Income-Related Inequities in Primary and Specialist Care Among First Nations Peoples Living Off-Reserve in Canada.

BACKGROUND: Improving equity in healthcare is a primary goal of health policy in Canada. Although the investigation of equity in healthcare utilization is common in the general population, little research has been conducted to assess equity in healthcare utilization within First Nations peoples living in Canada. OBJECTIVE: To examine income-related inequities in primary care (family doctor/general practitioner and nurse practitioner care) and specialist care within status and non-status First Nations adults living off-reserve. METHODS: Using the 2017 Aboriginal Peoples Survey (APS), a nationally representative survey of Indigenous peoples living off-reserve in Canada, we analyzed income-related inequities in healthcare among Indigenous adults (>18 years) who self-identified as a member of any First Nations group in Canada. Logistic regression analysis was performed to identify factors associated with the utilization of primary and specialist care. The Horizontal Inequity index (HI), which measures unequal healthcare use by income for equal need, was used to quantify and decompose income-related inequities for primary and specialist care for status and non-status, and total First Nations groups. RESULTS: The regression results revealed higher primary and specialist care use among females, high socioeconomic status (high income and more educated) and status First Nations peoples in Canada. The positive values of the HI suggested a higher concentration of primary care and specialist care utilization among higher income First Nations peoples after adjusting for healthcare need. These pro-rich inequities persisted for the total First Nations populations, and for those in each status group individually. The decomposition results suggested observed inequities in both primary and specialist care among First Nations peoples can be predominantly attributed to the unequal distribution of education and income. CONCLUSION: Although primary and specialist services in Canada are free at the point of the provision, we found pro-rich inequities in healthcare use among First Nations adults living off-reserve in Canada. These results warrant policies and initiatives to address barriers to healthcare use within and outside health system among low-income First Nations peoples living off-reserve.

Beliefs around the causes of inequities and intergroup attitudes among health professional students before and after a course related to Indigenous Peoples and colonialism.

BACKGROUND: Addressing the Truth and Reconciliation Calls to Action on including anti-racism and cultural competency education is acknowledged within many health professional programs. However, little is known about the effects of a course related to Indigenous Peoples and colonialism on learners' beliefs about the causes of inequities and intergroup attitudes. METHODS: A total of 335 learners across three course cohorts (in 2019, 2020, 2022) of health professional programs (e.g., Dentistry/Dental Hygiene, Medicine, Nursing, and Pharmacy) at a Canadian university completed a survey prior to and 3 months following an educational intervention. The survey assessed gender, age, cultural identity, political ideology, and health professional program along with learners' causal beliefs, blaming attitudes, support for social action and perceived professional responsibility to address inequities. Pre-post changes were assessed using mixed measures (Cohort x Time of measurement) analyses of variance, and demographic predictors of change were determined using multiple regression analyses. Pearson correlations were conducted to assess the relationship between the main outcome variables. RESULTS: Only one cohort of learners reported change following the intervention, indicating greater awareness of the effects of historical aspects of colonialism on Indigenous Peoples inequities, but unexpectedly, expressed stronger blaming attitudes and less support for government social action and policy at the end of the course. When controlling for demographic variables, the strongest predictors of blaming attitudes towards Indigenous Peoples and lower support for government action were gender and health professional program. There was a negative correlation between historical factors and blaming attitudes suggesting that learners who were less willing to recognize the role of historical factors on health inequities were more likely to express blaming attitudes. Further, stronger support for government action or policies to address such inequities was associated with greater recognition of the causal effects of historical factors, and learners were less likely to express blaming attitudes. CONCLUSION: The findings with respect to blaming attitudes and lower support for government social action and policies suggested that educational interventions can have unexpected negative effects. As such, implementation of content to address the Truth and Reconciliation Commissions Calls to Action should be accompanied by rigorous research and evaluation that explore how attitudes are transformed across the health professional education journey to monitor intended and unintended effects.

Relations between bullying and distress among youth living in First Nations communities: Assessing direct and moderating effects of culture-related variables.

