations, it is possible to produce policy- and service-relevant data and address the current deficiency in appropriate mental health and substance use services for urban Aboriginal people.

Key Words: Canada, urban Aboriginal health, First Nations, community-based research, respondent driven sampling, mental health, substance use

Mots Clés: Canada, santé autochtone en milieu urbain, Premières Nations, recherche communautaire, échantillonnage en fonction des répondants, santé mentale, consommation de substances

Footnotes

Funding: This project was funded by the Ontario Federation of Indigenous Friendship Centres (OFIFC), the Ministry of Health and Long-Term Care (MOHLTC) Aboriginal Health Transition Fund, and the Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital. J. Smylie was supported by a Canadian Institutes of Health Research New Investigator in Knowledge Translation award during the course of the project. Conflict of Interest: None to declare.

References

  • 1.Loppie Reading C, Wien F. Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. Prince George, BC: National Collaborating Centre for Aboriginal Health; 2009. [Google Scholar]
  • 2.National Collaborating Centre for Aboriginal Health NCCAH. An Overview of Aboriginal Health in Canada. Prince George, BC: Author; 2013. [Google Scholar]
  • 3.Health Canada. A Statistical Profile on the Health of First Nations in Canada. Ottawa, ON: Author; 2002. [Google Scholar]
  • 4.IndianNorthern Affairs Canada. Report of the Royal Commission on Aboriginal Peoples (RCAP) Ottawa: Author; 1996. [Google Scholar]
  • 5.Statistics Canada. Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census. Ottawa: Ministry of Industry; 2008. [Google Scholar]
  • 6.Garner R, Carrière G, Sanmartin C. The Health of First Nations Living Off -Reserve, Inuit, and Métis Adults in Canada: The Impact of Socio-economic Status on Inequalities in Health. Ottawa: Statistics Canada, Health Analysis Division; 2010. Longitudinal Health and Administrative Data Research Team. [Google Scholar]
  • 7.Kirmayer LJ, Brass GM, Tait CL. The mental health of aboriginal peoples: Transformations of identity and community. Can J Psychiatry. 2000;45:607–16. doi: 10.1177/070674370004500702. [DOI] [PubMed] [Google Scholar]
  • 8.Smylie J, Anderson I, Ratima M, Crengle S, Anderson M. Who is measuring and why? Indigenous health performance measurement systems in Canada, Australia, and New Zealand. Lancet. 2006;367:2029–31. doi: 10.1016/S0140-6736(06)68893-4. [DOI] [PubMed] [Google Scholar]
  • 9.Kirmayer LJ, Tait CL, Simpson C. The mental health of aboriginal peoples in Canada: Transformations of identity and community. In: Kirmayer LJ, Valaskakis G, editors. Healing Traditions: The Mental Health of Aboriginal Peoples in Canada. Vancouver, BC: UBC Press; 2009. pp. 3–35. [Google Scholar]
  • 10.Dumont J. First Nations Regional Longitudinal Health Survey (RHS): Cultural Framework. Ottawa: The First Nations Information Governance Centre; 2005. [Google Scholar]
  • 11.Assembly of First Nations. First Nations Regional Longitudinal Health Survey (RHS) 2002/03: Results for Adult, Youth and Children Living in First Nations Communities. 2007. [Google Scholar]
  • 12.Tjepkema M. The Health of the Off-reserve Aboriginal Population. Statistics Canada: Supplement to Health Reports, vol. 13.; 2002. [Google Scholar]
  • 13.Statistics Canada. Canadian Community Health Survey. Ottawa: Author; 2007. [Google Scholar]
  • 14.Chandler MJ, Lalonde C. Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcult Psychiatry. 1998;35(2):191–219. doi: 10.1177/136346159803500202. [DOI] [Google Scholar]
  • 15.Chandler MJ, Lalonde C. Cultural continuity as a moderator of suicide risk among Canada’s First Nations. In: Kirmayer LJ, Valaskakis G, editors. Healing Traditions: The Mental Health of Aboriginal Peoples in Canada. Vancouver: UBC Press; 2009. pp. 221–48. [Google Scholar]
  • 16.Aboriginal Healing Foundation. Suicide Among Aboriginal People in Canada. Ottawa: Author; 2007. [Google Scholar]
  • 17.Health Canada. Unintentional and Intentional Injury Profile for Aboriginal People in Canada 1990-1999. Ottawa: Minister of Public Works and Government Services Canada; 2001. [Google Scholar]
  • 18.Fraser Health Authority. Fraser Region Aboriginal Youth Suicide Prevention Collaborative: Suicide Prevention, Intervention and Postvention Initiative. 2010. [Google Scholar]
  • 19.Estey MA, Smylie J, Macaulay AC. Aboriginal Knowledge Translation: Understanding and Respecting the Distinct Needs of Aboriginal Communities in Research. Ottawa: Canadian Institutes of Health Research; 2009. [Google Scholar]
