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Rates of hospitalizations and emergency department (ED) visits due to self-harm are important indicators for understanding the impact of the COVID-19 pandemic on mental health. The objective of this study was to assess changes in self-harm hospitalizations and ED visits in Canada during the first two years of the pandemic. Rates of self-harm hospitalizations and ED visits during the pandemic were predicted based on regression analyses that modeled trends over a 5-year pre-pandemic period from fiscal year 2015 to 2019. The ratios of observed and model predicted (expected) rates in 2020 and 2021 were estimated separately to assess changes during the pandemic. Overall, rates of self-harm hospitalizations and ED visits were lower than expected during the pandemic, especially in 2020. In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. Females aged 10–14 years had higher than expected rates. The rate ratio of observed rate over expected rate was 1.2 in 2020 but further increased to 1.8 in 2021 for both hospitalizations and ED visits. Higher than expected rates were also observed among females aged 15–19 years in 2021 only. Suicide attempts and non-suicidal self-harm cases could not be distinguished. We observed lower than or close to expected rates of self-harm hospitalizations and ED visits during the pandemic for most population groups. The increased rates for young females highlights the importance of continued surveillance post-pandemic and targeted mental health services and suicide prevention programs. • This study assessed changes in self-harm hospitalizations and ED visits in Canada during the COVID-19 pandemic. • In 2020, overall rates of self-harm hospitalizations and ED visits were lower than expected. • In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. • Females aged 10–19 years had increased rates during the pandemic, especially for females aged 10–14 years in 2021. • The findings highlight the importance of continuing surveillance post-pandemic and targeted mental health services. [ABSTRACT FROM AUTHOR]

Introduction. Dans le cadre de l'approche en santé publique en matière de protection de l'enfance, il est essentiel de recueillir des données sur les enfants placés hors de leur foyer familial afin d'évaluer les tendances à l'échelle de la population, de comprendre les facteurs à l'origine des inégalités sociales et de santé et d'analyser les conséquences pour les enfants et les familles. Nous avons analysé des données administratives provenant de l'ensemble du Canada pour décrire la population des enfants placés hors de leur foyer familial, estimer et comparer les taux de placement hors du foyer familial par province ou territoire, année, sexe ou genre, groupe d'âge et type de placement. Méthodologie. Nous avons effectué une analyse transversale des données basées sur des dénombrements ponctuels dans toutes les provinces et tous les territoires pour la période 2013-2014 à 2021-2022. Nous avons utilisé des fréquences et des pourcentages pour décrire la population d'enfants (et de jeunes jusqu'à 21 ans) placés hors de leur foyer familial et nous avons estimé les taux globaux et les ratios de taux. Résultats. Nous estimons qu'au Canada, 61 104 enfants étaient placés hors de leur foyer familial au 31 mars 2022. Le taux national de placement des enfants hors de leur foyer familial était de 8,24 enfants pour 1 000. Les variations de taux par province et territoire étaient importantes et ont changé au fil du temps. Les taux les plus élevés ont été relevés chez les garçons ainsi que chez les enfants de 1 à 3 ans et chez les jeunes de 16 et 17 ans. Si les familles d'accueil sont restées le type de placement le plus courant, le placement dans la parenté a représenté une part croissante des placements. Conclusion. Cette analyse a montré que les données administratives sont utilisables pour produire des indicateurs nationaux sur les enfants encadrés par le système de protection de l'enfance au Canada. Ces données sont utilisables aussi pour mesurer les progrès en matière d'équité sociale et de santé pour les enfants et les jeunes du Canada. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. Methods: Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. Results: Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10–19 and 20–34-year old age groups. Females aged 10–19 in very remote areas had the highest self-harm hospitalization rate. Conclusion: The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts. [ABSTRACT FROM AUTHOR]