The well-being of Indigenous peoples continues to be affected by intergenerational effects of numerous harmful government policies, which are considered root causes for bullying and cyberbullying that exist in some communities. Despite ongoing stressors, Indigenous youth demonstrate resilience, which often appears grounded in connecting to their cultural identities and traditional practices. However, few studies have tested the direct and stress-buffering role of various aspects of culture in relation to well-being among First Nations youth. Analyses of the 2015-16 First Nations Regional Health Survey (RHS) revealed that bullying and cyberbullying were associated with increased psychological distress among youth aged 12-17 living in First Nations communities across Canada (N = 4,968; weighted = 47,918), and that these links were stronger for females. Feelings of community belonging were directly associated with lower distress and buffered the relationships between bullying/cyberbullying and distress. Among youth who experienced cyberbullying, those who participated in community cultural events at least sometimes reported lower distress compared to those who rarely or never participated. Those who disagreed that traditional cultural events were important reported the highest levels of distress, but perceived importance of such events failed to buffer the associations between bullying/cyberbullying and distress. These national data highlight the importance of certain culture-related variables as key factors associated with the well-being of youth living in First Nations communities across Canada.

Parent-Child Separations and Mental Health among First Nations and Métis Peoples in Canada: Links to Intergenerational Residential School Attendance.

First Nations children are over 17 times more likely to be removed from their families and placed in the child welfare system (CWS) than non-Indigenous children in Canada. The high rates of parent-child separation have been linked to discriminatory public services and the Indian Residential School (IRS) system, which instigated a multi-generational cycle of family disruption. However, limited empirical evidence exists linking the IRS to subsequent parent-child separations, the CWS, and mental health outcomes among First Nations, Inuit, and Métis populations in Canada. The current studies examine these relationships using a nationally representative sample of First Nations youth (ages 12-17 years) living in communities across Canada (Study 1), and among First Nations and Métis adults (ages 18+ years) in Canada (Study 2). Study 1 revealed that First Nations youth with a parent who attended IRS had increased odds of not living with either of their biological parents, and both IRS and not living with biological parents independently predicted greater psychological distress. Similarly, Study 2 revealed that First Nations and Métis adults with familial IRS history displayed greater odds of spending time in the CWS, and both IRS and CWS predicted elevated depressive symptoms. The increased distress and depressive symptoms associated with parent-child separations calls for First Nations-led interventions to address the inequities in the practices of removing Indigenous children and youth from their families.

Explaining the gaps in psychological distress and suicidal behaviours between non-Indigenous and Indigenous adults living off-reserve in Canada: a cross-sectional study.

BACKGROUND: Indigenous people are disproportionately affected by mental health issues in Canada. We investigated factors underlying the difference in psychological distress and suicidal behaviours between non-Indigenous and Indigenous populations living off-reserve in Canada. METHODS: We conducted a cross-sectional study using data from the 2012 Canadian Community Health Survey - Mental Health. Respondents were aged 18 years and older. We measured the variation in psychological distress (10-item Kessler Psychological Distress Scale scores, ranging from 10 [no distress] to 50 [severe distress]) and the prevalence of lifetime suicidal ideation and suicide plan between the Indigenous and non-Indigenous populations and explained these differences using the Blinder-Oaxaca approach. RESULTS: The overall response rate for the survey was 68.9%, comprising 18 300 respondents (933 Indigenous and 17 367 non-Indigenous adults). We found lower mean psychological distress scores among non-Indigenous people than among Indigenous people (15.1 v. 16.1, p < 0.001) and a lower prevalence of lifetime suicidal ideation (9.2% v. 16.8%, p < 0.001) and plan (2.3% v. 6.8%, p < 0.001). We found that if socioeconomic status among Indigenous people were made to be similar to that of the non-Indigenous population, the differences in mean psychological distress scores and prevalence of lifetime suicidal ideation and suicide plan would have been reduced by 25.7% (women 20.8%, men 36.9%), 10.2% (women 11.2%, men 11.9%) and 5.8% (women 7.8%, men 8.1%), respectively. INTERPRETATION: Socioeconomic factors account for a considerable proportion of the variation in mental health outcomes between non-Indigenous and Indigenous populations in Canada. Improving socioeconomic status among Indigenous people through plans like income equalization may reduce the gap in mental health outcomes between the 2 populations in Canada.

University Students' Self-Rated Health and Use of Health Services: A Secondary Analysis.

