Off-Reserve First Nations Teens Face Mental Health Challenges

First Nations adolescents living off reserve in Ontario, Canada, have significantly higher levels of mental health challenges, compared with their non–First Nations peers.

These mental health challenges are exacerbated by maternal distress, according to a report published online February 24 in Child Psychiatry and Human Development.

"Prior to this study, we didn't have a comprehensive understanding of the levels of mental health challenges that First Nations youth living off reserve may face," first author Sawayra Owais, an MD/PhD candidate at McMaster University in Hamilton, Ontario, told Medscape Medical News.

"Now, with this study that used data from a provincially representative survey, we found that First Nations youth living off reserve have a higher level of symptoms across many mental health challenges," Owais said.

Those challenges include conduct disorder (CD), oppositional-defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), social phobia (SP), generalized anxiety disorder (GAD), and separation anxiety disorder (SAD).

One Term, Many Peoples

"First Nations" is a broad term used to represent a group of indigenous peoples from over 600 diverse communities in Canada. They are the most populous indigenous group in Canada, followed in number by the Métis, whose ancestry consists of a mix of First Nations and European peoples, and Inuit, who live in the Arctic, Owais explained. The First Nations have different histories, languages, and cultures, but all share the history of European colonization.

Using data from the 2014 Ontario Child Health Study (OCHS), a large, representative sample of adolescents and their families, the researchers compared levels of common mental health challenges among 112 off-reserve First Nations teens and 3334 non–First Nations teens aged 12 to 17 years. The researchers also examined how maternal distress could affect these difficulties.

The adolescents reported their levels of mental health challenges using the OCHS–Emotional Behavioral Scales, which assessed symptoms of common DSM-5 disorders, including CD, ODD, ADHD, MDD, SP, GAD, and SAD.

Mothers reported levels of distress using the Kessler Psychological Distress Scale–6. The K6 is used to measure a person's emotional state in the past 30 days.

Being of adolescent age; sex; maternal long-term health conditions; household income; and current maternal distress were covariates the researchers included to account for social and environmental factors that may be associated with adolescent mental health challenges.

"Culturally Relevant Programming" Needed

Compared with the non–First Nations mothers, the First Nations mothers were more likely to be single, have long-term health conditions, and complete fewer years of formal education.

First Nations adolescents had higher levels of symptoms of all mental health challenges, compared with non–First Nations peers. In unadjusted analyses, the scores of the First Nations adolescents were statistically significantly higher for CD (β = 0.16, P < .001), ODD (β = 0.11, P < .001), ADHD (β = 0.10, P < .001), MDD (β = 0.10, P < .001), SP (β = 0.08, P < .001), GAD (β = 0.05, P = .001), and SAD (β = 0.05, P = .002).

These scores remained statistically significantly higher after controlling for variables.

"I hope this paper motivates and guides healthcare providers and policymakers to develop culturally relevant programming and interventions that are effective, that are evidence-based, so we can continue to promote the well-being of First Nations youth and their families," Oswais said.

Small Sample Size

"As Owais and colleagues themselves note, their study reconfirms the many studies outlining the deficits and disorders that can be measured among some First Nations, Inuit, and Métis communities living in Canada — in this case, off-reserve First Nations adolescents living in Ontario," Allison Crawford, PhD, psychiatrist at the Centre for Addiction and Mental Health and professor of psychiatry at the University of Toronto, Ontario, told Medscape Medical News.

Crawford, who was not involved in the study, is also a Fulbright Research Chair at the Center for American Indian Health at Johns Hopkins University in Baltimore, Maryland. "The study is novel in being able to link adolescent mental health with maternal well-being, although the sample size, as they acknowledge, is small, and care should be taken generalizing the results," she added.

Crawford also noted that the connection of the authors to the First Nations youth they research is not clear, nor do the researchers discuss First Nations data governance. "This is likely because these youth and their families are living off reserve, but I can't help but wonder if the results would have been contextualized differently with greater community engagement in their interpretation," she said.

Previous research, for example, highlights the harmful effects of centering psychological disorder and historical trauma. Researchers have proposed an Indigenous Connectedness Framework in which relationality is much more broadly defined than maternal–child relations to include familial, intergenerational, community, and environmental connectedness, Crawford said.

"The authors do acknowledge 'the historical and ongoing colonial policies that have resulted in structural disadvantages for indigenous peoples living in Canada, including First Nations individuals,' and they list 'discriminatory child apprehension and assimilation policies' as contextual factors in which their findings must be understood," she continued.

The researchers call for future work exploring potential community-based interventions and measuring risk and resilience within a framework of indigenous-specific determinants of health. "I only hope that future is not too long in coming," said Crawford.

"I hope that this study can be used to deepen our understanding of the need to pursue the kinds of support for First Nations youth living off reserve, as well as their families, that could support more equitable health outcomes," Sarah Newbery, MD, a family doctor in Marathon, Ontario, told Medscape Medical News.

"From a clinical practice standpoint, we have certainly seen an increase in the need for mental health supports for youth during the pandemic," added Newbery, who was not involved in the study. "Given that the study used data from 2014, I would expect that the need for the kinds of supports identified in the study is even greater now."

The study received no outside funding. Owais, Crawford, and Newbery reported no relevant financial relationships.

Child Psychiatry Hum Dev. Published online February 24, 2022. Full text

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