Introduction: Recent evidence has suggested that there has been an increase in suicidal ideation during the COVID-19 pandemic. Our objectives were to estimate the likelihood of suicidal ideation among adults in Canada who experienced pandemic-related impacts and to determine if this likelihood changed during the pandemic. Methods: We analyzed pooled data for 18 936 adults 18 years or older from two cycles of the Survey on COVID-19 and Mental Health collected from 11 September to 4 December 2020 and from 1 February to 7 May 2021. We estimated the prevalence of suicidal ideation since the pandemic began and conducted logistic regression to evaluate the likelihood of suicidal ideation by adults who experienced pandemic-related impacts, and by factors related to social risk, mental health status, positive mental health indicators and coping strategies. Results: Adults who had adverse pandemic-related experiences were significantly more likely to experience suicidal ideation; a dose-response relationship was evident. People who increased their alcohol or cannabis use, expressed concerns about violence in their home or who had moderate to severe symptoms of depression, anxiety or posttraumatic stress disorder also had significantly higher risk of suicidal ideation. The risk was significantly lower among people who reported high self-rated mental health, community belonging or life satisfaction, who exercised for their mental and/or physical health or who pursued hobbies. Conclusion: The COVID-19 pandemic has influenced suicidal ideation in Canada. Our study provides evidence for targeted public health interventions related to suicide prevention. [ABSTRACT FROM AUTHOR]

Background: The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador.Methods: We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide.Results: From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide.Conclusions: The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide. [ABSTRACT FROM AUTHOR]

The purpose of this selective narrative review is to provide an overview of suicide and suicide prevention in the Circumpolar North and the relevance of global strategies and policies to these themes. We conducted a selective review of the English language literature on Arctic Indigenous mental health, suicide, and suicide prevention. We briefly present the social context, epidemiology, and risk and protective factors for suicide in the Arctic, with a focus on Indigenous peoples. We highlight a recent collaborative, intergovernmental response to elevated suicide rates in this region, the Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks Initiative, which used a consensus methodology to identify key outcomes for evaluating suicide prevention interventions in the circumpolar context. In relation to the Sustainable Development Goals, we examine recent policy developments in Indigenous-led suicide prevention and identify opportunities for strengthening policy, community interventions, and research. Globally, suicide prevention is a public health priority, and reducing the number of suicide deaths is a key target for sustainable development. Although overall and country-specific suicide rates have decreased since 1990, there remains wide variation at the regional and local level. This is particularly evident in the Arctic region known as the Circumpolar North, where Indigenous peoples experience marked disparities in suicide risk and suicide deaths compared to non-Indigenous populations. The factors that influence these variations are complex and often rooted in the social and economic consequences of colonization. The integration of science, community-based and Indigenous knowledge, and policies that address upstream risks for suicide will play an important role in suicide prevention alongside the growing number of Indigenous suicide prevention strategies tailored for specific populations. [ABSTRACT FROM AUTHOR]

This special issue brings together a series of papers that were presented at the Northern, Rural, and Remote Health Conference in Labrador, Canada. In this collection, scholars and community leaders use local examples to explore some of the most pressing issues in Circumpolar health: Indigenous self-determination in health care and health research; access to traditional medicines; language and identity; youth engagement; mental health; climate change; and health technology. Recognizing the dynamic ways that these topics were raised at the conference, we've included a diverse slate of papers: from commentary essays and case studies, to primary research and evidence synthesis. The goal of this special issue is to bridge local insights, innovations, and varied forms of evidence from the Circumpolar North, with global conversations about health equity, health system transformation, and the rights of Indigenous peoples. This editorial provides an overview of the conference and an introduction to the scholarship that emerged from it. [ABSTRACT FROM AUTHOR]

