Dickson, M.J., Cruise, K., McCall, A.C., Taylor, J.P. (2019). A systematic review of the antecedents and prevalence of suicide, self-harm and suicide ideation in Australian Aboriginal and Torres Strait Islander youth. International Journal of Environmental Research and Public Health, 16(17).
Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.
Lopez-Carmen, V., McCalman, J., Benveniste, T., Askew, D., Spurling, G., Langham, E., & Bainbridge, R. (2019). Working together to improve the mental health of Indigenous children: A systematic review. Children and Youth Services Review, 104, 104408.
This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools. Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among thenine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity. Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.
Macedo, D., Smithers, L., Roberts, R., Haag, D., Paradies, Y., & Jamieson, L. (2019). Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children? PLoS ONE, 14(8), e0220744.
Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RR) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RR 2.53, 95% CI 1.17, 5.48), conduct problems (RR 2.35, 95% CI 1.07, 5.15), and total difficulties (RR 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RR 1.66, 95% CI 0.78, 3.52). Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.
Macedo, D., Smithers, L., Roberts, R., Paradies, Y., & Jamieson, L. (2019). Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. International Journal for Equity in Health, 18(1), 132.
Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis. Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73). Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.
Moss, M. & Duwun Lee, A. (2019). TeaH (turn ‘em around healing): A therapeutic model for working with traumatised children on Aboriginal communities. Children Australia, 44(2), 55-59.
Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.
Wright, M., Culbong, T., Crisp, N., Biedermann, B., & Lin, A. (2019). “If you don’t speak from the heart, the young mob aren’t going to listen at all”: An invitation for youth mental health services to engage in new ways of working. Early Intervention in Psychiatry, 1-7.
Aim: Aboriginal and Torres Strait Islander young people are more likely to experience mental health issues or end their life by suicide than non-Aboriginal youth, but are less likely to access mental health services for support. Systemic change is required if mainstream youth mental health services are to be relevant and culturally secure for Aboriginal and Torres Strait Islander young people. Methods: Building Bridges (2017-2019) is a three-year participatory action research project being conducted in partnership with the Nyoongar community and three main-stream youth mental health services in Perth, Western Australia. The project involves Nyoongar Elders and Aboriginal and Torres Strait Islander young people working directly with senior management and key staff of youth mental health services to co-design, implement and evaluate a framework for systems change. The aim of the project is to increase Aboriginal and Torres Strait Islander young people’s engagement with services and improve mental health outcomes for young people and their families. Results: This paper outlines the engagement process that underpinned the first phase of the project. Our research methods are premised by an investment in establishing safe spaces for the Elders, young people and service staff to engage in open, honest dialogue. We present two key activities that illustrate this process of building trust and deepening understanding, namely: spending time “On Country” and engaging in a “storying” process. Conclusions: Building Bridges demonstrates the centrality of trusting relationships for systemic change and the way in which meaningful engagement is at the core of both the process and the outcome.