Abstract
OBJECTIVES: To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender.
METHODS: As a component of a community-based participatory research project, a cross-sectional, interviewer-administered survey of 874 adults living on 2 Cree First Nation reserves in rural north-central Saskatchewan was conducted during May–August in 2012 and 2013. Self-reported, health-provider diagnosis of depression was the dependent variable and experiences of interpersonal racial discrimination was the primary exposure. Chi-square and multiple logistic regression were the main analytic techniques. Generalized estimating equations were applied to account for clustering within households.
RESULTS: Overall, 64% of participants reported being treated unfairly in 1 or more situations because of their ethnicity; 38% indicated discrimination occurring in 3 or more situations. Nineteen percent reported a diagnosis of depression. Adjusted analyses indicated that compared to those with no experience of racial discrimination, those reporting 1–2 and 3 or more situations were 1.77 times (95% CI: 1.06–2.95) and 1.91 times (95% CI: 1.19–3.04) more likely to have diagnosed depression respectively. The relationship between racial discrimination and depression was not modified by gender, although women were 1.85 times (95% CI: 1.24–2.76) more likely to report depression than men.
CONCLUSION: Interpersonal racial discrimination was associated with depression among First Nations women and men in rural Saskatchewan. Research directed at identifying the most efficacious interventions, programs and policies to combat racism is required to advance the goal of health equity.
Key words: Racial discrimination, First Nations, depression
Résumé
OBJECTIFS: Déterminer, chez les membres des Premières Nations de la Saskatchewan vivant dans des réserves en zone rurale, si la discrimination raciale est associée à la dépression et si, en retour, cette relation est modulée par le sexe.
MÉTHODE: Dans le cadre d’un projet de recherche participative communautaire, nous avons mené une enquête transversale administrée par un intervieweur auprès de 874 adultes vivant dans deux réserves de la Première Nation crie dans le centre-nord rural de la Saskatchewan entre mai et août en 2012 et en 2013. La variable dépendante était un diagnostic de dépression autodéclaré posé par un dispensateur de soins de santé, et l’exposition directe était l’expérience de la discrimination raciale interpersonnelle. Nos principales techniques étaient l’analyse du khi-carré et l’analyse de régression logistique multiple. Nous avons appliqué des équations d’estimation généralisées pour tenir compte des regroupements au sein des ménages.
RÉSULTATS: Dans l’ensemble, 64 % des participants ont déclaré avoir été traités injustement dans une situation ou plus en raison de leur ethnicité; 38 % ont fait état de discrimination dans trois situations ou plus. Dix-neuf p. cent ont dit avoir un diagnostic de dépression. Les analyses ajustées ont indiqué que comparativement aux répondants n’ayant aucune expérience de discrimination raciale, ceux qui ont déclaré une ou deux situations et trois situations ou plus étaient 1,77 fois (IC de 95 %: 1,06–2,95) et 1,91 fois (IC de 95 %: 1,19–3,04) plus susceptibles d’avoir un diagnostic de dépression, respectivement. La relation entre la discrimination raciale et la dépression n’était pas modulée par le sexe, mais les femmes étaient 1,85 fois (IC de 95 %: 1,24–2,76) plus susceptibles de déclarer un diagnostic de dépression que les hommes.
CONCLUSION: La discrimination raciale interpersonnelle était associée à la dépression chez les femmes et les hommes des Premières nations vivant en zone rurale en Saskatchewan. Pour atteindre l’objectif de l’équité en santé, il faut faire de la recherche pour déterminer quels sont les interventions, les programmes et les politiques les plus efficaces pour combattre le racisme.
Mots clés: discrimination raciale, Premières Nations, dépression
Footnotes
Acknowledgements: This study was funded by a grant from the Canadian Institutes of Health Research “Assess, Redress, Re-assess: Addressing Disparities in Respiratory Health among First Nations People”, CIHR MOP-246983-ABH-CCAA-11829. We are grateful for the contributions of all the participants who donated their time to complete and return the survey. Co-Principal Investigators of the First Nations Lung Health Project: Punam Pahwa, Sylvia Abonyi, Jo-Ann Episkenew and James A. Dosman.
Conflict of Interest: None to declare.
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