Historically, Indigenous health research in Canada has failed to engage Indigenous peoples and communities as primary stakeholders of research evidence. Increasingly, research ethics and methodologies are being positioned as tools for Indigenous self-determination. In response, mainstream institutions have developed new ethical principles for research involving Indigenous people. While these transformations are necessary steps towards re-orienting research practices, they are not prescriptive. In this paper, we make visible three dilemmas from a case study in which Indigenous health research frameworks provided limited guidance or were unclear about how to balance community priorities with Indigenous research principles. We also discuss the strategies used to resolve each of these dilemmas. We draw examples from a project that examined the lived experiences of children and youth living with FASD and their caregivers. This project was conducted in collaboration with Sheshatshiu Innu First Nation, an Indigenous community in Labrador, Canada. In doing so, we argue that knowing the key guiding principles in Indigenous health research is not always enough, and that the ‘real-world’ context of practices and relationships can lead to conflicts that are not easily resolved with adherence to these principles. [ABSTRACT FROM AUTHOR]

Objectives. To compare suicide rates in Aboriginal communities in Labrador, including Innu, Inuit, and Southern Inuit, with the general population of Newfoundland, Canada. Methods. In partnership with Aboriginal governments, we conducted a populationbased study to understand patterns of suicide mortality in Labrador.We analyzed suicide mortality data from 1993 to 2009 from the Vital Statistics Death Database. We combined this with community-based methods, including consultations with Elders, youths, mental health and community workers, primary care clinicians, and government decision-makers. Results. The suicide rate was higher in Labrador than in Newfoundland. This trend persisted across all age groups; however, the disparity was greatest among those aged 10 to 19 years. Males accounted for the majority of deaths, although suicide rates were elevated among females in the Inuit communities. When comparing Aboriginal subregions, the Innu and Inuit communities had the highest age-standardized mortality rates of, respectively, 165.6 and 114.0 suicides per 100 000 person-years. Conclusions. Suicide disproportionately affects Innu and Inuit populations in Labrador. Suicide rates were high among male youths and Inuit females. [ABSTRACT FROM AUTHOR]

Background: Sexual and gender minority populations experience elevated risks for suicidality. This study aimed to assess prevalence and disparities in non-fatal suicidality and potential protective factors related to social support and health care access among sexual and gender minority youth and adults and their heterosexual and cisgender counterparts in Canada. The second objective was to examine changes in the prevalence of suicidal ideation and protective factors during the COVID-19 pandemic. Methods: Pooled data from the 2015, 2016 and 2019 Canadian Community Health Surveys were used to estimate pre-pandemic prevalence of suicidal ideation, plans and attempts, and protective factors. The study also estimated changes in the prevalence of recent suicidal ideation and protective factors in fall 2020, compared with the same period pre-pandemic. Results: The prevalence of suicidality was higher among the sexual minority populations compared with the heterosexual population, and the prevalence was highest among the bisexual population, regardless of sex or age group. The pre-pandemic prevalence of recent suicidal ideation was 14.0% for the bisexual population, 5.2% for the gay/lesbian population, and 2.4% for the heterosexual population. The prevalence of lifetime suicide attempts was 16.6%, 8.6%, and 2.8% respectively. More than 40% of sexual minority populations aged 15–44 years had lifetime suicidal ideation; 64.3% and 36.5% of the gender minority population had lifetime suicidal ideation and suicide attempts. Sexual and gender minority populations had a lower prevalence of protective factors related to social support and health care access. The prevalence of recent suicidal ideation among sexual and gender minority populations increased in fall 2020, and they tended to experience longer wait times for immediate care needed. Conclusions: Sexual and gender minority populations had a higher prevalence of suicidality and less social support and health care access compared to the heterosexual and cisgender populations. The pandemic was associated with increased suicidal ideation and limited access to care for these groups. Public health interventions that target modifiable protective factors may help decrease suicidality and reduce health disparities. Highlights: • This study provides population-based pre-pandemic estimates of the prevalence of non-fatal suicidality (suicidal ideation, plans, and attempts) among sexual and gender minority populations in Canada using pooled data from the 2015, 2016, and 2019 Canadian Community Health Survey. • Sexual and gender minority populations had a higher prevalence of suicidal ideation, plans, and attempts, compared with heterosexual and cisgender populations, regardless of sex or age group. Among sexual minority populations the bisexual population had the highest prevalence of suicidality. • More than 40% of sexual minority populations aged 15 to 44 years had lifetime suicidal ideation; two thirds and one third of the gender minority population had lifetime suicidal ideation and suicide attempts, respectively. • Sexual minority populations had a lower prevalence of social support and health care access; the presence of social support and health care access was related to lower prevalence of recent suicidal ideation. • The onset of the COVID-19 pandemic was associated with increased recent suicidal ideation among the sexual and gender minority populations, especially for males, adolescents, and young adults. [ABSTRACT FROM AUTHOR]

