Association between intergenerational solidarity involving elders and mental health of Indigenous people living off reserve

Indigenous people generally face more important mental health and wellness issues than the non-Indigenous population in Canada, as a result of disparities in living conditions, education, housing, and economic development [1‐4]. These disparities are enhanced by the fact that the theories and practices used in western health services cause inequities, cultural insecurity, and even harm to Indigenous people [5, 6]. Monitoring the determinants of Indigenous health, such as education and relationships with family and friends, is key to developing appropriate health services [7]. Moreover, culturally sound health services need to be implemented, as approaches based on western science fail to properly address the issues experienced by Indigenous people [8, 9]. For this purpose, holistic approaches that consider all dimensions of wellness and focus on the strengths of individuals and communities may produce better results than interventions focusing on specific problems without considering interactions between dimensions [10].

Elders play an important role in Indigenous communities, notably by transmitting knowledge, values, and culture, hence fostering identity-building through intergenerational solidarity [11‐14]. The social participation of elders thus contributes to the development of positive attitudes and behaviors in Indigenous communities [13]. More specifically, Indigenous elders contribute to the development of inner strength, resilience, harmony, self esteem, meaning of life, emotion management, family relationships, as well as formal and informal education [13]. Studies with Indigenous and non-Indigenous elders have shown that their involvement in intergenerational activities provides benefits to themselves (functional and intellectual skills), but also to youth (meaning of life), families (development of a network) and communities (vitality, governance) [15‐17]. Hence, intergenerational solidarity involving elders should be considered to develop holistic approaches to healthcare and wellness [18, 19]. Intergenerational solidarity is composed of intimacy (affectual solidarity), agreement (consensual solidarity), dependency (functional solidarity), integration (associational solidarity), opportunities for interaction (family solidarity), and familism (normative solidarity) [20]. Intergenerational solidarity is part of more general social support, which is the perception of being part of a network encompassing four functions: emotional, tangible, informational and companionship [21].

Holistic approaches to health and wellness based on the contribution of Indigenous elders to intergenerational solidarity could positively influence mental health of community members, for example, reducing mood disorders, anxiety, and suicide [22, 23]. To benefit from the role that elders can play in the health and wellness of Indigenous people, it is essential to have a better understanding of how intergenerational solidarity influences mental health outcomes of Indigenous community members. To our knowledge, none of the studies documenting intergenerational solidarity has investigated these associations so far. Hence, in the present study, we aimed to verify the association between intergenerational solidarity involving Indigenous elders and mental health outcomes of Indigenous people living off reserve.

We conducted secondary analyses of data retrieved from the Aboriginal Peoples Survey (APS) conducted in 2012 by Statistics Canada [27]. More than 50,000 individuals were selected to participate in this cross-sectional survey, and data on socioeconomic conditions were obtained from 28,410 Indigenous respondents aged 6 years and older, living off reserve in private dwellings in Canada. The sample design used stratification-specific domains of estimation (geographical regions, education level and Indigenous group, i.e. First Nation, Metis or Inuit) [27].

Respondents were 30 years old on average, slightly more than half were women, and almost all lived in an uncrowded household (Table 1). While men and women did not have significantly different levels of material deprivation, women experienced more social deprivation than men.

In terms of intergenerational solidarity, more than one third of the respondents spent time with an elder, and less than one out of ten indicated they would turn to an elder or a grandparent for support in times of need (Table 2). With regards to mental health outcomes, women more often perceived their mental health as fair or poor than men. The proportion of women experiencing mood disorder or anxiety was twice higher than that of men (Table 2). In addition, about one out of 20 respondents had suicidal thoughts in the last 12 months, and this proportion did not significantly differ between men and women. Suicide attempts were about two times more frequent in woman than men.

After adjusting for age and level of material and social deprivation, Indigenous people living off reserve who lacked intergenerational solidarity were more likely to experience mental health issues (Table 3). Men not having spent time with an elder were more likely to have mood disorders (Table 3). Women who mentioned that they would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health and anxiety (Table 3). Moreover, women not having spent time with an elder were more likely to have reported suicidal thoughts in the last 12 months (Table 3). Finally, women who would not turn to an elder or grandparent for support in times of need were more than three times more likely to have attempted suicide.

We aimed to verify the association between intergenerational solidarity involving Indigenous elders and mental health outcomes of Indigenous people living off reserve. We found partial association between intergenerational solidarity involving elders and mental health in Indigenous people living off reserve. Men were more likely to have mood disorders if they had not spent time with an elder. Women who would not turn to an elder or a grandparent in times of need were more likely to have anxiety disorders and much more likely to attempt suicide. Women who had not spent time with an elder were more likely to report suicidal thoughts.