  • 20.Vukic A, Rudderham S, Misener-Martin R. A community partnership to explore gaps in mental health services in First Nations communities in Nova Scotia. Can J Public Health. 2009;100(6):432–35. doi: 10.1007/BF03404339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Smye V, Mussell B. Aboriginal Mental Health: What Works Best. Vancouver: Mental Health Evaluation and Community Consultation Unit, UBC; 2001. [Google Scholar]
  • 22.Abdul-Quader A, Heckathorn D, Sabin K, Saidel T. Implementation and analysis of respondent driven sampling: Lessons from the field. J Urban Health. 2006;83(1):1–5. doi: 10.1007/s11524-006-9108-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Heckathorn D. Respondent-driven sampling II: Deriving valid population estimates from chain referral samples of hidden populations. Soc Probl. 2002;49(1):11–34. doi: 10.1525/sp.2002.49.1.11. [DOI] [Google Scholar]
  • 24.Heckathorn D, Seeman S, Broadhead R, Hugues J. Extensions of respondent driven sampling: A new approach to the study of injection drug users aged 18–25. AIDS Behav. 2002;6(1):55–67. doi: 10.1023/A:1014528612685. [DOI] [Google Scholar]
  • 25.Canadian Institutes of Health Research. CIHR Guidelines for Health Research Involving Aboriginal People. Ottawa: Author; 2007. [Google Scholar]
  • 26.Ball J, Janyst P. Enacting research ethics partnerships with Indigenous communities and Canada: “Do it in a good way”. J EmpirRes Hum Res Ethics. 2008;3(2):33–51. doi: 10.1525/jer.2008.3.2.33. [DOI] [PubMed] [Google Scholar]
  • 27.First Nations Centre. First Nations Conceptual Frameworks and Applied Models on Ethics, Privacy, and Consent in Health Research and Information. Ottawa: National Aboriginal Health Organization; 2006. [Google Scholar]
  • 28.Ontario Federation of Indian Friendship Centres. USAI Utility Self-Voicing Access Inter-relationality Reserach Framework, Toronto, ON. 2012. [Google Scholar]
  • 29.Smylie J, Firestone M, Cochran L, Prince C, Maracle S, Morley M, et al. Our Health Counts - Urban Aboriginal Health Database Research Project: Community Report. 2011. [Google Scholar]
  • 30.Firestone M., Smylie J., Maracle S., Spiller M., O'Campo P. Unmasking health determinants and health outcomes for urban First Nations using respondent-driven sampling. BMJ Open. 2014;4(7):e004978–e004978. doi: 10.1136/bmjopen-2014-004978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Statistics Canada. Hamilton, Ontario (Code3525005) (table). 2006 Community Profiles. 2006 Census. Ottawa: Author; 2007. [Google Scholar]
  • 32.Salganik MJ. Variance estimation, design effects, and sample size calculations for respondent-driven sampling. J Urban Health. 2006;83(6Suppl):98–112. doi: 10.1007/s11524-006-9106-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Firestone M, Smylie J, Maracle S, Siedule C, O’Campo P. Concept mapping: Application of a community-based methodology in three urban Aboriginal populations. Am Indian Cult Res J. 2014;38(4):85–104. doi: 10.17953/aicr.38.4.571154up25876h72. [DOI] [Google Scholar]
  • 34.IBM® SPSS® Data Collection Author [computer program]. Version 6.0.1. Chicago, IL: SPSS Inc., 2000.
  • 35.Kessler RC, Andrew G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32:959–76. doi: 10.1017/S0033291702006074. [DOI] [PubMed] [Google Scholar]
  • 36.Andrews G, Slade T. Interpreting scores on the Kessler Psychological Distress Scale. Aust N Z J Public Health. 2001;25(6):494–97. doi: 10.1111/j.1467-842X.2001.tb00310.x. [DOI] [PubMed] [Google Scholar]
  • 37.Slade T, Grove R, Burgess P. Kessler Psychological Distress Scale: Normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2011;45(4):308–16. doi: 10.3109/00048674.2010.543653. [DOI] [PubMed] [Google Scholar]
  • 38.Mitchell C, Beals J. The utility of the Kessler Screening Scale for Psychological Distress (K6) in two American Indian communities. Psychol Assess. 2011;23(3):752–61. doi: 10.1037/a0023288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Prins A, Ouimette P, Kimerling R, Camerond RP, Hugelshofer DS, Shaw-Hegwer J. The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Prim Care Psychiatry. 2003;9(1):9–14. doi: 10.1185/135525703125002360. [DOI] [Google Scholar]
  • 40.Statistics Canada. Aboriginal Peoples Survey 2006: Adults, Children and Youth. Ottawa: Author; 2006. [Google Scholar]