Using data from the 2020 and 2021 cycles of the Survey on COVID-19 and Mental Health, we examined suicidal ideation among adults in Canada aged 18 to 34 years. The prevalence of suicidal ideation among adults aged 18 to 34 years was 4.2% in fall 2020 and 8.0% in spring 2021. The subgroup of adults aged 18 to 24 years had the highest prevalence of suicidal ideation, 10.7%, in spring 2021. Prevalence varied by sociodemographic characteristics and tended to be higher among people living in materially deprived areas. Suicidal ideation was strongly associated with pandemic-related stressors respondents experienced. [ABSTRACT FROM AUTHOR]

Background: Indigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health. Methods: This paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis. Discussion: The synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects. Systematic review registration: Registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720) [ABSTRACT FROM AUTHOR]

Dr. Gomez and colleagues offered much-needed insight into the geographic patterns of firearm injuries in Ontario, Canada.[1] They found that assault-related injuries were concentrated in cities, and rates of self-harmrelated injuries were highest in rural areas. 2019;19:12. 9 Monuteaux MC, Azrael D, Miller M. Association of increased safe household firearm storage with firearm suicide and unintentional death among US youths. [Extracted from the article]

Background: Indigenous palliative persons and their families often have different values, spiritual traditions, and practices from Western culture and Canadian health systems. Additionally, many healthcare policies and practices have been established without adequate consultation of the Indigenous populations they are meant to serve. This can result in barriers to Innu receiving culturally safe end-of-life care. Innu community leaders from Sheshatshiu, Labrador, have identified a need for further research in this area. The purpose of this study is to: (1) describe the cultural and spiritual practices related to death and dying of the Innu in Sheshatshiu; (2) identify aspects of current end-of-life care delivery that serve and/or fail to meet the cultural and spiritual needs of the Innu in Sheshatshiu; and (3) explore ways to integrate current end-of-life care delivery practices with Innu cultural and spiritual practices to achieve culturally safer care delivery for the Innu. Methods: This qualitative patient-oriented research study was co-led by Innu investigators and an Innu advisory committee to conduct semi-structured interviews of 5 healthcare providers and 6 decision-makers serving the community of Sheshatshiu and a focus group of 5 Innu Elders in Sheshatshiu. Data was analyzed thematically from verbatim transcripts. The codebook, preliminary themes, and final themes were all reviewed by Innu community members, and any further input from them was then incorporated. Quotations in this article are attributed to Innu Elders by name at the Elders' request. Results: The findings are described using eight themes, which describe the following: relationships and visitation support a "peaceful death"; traditional locations of death and dying; the important role of friends and community in providing care; flexibility and communication regarding cultural practices; adequate and appropriate supports and services; culturally-informed policies and leadership; and Innu care providers and patient navigators. Conclusions: The Innu in Sheshatshiu have a rich culture that contributes to the health, care, and overall well-being of Innu people approaching end of life. Western medicine is often beneficial in the care that it provides; however, it becomes culturally unsafe when it fails to take Innu cultural and spiritual knowledge and traditions into account. [ABSTRACT FROM AUTHOR]

