Racial discrimination and depression among on-reserve First Nations people in rural Saskatchewan

OBJECTIVES: To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender. METHODS: As a component of a community-based participatory research project, a cross-sectional, interviewer-administered survey of 874 adults living on 2 Cree First Nation reserves in rural north-central Saskatchewan was conducted during May-August in 2012 and 2013. Self-reported, health-provider diagnosis of depression was the dependent variable and experiences of interpersonal racial discrimination was the primary exposure. Chi-square and multiple logistic regression were the main analytic techniques. Generalized estimating equations were applied to account for clustering within households. RESULTS: Overall, 64% of participants reported being treated unfairly in 1 or more situations because of their ethnicity; 38% indicated discrimination occurring in 3 or more situations. Nineteen percent reported a diagnosis of depression. Adjusted analyses indicated that compared to those with no experience of racial discrimination, those reporting 1-2 and 3 or more situations were 1.77 times (95% CI: 1.06-2.95) and 1.91 times (95% CI: 1.19- 3.04) more likely to have diagnosed depression respectively. The relationship between racial discrimination and depression was not modified by gender, although women were 1.85 times (95% CI: 1.24-2.76) more likely to report depression than men. CONCLUSION: Interpersonal racial discrimination was associated with depression among First Nations women and men in rural Saskatchewan. Research directed at identifying the most efficacious interventions, programs and policies to combat racism is required to advance the goal of health equity. KEY WORDS: Racial discrimination; First Nations; depression OBJECTIFS : Determiner, chez les membres des Premieres Nations de la Saskatchewan vivant dans des reserves en zone rurale, si la discrimination raciale est associee a la depression et si, en retour, cette relation est modulee par le sexe. METHODE : Dans le cadre d'un projet de recherche participative communautaire, nous avons mene une enquete transversale administree par un intervieweur aupres de 874 adultes vivant dans deux reserves de la Premiere Nation crie dans le centre-nord rural de la Saskatchewan entre mai et aout en 2012 et en 2013. La variable dependante etait un diagnostic de depression autodeclare pose par un dispensateur de soins de sante, et l'exposition directe etait l'experience de la discrimination raciale interpersonnelle. Nos principales techniques etaient l'analyse du khi-carre et l'analyse de regression logistique multiple. Nous avons applique des equations d'estimation generalisees pour tenir compte des regroupements au sein des menages. RESULTATS : Dans l'ensemble, 64% des participants ont declare avoir ete traites injustement dans une situation ou plus en raison de leur ethnicite; 38% ont fait etat de discrimination dans trois situations ou plus. Dix-neuf p. cent ont dit avoir un diagnostic de depression. Les analyses ajustees ont indique que comparativement aux repondants n'ayant aucune experience de discrimination raciale, ceux qui ont declare une ou deux situations et trois situations ou plus etaient 1,77 fois (IC de 95% : 1,06-2,95) et 1,91 fois (IC de 95% : 1,19-3,04) plus susceptibles d'avoir un diagnostic de depression, respectivement. La relation entre la discrimination raciale et la depression n'etait pas modulee par le sexe, mais les femmes etaient 1,85 fois (IC de 95% : 1,24-2,76) plus susceptibles de declarer un diagnostic de depression que les hommes. CONCLUSION : La discrimination raciale interpersonnelle etait associee a la depression chez les femmes et les hommes des Premieres nations vivant en zone rurale en Saskatchewan. Pour atteindre l'objectif de l'equite en sante, il faut faire de la recherche pour determiner quels sont les interventions, les programmes et les politiques les plus efficaces pour combattre le racisme. MOTS CLES : discrimination raciale; Premieres Nations; depression
Racial discrimination is increasingly recognized within the population health literature as an important determinant of health inequities. Different levels of racial discrimination exist, ranging from structural to interpersonal, the latter [...]