As intergenerational solidarity is part of the more general social support from family and friends, our results are in line with those of previous studies that demonstrated the importance of social support for mental health in various populations [29], including Indigenous people [30]. The latter study showed that having higher social support significantly decreased the likelihood of depression and anxiety in women, but not in men. Men and women might experience depression and anxiety differently, or the data collection tools used by Bernards et al. [30] might not have adequately captured social support as experienced by men. Higher perceived social support has been related with fewer symptoms of anxiety and a lower risk of suicidal thoughts and attempts [31, 32]. The higher rate of suicidal attempts in women should be interpreted with caution, as men are less likely to survive after suicidal attempts because they use more drastic means [33]. A meta-analysis showed that having high social connections (subjectively and objectively) was positively associated with good mental health, lower risk of mortality, and better health habits [34]. Specifically, having high social connections was associated with a 50% higher proportion of survival [34], for both men and women. When faced with cultural challenges, social support could be more beneficial to mental health for people with lower socioeconomic conditions and education level [35].

It has been largely shown that positive social connectedness is associated with better psychological wellbeing and mental health [34‐36]. In fact, positive interactions with those who are closest such as our intimate friends and family members have significant effect to positively change our mood. At long, these interactions may serve as a buffer against stressors and build resiliency. In opposition, social isolation has adverse consequences on health and mental health. Moreover, loneliness has been associated with depressive symptomatology and suicidal ideation [36]. As a form of social support, indigenous elders contribute to the transmission of values, culture and collective identity, hence fostering community cohesion and development [13, 15]. In the present study, focusing on the role of Indigenous elders in intergenerational solidarity highlighted that their contribution to more general social support improves mental health outcomes of younger generations. Previous studies had shown the key role of intergenerational solidarity within the social support mechanisms that improve mental health [37]. Indeed, Indigenous elders contribute to a sense of belonging to family, community and peers that helps youngers to deal with adversity [13] Moreover, greater social participation increases resilience and sense of community belonging [38] including by indigenous Elders [12]. Resilience allows one to recover good mental health after adverse, stressful or traumatic experiences [39]. A higher sense of community belonging facilitates elder involvement in the teaching of traditional knowledge, values and practices [11‐13].

We found a significantly higher rate of social deprivation among Indigenous women, which could explain why they benefited more from intergenerational solidarity than men for most mental health outcomes. Indeed, Belsky et al. [40] demonstrated that intergenerational relations were more beneficial for persons experiencing lower socioeconomic conditions and having less social interactions or support. Considering the benefits of spending time with an elder or turning to an elder or grandparent in times of need, mental health services could be improved by enhancing interactions with elders [22, 23].

Future studies should aim to better understand the differential associations between intergenerational solidarity and mental health outcomes in Indigenous men and women, especially mood disorders for men and anxiety and suicidal thoughts and attempts for women. Future studies using qualitative data (in-depth interviews) should also examine the quality of relationships, beyond merely spending time with elders. Moreover, further research is needed to understand how the association between intergenerational solidarity and mental health outcomes vary according to age, as well as social and material deprivation.

Our study had limitations. First, respondents to the APS could have felt discomfort when prompted by strangers to talk about mental health issues, which may have led to their underreporting due to a social desirability bias [41]. Moreover, for people with a physical or mental disability, the questions were answered by a proxy, possibly not representing the real answers, especially for mental health issues. In addition, proxy variables for intergenerational solidarity might not have allowed us to fully depict the complexity of such associations. Moreover, intergenerational solidarity is one aspect of the larger concepts of social support and social connectedness, which were not considered in the present study specifically interested in the role of elders, of key importance in Indigenous contexts [11‐14]. Among the limitations of the study, it should be noted that our analyzes were carried out using pre-existing data, so we did not have access to all the variables that could have been of interest. Even though the association between intergenerational solidarity and mental health issues were adjusted for material and social deprivation, future studies should clarify the importance of broader intergenerational solidarity according to other dimensions of social support and connectedness. Finally, our results only apply to Indigenous people living off reserve. Similar studies are crucially needed for Indigenous people living in reserves and communities, but unfortunately data are currently lacking.

We found associations between intergenerational solidarity involving elders and mental health outcomes in Indigenous people living off reserve. Our results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations. With this guidance, Indigenous elders could also be more involved in the development of mental health and wellness programs to foster a holistic approach and cultural safety.