Psychological distress and community exclusion in Indigenous communities: a convergent parallel (mixed methods) study

Abstract

Indigenous people make up approximately 3% of the Australian population, but carry a heavy burden of mental ill-health. Almost 75% of Indigenous people have moderate to severe scores on the Kessler 10 measure of psychological distress. Robust research recognises racism as a risk factor for depression and social exclusion. However, there are significant within-community factors that add to the level of psychological distress. Using Bronfenbrenner’s ecological social capital model, Tajfel’s social identity theory and a created model of indigenist research (the Yerin Dilly Bag model) a 52-item questionnaire was created for a mixed method, parallel convergent study to answer the research questions: 1) What are the risks and protective factors that contribute to psychological distress in Indigenous populations?; 2) What is the self-perceived level of community inclusion / exclusion of Indigenous Australians?; 3) Is being manifestly Indigenous a protective factor for the psychological distress of Indigenous Australians?; and 4) What interactions of Indigenous participants with their communities add to the prediction of psychological distress? Using a purposive snowball sampling technique, 172 participants from 3 Indigenous communities completed either a hard or electronic questionnaire that assessed the perceived level of their community inclusion, their skin colour scores, their level of psychological distress and using a modified Measure of Indigenous Racism Experiences (Paradies, 2006), their experience of lateral violence, or community exclusion. Of these participants, 32 were interviewed using eco-map genograms to prompt narrative style questions about their life experiences, ending in 45.5 hours of recorded interviews. Quantitative data was scored using SPSS V23, with descriptive and interpretive results obtained. Qualitative findings were coded using thematic analysis. Both data sets were then triangulated looking for silence, dissonance, and agreements, using Bronfenbrenner’s four systems of ecological social capital model. Results demonstrated that the most reliable predictor of psychological distress in Indigenous people was community exclusion. The risk factors for community exclusion are living off country, having a different skin colour to the majority of the community (either darker or fairer), and not being involved with the Indigenous people in one’s family. Interventions to improve mental well-being are best placed in the mesosystem of Bronfenbrenner’s model, and might include increasing access to family support services, and alternative ways of being formally recognised as ‘Indigenous’. The Yerin Dilly Bag model is a useful method for working in Indigenous communities as it keeps the focus of the research on the best outcomes for Indigenous communities, where the focus should always be. Policy makers need to consider vehicles of community and social inclusion to decrease psychological distress and its concomitent risk of depression in Indigenous people and communities. Indigenous communities are often violent places, and all interventions need to have community inclusion as a core component. Unless this root cause of psychological distress is addressed, Indigenous Australians will continue to live with a high risk of inter and intra generational depression. Show more