BACKGROUND: University students belonging to various ethnic groups have specific health needs that influence their self-rated health and health service use. PURPOSE: To examine which determinants of health serve as key predictors of self-rated health and health service use in a sample of ethnically diverse undergraduate students. METHODS: Data were abstracted from the 2012 Maritime Undergraduate Student Sexual Health Services Survey (N = 10,512). Logistic regression was used to explore the predictors of self-rated health and use of university-based health services according to ethnicity. RESULTS: Social support (Caucasian: odds ratio (OR) = 1.018; 95% confidence interval (CI) [1.008, 1.028]; African: OR = 1.890; 95% CI [1.022, 1.160]; Other: OR = 1.096; 95% CI [1.023, 1.175]), and depression risk (Caucasian: OR = .899; 95% CI [.844, .914]; Indigenous: OR = .904; 95% CI [.844, .969]; Asian: OR = .894; 95% CI [.839, .953]; Multiracial: OR = .892; 95% CI [.812, .980]) were the most frequent predictors of self-rated health across the different ethnic groups; while year of study (Caucasian: OR = 1.855; 95% CI [1.764, 1.952]; African: OR = 2.979; 95% CI [2.068, 4.291]; Indigenous OR = 1.828; 95% CI [1.371, 2.436]; Asian: OR = 1.457; 95% CI [1.818, 1.797]; Middle Eastern: OR = 1.602; 95% CI [1.088, 2.359]; Other: OR = 1.485; 95% CI [1.093, 2.018]; Multiracial: OR = 2.064; 95% CI [1.533, 2.778]) was found to be the most significant predictor of health service use. CONCLUSION: Findings from this research shed light on the various factors that impact university students belonging to different ethnic groups, their health, and their access to healthcare that addresses their distinct health needs. Nurses can advocate for the development of health promotion and illness prevention strategies that target the needs of the diverse student population.

Intergenerational communication regarding Indian Residential Schools: Implications for cultural identity, perceived discrimination, and depressive symptoms.

Two studies assessed the nature of parental communication about the trauma of Indian Residential Schools (IRSs) in relation to the psychological distress of their adult offspring, and whether the link between parental communication and distress was mediated by offsprings' greater awareness of collective discrimination or sense of pride in cultural identity. In Study 1, an online survey of Indigenous participants from across Canada (N = 498) demonstrated a curvilinear relation between the extent to which parents talked about their negative IRS experiences and the severity of depressive symptoms among offspring, among whom symptoms were particularly pronounced with more frequent communication. This relation was mediated by greater perceived discrimination. A similar, but inverse, association was found when parental communications conveyed positive construals of their IRS experiences. Study 2 (N = 134) further demonstrated an association between direct communications from IRS survivors and offspring wellbeing in that, either the absence of, or especially frequent communications were related to more severe depressive symptoms among offspring. However, hearing about parental IRS experiences from someone other than the parent was not related to offsprings' depressive symptoms. Qualitative analyses indicated that direct communications from parents tended to provide excessive detail, whereas parental silence was associated with speculation and feelings of isolation or resentment among offspring of IRS survivors. Taken together, the results suggest that either insufficient or excessive parental communication about trauma might undermine offspring wellbeing, whereas moderate levels of communication that provide positive meaning and promote cultural pride or diminish perceptions of personal discrimination could be beneficial.

The tools at their fingertips: How settler colonial geographies shape medical educators' strategies for grappling with Anti-Indigenous racism.

Settler colonialism implicates settler and Indigenous populations differently within ongoing projects of settlement and nation building. The uneven distribution of benefits and harms is a primary consequence of settler colonialism. Indeed, it is a central organizing feature of the settler state's governance of Indigenous societies and is animated, in part, through pervasive settler ignorance and anti-Indigenous racism, which has manifested in persistent health disparities amongst Indigenous peoples. This broader socio-political context surrounding medical schools, which are seeking to develop teaching and learning about Indigenous health presents a significant challenge. Understanding the cognitive and affective tools that settler educators use when grappling with questions of race, racialization, and Indigenous difference is an important step in addressing anti-Indigenous racism in health care provision. This paper reports on findings from in-depth semi-structured interviews with educators at one Canadian medical school. Our intent was to elicit respondents' understandings, experiences, and attitudes regarding Indigenous-settler relations, Indigenous health and healthcare, and the inclusion of Indigenous health in the curriculum as a means of identifying facilitators and barriers to improving Indigenous health and health care experiences. Respondents were generally sympathetic and evinced an earnest desire to include more Indigenous-related content in the curriculum. What became clear over the course of the data collection and analysis, however, was that most respondents lacked the tools to engage critically with questions of race and racialization and how these are manifested in the context of asymmetrical settler colonial power. We argue that this inability, at best, limits the effectiveness of much needed efforts to incorporate more content relating to Indigenous health, but worse yet, risks re-entrenching anti-Indigenous racism and settler dominance.