Indigenous peoples in Canada experience disproportionate rates of suicide compared to non-Indigenous populations. Indigenous communities and organizations have designed local and regional approaches to prevention, and the federal government has developed a national suicide prevention framework. However, public health systems continue to face challenges in monitoring the population burden of suicide and suicidal behaviour. National health data systems lack Indigenous identifiers, do not capture data from some regions, and do not routinely engage Indigenous communities in data governance. These challenges hamper efforts to detect changes in population-level outcomes and assess the impact of suicide prevention activities. Consequently, this limits the ability to achieve public health prevention goals and reduce suicide rates and rate inequities.This paper provides a critical analysis of the challenges related to suicide surveillance in Canada and assesses the strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities. To better understand these challenges, we discuss the policy context for suicide surveillance and examine the survey and administrative data sources that are commonly used in public health surveillance. We then review recent data on the epidemiology of suicide and suicidal behaviour among Indigenous populations, and identify challenges related to national surveillance.To enhance capacity for suicide surveillance, we propose strategies to better track progress in Indigenous suicide prevention. Specifically, we recommend establishing an independent community and scientific governing council, integrating Indigenous identifiers into population health datasets, increasing geographic coverage, improving suicide data quality, comprehensiveness, and timeliness, and developing a platform for making suicide data accessible to all stakeholders. Overall, the strategies we propose can build on the strengths of the existing national suicide surveillance system by adopting a collaborative and inclusive governance model that recognizes the stake Indigenous communities have in suicide prevention. [ABSTRACT FROM AUTHOR]

Background: Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.Methods: We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.Results: The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.Conclusions: This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention. [ABSTRACT FROM AUTHOR]

Background: Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. Methods: We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. Results: Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. Discussion: The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts. [ABSTRACT FROM AUTHOR]

Climate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations. Daily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012–2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality. Mental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR -5≤5ᵒC = 1.47, 95% CI = 1.21–1.78; IRR 6≤15ᵒC = 2.24, 95% CI = 1.66–3.03; IRR >15ᵒC = 1.73, 95% CI = 1.02–2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within −5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94–0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits. Regionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. −5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet. • Longer periods of warm temperatures significantly increased mental health clinic visits in Nunatsiavut. • Temperature-mental health associations aligned with community participation in land-based activities. • Results suggest that place will modify the impact of climate change on mental health. [ABSTRACT FROM AUTHOR]

Background: Burnout among physicians is a consequence of chronic occupational stresses and emotionally intense work demands. However, much of the evidence exploring burnout is derived from urban settings and may not reflect the work and social contexts of physicians in Indigenous communities or in rural and resource-constrained areas. We sought to characterize health system factors that influence burnout among physicians practicing in the three northern territories of Canada.Methods: We conducted a mixed-methods study that included an online survey and qualitative interviews with physicians practicing in Nunavut, Northwest Territories, or Yukon in 2019. The survey adapted content from the Maslach Burnout Inventory. Results were analyzed with logistic regression to assess the association between health system factors and burnout. We conducted in-depth interviews with 14 physicians. Qualitative data was coded and analyzed for themes using the ATLAS.ti software.Results: Thirty-nine percent of survey respondents (n = 22/57) showed features associated with burnout. Factors associated with burnout included use of electronic medical records (β = - 0.7, p < .05), inadequate financial remuneration (β = - 1.0, p < .05), and cross-cultural issues (β = - 1.1, p < .05). Qualitative analysis further identified physician perceptions of lack of influence over health system policies, systemic failures in cultural safety, discontinuity of care, administrative burden, and physician turnover as important drivers of burnout.Conclusions: Physicians practicing in northern regions in Canada experience stress and burnout related to health system factors and cross-cultural issues. The relationship between cross-cultural issues and burnout has not previously been reported. This work may have implications for physician wellbeing and workforce attrition in other resource-constrained or culturally diverse clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group. Methods: We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis. Results: The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1. Conclusion: The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada. [ABSTRACT FROM AUTHOR]

