Search

Objective: The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people. Methods: A total of 132 Indigenous and 247 non-Indigenous young people aged 6–16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms. Results: The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms. Conclusions: High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity. [ABSTRACT FROM AUTHOR]

Over the past two decades researchers have been exploring new hybrid methodologies to decolonise Indigenous mental health research. Grounded Theory with Community Participatory Action Research (CPAR), often using Indigenist methods, is the most common. Grounded Theory's claim to rigour is its transparent, organised process of sifting and theme finding, while CPAR respects Indigenous self-determination and Indigenous ways of knowing doing and being, involving Indigenous research participants in all stages of the research from data collection to analysis. On the surface it would seem to be the ideal methodological approach to navigate the cultural divide. However, this article will argue that Grounded Theory's inherent weakness is in the process of thematic analysis, which uses consensus during the analysis phase to find dominant themes. Drawing on the social systems theory of Niklas Luhmann and the political theory of Chantal Mouffe, this article will argue for a group process of "agonistic pluralism" instead. Searching for shared truths has a tendency to smooth out differences. The article proposes an approach for configuring a research team and conducting team analysis that struggles with, and accounts for, dissonances, disagreements and differences. Furthermore, it argues these differences should be recorded as important findings along with agreed themes. The approach has been developed to explore community perspectives on the relationship between culture and health, and in turn, to develop culturally appropriate mental health therapies for First Nations young people within a Western paediatric hospital. [ABSTRACT FROM AUTHOR]

Objective: Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way. Methods: A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups. Results: The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference. Conclusions: It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed. [ABSTRACT FROM AUTHOR]

Objective: Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. Methods: In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6–16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. Results: Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14–7.69) among the First Nations compared to the non-First Nations clinical group. Conclusion: Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured. [ABSTRACT FROM AUTHOR]

The extant literature has scant detail about everyday spiritual practices that aid Indigenous young people. This paper systematically explores Indigenous Spirituality, health, and well-being through Elder-governed yarns conducted via Zoom with 44 Aboriginal Elders, Healers, and Senior and Junior people involved in health and well-being of the Victorian Aboriginal community. These yarns were analyzed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Key findings are that Spirituality is crucial for health and well-being, leading to a clear mind and at-peace “center” in a person. Aboriginal spiritual practices reflect the unique characteristics and essential rhythms of Country. Spiritual development is incremental and increases the obligations and responsibilities a person has to community and Country and leads to increased caring for Country. This paper provides rich detail about practical spiritual techniques to aid Indigenous young people and their kinship networks. It has the potential to shape future policy. [ABSTRACT FROM AUTHOR]

A 10-year review of the 2008 Council of Australian Governments’ (COAG) Close the Gap Strategy identified the lack of involvement of Indigenous people in developing policies as a key reason health disparities persist. It also posits that disconnection from Country and culture have been crucial factors. Physical and mental health cannot be separated from spiritual health and well-being amongst Indigenous Australians. This article describes the co-development of a cultural enrichment research study with Indigenous Elders, health service leaders, and community members that places culture at the centre of care to augment traditional Western mental health management. The study has been overseen and nurtured from its inception by a governance board of Traditional Custodian Elders and an Advisory Group of Indigenous health workers. Qualitative data were collected through community ‘zoom-yarns’ between an Indigenous research assistant and 44 community members during COVID-19 lockdowns. These yarns were analysed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Findings have led to an Elder-governed adjuvant cultural therapy which is currently being trialled and will be evaluated using the same multi-perspectival discursive grounded theory research methodology. One third of all Indigenous Australians now live in capital cities, so developing models to bring culture and Country into urban health facilities are becoming increasingly important. The Indigenous-led research approach outlined in this paper suggests a model for engaging Indigenous communities that mainly distrust Western research and have been failed by Western mental health care. It has the potential to shape future policy. [ABSTRACT FROM AUTHOR]

Objective: Recently, Indigenous academics have evolved an Indigenist discourse that centralises Indigenous 'ways of knowing, being and doing'. Through this dialogue, Indigenous 'ways of knowing and being' augment Western biopsychosocial treatments.Methods: This paper outlines the authors' clinical encounters with young people from the Koori community and ongoing consultation with Koori community Elders in Victoria that led to engaging young people and their families in an Indigenist dialogue.Results: The Indigenist dialogue facilitates deeper engagement in the therapeutic process, opportunities to mirror and reflect on young people's experiences, and drawing parallels between Western health interventions and Aboriginal cultural ways of doing health and being healthy.Conclusions: The young people and their families evince greater faith in the management process and a deeper focus, centred awareness and knowledge of their Cultural rights and responsibilities. Future developments should include a systematic database with qualitative and quantitative data to support its evaluation and iterative development and improved community engagement to ensure holistic health gains are maintained. [ABSTRACT FROM AUTHOR]