Traumatic Experiences, Perceived Discrimination, and Psychological Distress Among Members of Various Socially Marginalized Groups.

Perceived discrimination has consistently been shown to be associated with diminished mental health, but the psychological processes underlying this link are less well understood. The present series of four studies assessed the role of a history traumatic events in generating a proliferation of discrimination stressors and threat appraisals, which in turn predict psychological distress (depressive and posttraumatic stress symptoms) (mediation model), or whether prior traumatic events sensitize group members, such that when they encounter discrimination, the link to stress-related symptoms is heightened (moderation model). Each of the studies assessed a different marginalized group in Canada, including Indigenous peoples, Blacks, Jews, and a diverse sample of women. Participants completed measures assessing history of traumatic events, perceived explicit and ambiguous discrimination, discrimination threat appraisals, and symptoms of depression and posttraumatic stress. The four populations varied in their experiences, with Indigenous peoples encountering the highest levels of trauma, discrimination, and psychological distress symptoms. A mediated model was evident among Indigenous peoples and women, possibly reflecting the role of systemic processes that engender discrimination when traumatic events are experienced. There was evidence for a moderating role of a history of traumatic events on the relations between discrimination and depressive symptoms among Jewish and Black participants. Although the hypothesized synergistic effects of traumatic experiences were noted when assessing the relation between perceived discrimination and depressive symptoms among Jews, the presence of trauma blunted these relations among Blacks. The results suggest that trauma-informed approaches to addressing stress-related processes and psychological outcomes need to consider the unique social context of members of various socially marginalized groups.

Socioeconomic inequalities in psychological distress and suicidal behaviours among Indigenous peoples living off-reserve in Canada.

BACKGROUND: Indigenous peoples in Canada have high rates of psychological distress and suicide. We sought to assess the socioeconomic inequalities in psychological distress and suicidal behaviours, and the factors that explain them within Indigenous peoples living off-reserve. METHODS: Using the nationally representative 2012 Aboriginal Peoples Survey collected from Indigenous adults living off-reserve in Canada, we measured income-related inequalities in psychological distress (measured on the 10-item Kessler Psychological Distress Scale) and suicidal behaviours (suicidal ideation and suicide attempt) and identified factors contributing to these inequalities using the concentration index (C) approach. RESULTS: Among 14 410 individuals representing 600 750 Indigenous adults (aged ≥ 18 yr) living off-reserve in Canada, the mean score of psychological distress was 16.1; 19.4% reported lifetime suicidal ideation and 2.2% reported a lifetime suicide attempt. Women had higher psychological distress scores (mean score 16.7 v. 15.2, p < 0.001), and prevalence of suicidal ideation (21.9% v. 16.1%, p < 0.001) and suicide attempts (2.3% v. 2.0%, p = 0.002) than men. Poorer individuals disproportionately experienced higher psychological distress (C = -0.054, 95% confidence interval [CI] -0.057 to -0.050), suicidal ideation (C n = -0.218, 95% CI -0.242 to -0.194) and suicide attempts (C n = -0.327, 95% CI -0.391 to -0.263). Food insecurity and income, respectively, accounted for 40.2% and 13.7% of the psychological distress, 26.7% and 18.2% of the suicidal ideation and 13.4% and 7.8% of the suicide attempts concentrated among low-income Indigenous peoples. INTERPRETATION: Substantial income-related inequalities in psychological distress and suicidal behaviours exist among Indigenous peoples living off-reserve in Canada. Policies designed to address major contributing factors such as food insecurity and income may help reduce these inequalities.

Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study.

BACKGROUND: Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours. METHODS: A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. RESULTS: Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. CONCLUSIONS: Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.

Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants.

Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (RC and AC, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions. Moreover, we performed decomposition analysis to determine factors that explain income-related inequality in health within the Indigenous peoples living off-reserve in Canada. The prevalence of poor/fair health status among the Indigenous population living off-reserve increased from 18% in 2001 to 22% in 2012. The extent of pro-rich relative (absolute) income-related inequalities in health increased by 23% (42%) from 2001 to 2012. Income-related inequalities in health increased statistically significantly within First Nations and Métis populations as well as in Atlantic provinces, Ontario, Alberta, British Columbia and Territories. Decomposition analyses indicated that, besides income itself, occupational status and educational attainment were the most important factors contributing to the pro-rich distribution of health among Indigenous peoples living off-reserve. Growing socioeconomic inequalities in health among Indigenous peoples should warrant more attention. Policies designed to address the broader array of social determinants of health may mitigate the continuing inequalities in health among Indigenous peoples living off-reserve in Canada.

Suicide Ideation and Attempts among First Nations Peoples Living On-Reserve in Canada: The Intergenerational and Cumulative Effects of Indian Residential Schools.

OBJECTIVE: Suicide rates among Indigenous peoples in Canada are at least twice that of their non-Indigenous counterparts. Although contemporary stressors contribute to this increased risk, historical experiences such as the Indian Residential School (IRS) system may also have continuing links with the risk for suicidal thoughts and behaviors. The current investigation examined the intergenerational and cumulative links between familial IRS attendance in relation to lifetime suicide ideation and attempts among First Nations adults living on-reserve. METHOD: Data from the 2008-2010 First Nations Regional Health Survey were analyzed, and participants comprised a representative sample of First Nations adults older than 18 years (weighted N = 127,338; IRS attendees were excluded). Of those who knew their familial IRS history, 38.0% had no history of attendance, 19.3% had a grandparent who attended, 16.2% had a parent who attended, and 26.5% had a parent and grandparent who attended. RESULTS: Exposure of one previous familial generation to the IRS experience was associated with increased risk for lifetime suicide ideation (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.16 to 1.84; P = 0.001) and attempts (OR, 1.44; 95% CI, 1.07 to 1.94; P < 0.016) compared with those with no IRS history. Having 2 generations of IRS familial history was associated with greater odds of reporting a suicide attempt compared with having one generation (OR, 1.35; 95% CI, 1.05 to 1.75; P = 0.022), which was reduced when current levels of distress and ideation were accounted for. CONCLUSION: Findings support the existence of linkages between intergenerational exposure to IRS and risk for suicidal ideation and attempts and for a potential cumulative risk in relation to suicide attempts across generations.

Indigenous identity transformations: The pivotal role of student-to-student abuse in Indian Residential Schools.

Embracing a shared social identity typically serves to protect group members in the face of threats. However, under some conditions, intragroup dynamics are diverted so that instead, they contribute to disturbances in collective well-being. The present analysis applies a social identity framework to understand how intragroup processes elicited in Indian Residential Schools (IRS) altered the capacity of Indigenous peoples to overcome damage to their identity and collective functioning. With the alleged goal of assimilating the Indigenous population, residential schools in Canada entailed the forced removal of Indigenous children from their communities. A Truth and Reconciliation Commission established in 2008 confirmed the extensive abuse perpetrated by IRS staff, but also raised awareness of the pervasiveness of student-to-student abuse. Supported by qualitative analyses of the reports of social service providers working with IRS survivors (N = 43), it is argued that a key part of the dynamics in the IRSs was the subversion of intragroup processes among Indigenous children in attendance. Understanding intragroup dynamics provides a basis for recognizing the persistent effects of IRSs, and for identifying strategies to heal and reclaim a positive collective identity.

Reframing Narratives of Aboriginal Health Inequity: Exploring Cree Elder Resilience and Well-Being in Contexts of Historical Trauma.

A large body of literature explores historical trauma or intergenerational trauma among Aboriginal communities around the globe. This literature connects contemporary forms of social suffering and health inequity to broader historical processes of colonization and the residential school systems in Canada. There are tendencies within this literature, however, to focus on individual pathology and victimization while minimizing notions of resilience or well-being. Through a social constructionist lens, this research examined how interpersonal responses to historical traumas can be intertwined with moments of and strategies for resilience. Detailed narrative interviews occurred with four Aboriginal Cree elders living in central Saskatchewan, Canada, who all experienced historical trauma to some extent. From this analysis, we argue that health research among Aboriginal populations must be sensitive to the complex individual and social realities that necessarily involve both processes of historical and contemporary traumas as well as resilience, strength, and well-being.