  • 41.The First Nations Information Governance Centre. First Nations Regional Health Survey (RHS) Phase 2 (2008/10) National Report on theAdult, Youth and Children Living in First Nations Communities. Ottawa: Author; 2012. [Google Scholar]
  • 42.Respondent-Driven Sampling Analysis Tool RDSAT Version 7.1 [computer program]. Ithaca, NY: Cornell University. 2007. [Google Scholar]
  • 43.Wejnert C. An empirical test of respondent-driven sampling: Point estimates, variance, degree measures, and out-of-equilibrium data. Soc Methodol. 2009;39(1):73–116. doi: 10.1111/j.1467-9531.2009.01216.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Anderson M, Smylie J. Performance measurement systems in Canada: How well do they perform in First Nations, Inuit and Métis contexts? Pimatisiwin. 2009;7(1):99–115. [PMC free article] [PubMed] [Google Scholar]
  • 45.Smylie J, Anderson M. Understanding the health of Indigenous peoples in Canada: Key methodologic and conceptual challenges. Can Med Assoc J. 2006;175(6):602–5. doi: 10.1503/cmaj.060940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Stolk Y, Kaplan I, Szwarc J. Clinical use of the Kessler Psychological Distress Scales with culturally diverse groups. Int J Methods in Psychiatric Res. 2014;23(2):161–83. doi: 10.1002/mpr.1426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Cunningham J, Paradies Y. Sociodemographic factors and psychological distress in Indigenous and non-Indigenous Australian adults aged 18–64 years: Analysis of national survey data. BMC Public Health. 2012;12(95):1–15. doi: 10.1186/1471-2458-12-95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Environics Institute. Urban Aboriginal Peoples Study Main Report. Toronto: Author; 2010. [Google Scholar]
  • 49.The First Nations Information Governance Centre. First Nations Regional Health Survey (RHS) Phase 2 (2008/10) National Report on the Adult, Youth and Children Living in First Nations Communities. Ottawa: Author; 2012. [Google Scholar]
  • 50.Battiste M. Introduction: Unfolding the lessons of colonization. In: Battiste M, editor. Reclaiming Indigenous Voice and Vision. Vancouver: UBC Press; 2000. pp. xvi–xxx. [Google Scholar]
  • 51.Waldram JB, Herring AD, Young TK. Aboriginal Health in Canada: Historical, Cultural and Epidemiological Perspectives. Toronto: University of Toronto Press; 2009. [Google Scholar]
  • 52.Bombay A, Matheson K, Anisman H. Intergenerational trauma: Convergence of multiple processes among First Nations peoples in Canada. J Aborig Health. 2009;5(3):6–47. [Google Scholar]
  • 53.Van Ameringen M, Mancini C, Patterson B, Boyle MH. Post-traumatic stress disorder in Canada. CNS Neurosci Ther. 2008;14(3):171–81. doi: 10.1111/j.1755-5949.2008.00049.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Menzies P. Intergenerational trauma from a mental health perspective. Native Soc Work J. 2010;7:63–85. [Google Scholar]
  • 55.Corrado RR, Cohen IM. Mental Health Profiles for a Sample of British Columbia’s Survivors of the Canadian Residential School System. Ottawa: Aboriginal Health Foundation; 2003. [Google Scholar]
  • 56.Ontario Federation of Indian Friendship Centres OFIFC . Urban Aboriginal Task Force Final Report. 2007. Ontario Métis Aboriginal Association, Ontario Native Women’s Association (ONWA) [Google Scholar]
  • 57.Anishnawbe Health Toronto. About Anishnawbe Health Toronto. 2010. [Google Scholar]
  • 58.Zahradnik M, Stewart SH, O’Connor RM, Stevens D, Ungar M, Wekerle C. Resilience moderates the relationship between exposure to violence and posttraumatic reexperiencing in mi’kmaq youth. Int J Ment Health Addict. 2010;8(2):408–20. doi: 10.1007/s11469-009-9228-y. [DOI] [Google Scholar]
  • 59.White RG, Lansky A, Goel S, Wilson D, Hladik W, Hakim A, et al. Respondent driven sampling - where we are and where should we be going? Sex Transm Dis. 2012;88(6):397–99. doi: 10.1136/sextrans-2012-050703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Gile KJ, Handcock MS. Respondent-driven sampling: An assessment of current methodology. Soc Methodol. 2010;40(1):285–327. doi: 10.1111/j.1467-9531.2010.01223.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Wejnert C, Pham H, Krishna N, Le B, DiNenno E. Estimating design effect and calculating sample size for respondent-driven sampling studies of injection drug users in the United States. AIDS Behav. 2012;16(4):797–806. doi: 10.1007/s10461-012-0147-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.City of Hamilton. Hamilton Homelessness Partnering Strategy Priority Development (2012-2014) 2011. [Google Scholar]

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