Background. Suicide is a serious public health challenge in circumpolar regions, especially among Indigenous youth. Indigenous communities, government agencies and health care providers are making concerted efforts to reduce the burden of suicide and strengthen protective factors for individuals, families and communities. The persistence of suicide has made it clear that more needs to be done. Objective. Our aim was to undertake a scoping review of the peer-reviewed literature on suicide prevention and interventions in Indigenous communities across the circumpolar north. Our objective was to determine the extent and types of interventions that have been reported during past decade. We want to use this knowledge to support community initiative and inform intervention development and evaluation. Design. We conducted a scoping review of online databases to identify studies published between 2004 and 2014. We included articles that described interventions in differentiated circumpolar Indigenous populations and provided evaluation data. We retained grey literature publications for comparative reference. Results. Our search identified 95 articles that focused on suicide in distinct circumpolar Indigenous populations; 19 articles discussed specific suicide-related interventions and 7 of these described program evaluation methods and results in detail. The majority of publications on specific interventions were found in North American countries. The majority of prevention or intervention documentation was found in supporting grey literature sources. Conclusion. Despite widespread concern about suicide in the circumpolar world and active community efforts to promote resilience and mental well-being, we found few recorded programs or initiatives documented in the peer-reviewed literature, and even fewer focusing specifically on youth intervention. The interventions described in the studies we found had diverse program designs and content, and used varied evaluation methods and outcomes. The studies we included consistently reported that it was important to use community based and culturally guided interventions and evaluations. This article summarizes the current climate of Indigenous circumpolar suicide research in the context of intervention and highlights how intervention-based outcomes have largely remained outside of peer-reviewed sources in this region of the world. [ABSTRACT FROM AUTHOR]

Rapid environmental change due to climate change impacts Inuit mental wellness by altering the relationships between people, place, livelihoods, and culture. Little is known, however, about how fluctuations in weather contribute to the experience of place and the connection to mental wellness in Inuit communities. This study aimed to characterize the importance of changes in weather among Inuit, and how these changes influence mental health and wellness in the context of climate change. Data were drawn from a community-driven and Inuit-led study in the Nunatsiavut region of Labrador, Canada. In-depth interviews (n = 116 people) were conducted between November 2012 to May 2013 in the five Nunatsiavut communities. Qualitative data were thematically analyzed using a constant comparative method. Results indicated that weather impacted mental wellness through three key pathways: 1) shaping daily lived experiences including connection to place and other determinants of wellbeing; 2) altering mood and emotion on a transient basis; and 3) seasonally influencing individual and community health and wellbeing. These results demonstrate the immediate role weather has in shaping mental wellness in Nunatsiavut. In turn, this understanding of the climate-mental wellness relationship points to multiple pathways for action on climate adaptation policy and programming, and underscores the need for more culturally-specific and place-based investigations to appropriately respond to the mental health impacts of climate change. [ABSTRACT FROM AUTHOR]

OBJECTIVES To assess the risk of on-screen death of important characters in children’s animated films versus dramatic films for adults. DESIGN Kaplan-Meier survival analysis with Cox regression comparing time to first on-screen death. SETTING Authors’ television screens, with and without popcorn. PARTICIPANTS Important characters in 45 top grossing children’s animated films and a comparison group of 90 top grossing dramatic films for adults. MAIN OUTCOME MEASURES Time to first on-screen death. RESULTS Important characters in children’s animated films were at an increased risk of death compared with characters in dramatic films for adults (hazard ratio 2.52, 95% confidence interval 1.30 to 4.90). Risk of on-screen murder of important characters was higher in children’s animated films than in comparison films (2.78, 1.02 to 7.58). CONCLUSIONS Rather than being the innocuous form of entertainment they are assumed to be, children’s animated films are rife with on-screen death and murder. [ABSTRACT FROM AUTHOR]