Childhood adversity, perceived discrimination, and coping strategies in relation to depressive symptoms among First Nations adults in Canada: The moderating role of unsupportive social interactions from ingroup and outgroup members.

Aboriginal peoples are at greater risk of experiencing early life adversity relative to non-Aboriginal peoples in Canada, and as adults frequently experience high levels of discrimination that act as a further stressor. Although these factors appear to contribute to high rates of depressive disorders and suicidality in Aboriginal peoples, the psychosocial factors that contribute to the relationship between childhood adversity and the development of depressive symptoms have hardly been assessed in this group. The present investigation explored potential mediators to help explain the relation between childhood trauma and depressive symptoms among a sample of First Nations adults from across Canada. These mediated relationships were further examined in the context of unsupportive social interactions from ingroup and outgroup members. In Study 1, (N = 225), the relationship between childhood trauma and depression scores was mediated by perceived discrimination, and this was particularly notable in the presence of unsupportive relations with outgroup members. In Study 2, (N = 134) the relationship between childhood trauma and depressive symptoms was mediated by emotion-focused coping that was specific to coping with experiences of ethnic discrimination, and this mediated effect was moderated by both outgroup and ingroup unsupportive social interactions. Thus, it seems that experiences of discrimination and unsupport might contribute to depressive symptoms among First Nations adults who had experienced early life adverse events.

Finding benefit in stressful uncertain circumstances: relations to social support and stigma among women with unexplained illnesses.

Living with a chronic illness can be challenging, but the ability to derive benefits and grow from this experience may enhance well-being. However, the possibility of obtaining such benefits may be dependent on the levels of stigmatization and lack of social support experienced by an individual as a result of the illness. Chronic fatigue syndrome (CFS) and fibromyalgia are chronic conditions that remain largely unexplained and those with these conditions must often contend with stigma and skepticism from others. Individuals with CFS/fibromyalgia often display stress-related biological alterations and the experience of stressful life events has been associated with illness development. The present study demonstrated that women with CFS/fibromyalgia (n = 40) as well as community participants who were depressed/anxious (n = 37), reported higher stigma levels than healthy women (n = 33). Moreover, women with CFS/fibromyalgia and those with depression/anxiety also reported greater levels of stigma than women with a chronic yet more widely accepted condition (n = 35; rheumatoid arthritis, osteoarthritis and multiple sclerosis). Secrecy related to stigma among those with CFS/fibromyalgia declined with increased social support, but this was not apparent among those with other chronic conditions. In addition, posttraumatic growth was lower among women with CFS/fibromyalgia compared to those with other chronic conditions. Qualitative analysis examining both negative impacts and positive changes stemming from illness experience revealed many similarities between women with CFS/fibromyalgia and those with other chronic conditions, including elevated appreciation for life, personal growth and compassion for others. However, women with CFS/fibromyalgia tended to report less positive change regarding interpersonal relationships compared to women with other chronic conditions. In general, unexplained illnesses were also accompanied by stigmatization which might ultimately contribute to women's lower ability to derive positive growth from their illness experience.

The intergenerational effects of Indian Residential Schools: implications for the concept of historical trauma.

The current paper reviews research that has explored the intergenerational effects of the Indian Residential School (IRS) system in Canada, in which Aboriginal children were forced to live at schools where various forms of neglect and abuse were common. Intergenerational IRS trauma continues to undermine the well-being of today's Aboriginal population, and having a familial history of IRS attendance has also been linked with more frequent contemporary stressor experiences and relatively greater effects of stressors on well-being. It is also suggested that familial IRS attendance across several generations within a family appears to have cumulative effects. Together, these findings provide empirical support for the concept of historical trauma, which takes the perspective that the consequences of numerous and sustained attacks against a group may accumulate over generations and interact with proximal stressors to undermine collective well-being. As much as historical trauma might be linked to pathology, it is not possible to go back in time to assess how previous traumas endured by Aboriginal peoples might be related to subsequent responses to IRS trauma. Nonetheless, the currently available research demonstrating the intergenerational effects of IRSs provides support for the enduring negative consequences of these experiences and the role of historical trauma in contributing to present day disparities in well-being.