The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities

Abstract

Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada’s child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008–2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25–8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94–5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00–3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63–10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04–7.99), violence (HR: 2.54, 95%CI: 1.52–4.27) or overdose (HR: 4.97, 95%CI: 2.96–8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23–1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.

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

“…These findings are consistent with previous prospective studies of Indigenous youth in British Columbia that showed that having at least one parent who attended IRS was associated with twice the odds of having been in the care of the CWS compared to youth without familial IRS exposure [ 22 , 23 ]. In this same BC cohort, young Indigenous mothers who reported recent child removal, were more likely to have a parent who attended IRS, and most (70%) had been in CWS care themselves as children [ 24 ]. Moreover, among Indigenous adults from across Canada who were born during the Sixties Scoop era we found that parental IRS attendance increased the odds of spending time in the CWS, and that this relation was mediated by adverse childhood household experiences [ 11 ].…”

“…However, few studies have empirically explored the link between IRS exposure, subsequent parent-child separations, and distress levels. Existing studies typically comprised non-representative samples of Indigenous adults and/or young people living off-reserve [ 11 , 22 , 23 , 24 ]. The current studies explored the link between intergenerational IRS exposure (i.e., those who had a parent and/or grandparent who attended IRS), parent-child separation, and youth psychological distress in a nationally representative sample of First Nations youth living on-reserve and in northern communities in Canada (Study 1).…”

Adverse childhood experiences (ACEs) are increasing in indigenous populations in Canada: Now what?

“…Although there is more literature on programmes and policies that have demonstrated effectiveness within non-Indigenous communities, similar analyses have yet to be completed within Indigenous populations. The programmes described in (Perdacher et al, 2019;Gutierrez et al, 2018) Social services -Prioritize Indigenous systems of child welfare with First Nation communities (Haight et al, 2018) -Increase holistic wellness supports for families whose children must be apprehended (Ritland et al, 2021) -Increase accessibility to preventative or alternative sector services rather than child welfare (Sinha et al, 2013) -Income -Provide equitable funding for Indigenous children in child welfare systems (Blackstock, 2016) -Health care -Promote Indigenous-led healthcare partnerships (Allen et al, 2020) -Increase cultural and trauma-informed training in health settings (Cullen et al, 2021;Rizkalla et al, 2020) -Improve access to community-based primary care services (Tompkins et al, 2018; have some support for promoting wellness among Indigenous communities, although more research is required to explore how such programmes can be implemented collaboratively to reduce exposures to ACEs. Among these proposed programmes and strategies, it is likely that it is not the individualization of programmes that will warrant the most benefit within Indigenous communities, but the intersectional implementation of strategies across sectors.…”

“…Increase holistic wellness supports for families whose children must be apprehended (Ritland et al, 2021)…”

Introduction to the PLOS ONE collection on ‘Understanding and preventing suicide: Towards novel and inclusive approaches’

“…For example, the study by Gebremeskel found the prevalence of suicidal ideation to be high among Eritrean refugees in Tigray, Ethiopia, in particular amongst those with a previous history of trauma, post-traumatic stress disorder, and a family history of mental illness [ 24 ]. Finally, the study by Ritland and colleagues identified a relationship between child apprehension and suicide attempt among a cohort of young Indigenous women in Canada who had been impacted by substance use [ 25 ].…”