Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way

Abstract

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.

Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescents

“…Moreover, the Indigenous clinical group had a greater SAS than the non-Indigenous clinical group. DSM mental disorders and Intelligence Quotients for the three groups are reported in Vance et al (2022).…”

Culture, Health and Wellbeing: Yarning with the Victorian Indigenous community

“…Culture profoundly affects all aspects of our Indigenous participants' lives: it is a central rather than peripheral factor in being healthy and maintaining health and well-being, and in the onset, progression and treatment response of mental disorder (Vance et al, 2023). Indeed, Tseng (2006) outlines that culture is crucial for the formation of mental disorder, its clinical manifestation, frequency and severity, the coping styles used to manage stress linked to disorder and its ultimate management.…”

“…The mental health of Indigenous young people (12-25 years) is significantly worse than their non-Indigenous peers; a much higher percentage report high or very high levels of psychological distress (33% vs 13%) and/or a long-term mental health condition (29% vs 16%), are hospitalized for injury or poisoning (37% vs 23%), or die from injury or poisoning (52% vs 18%), are hospitalized for intentional self-harm (5% vs 2%), or die from intentional self-harm (29% vs 7%) (AIHW data, 2018). Moreover, mental illness remains an independent risk factor for worse overall health status and premature death and its effects are known to be large, long-lasting and potentially trans-generational (Deferio et al, 2019;Vance et al, 2022).…”