In research on the mental health of Indigenous populations in Canada there is a growing trend towards recognizing the important role that Indigenous histories and cultures play as determinants of health. For example, recent research has examined the relationship between speaking an Indigenous language or participating in traditional Indigenous activities and mental health [
1,
2]. There is also increased recognition of the ongoing impact of colonialism on the intergenerational transmission of Indigenous histories and cultures, and the resulting effects on the health and wellbeing of Indigenous communities. Colonial instruments, such as the residential school system and laws governing membership in Indigenous communities, continue to have gender-specific impacts on access to Indigenous networks and communities that are critical for many Indigenous people’s wellbeing [
3]. This paper seeks to contribute to this growing body of literature by using the 2012 cycle of the Aboriginal Peoples Survey (APS) to examine the relationship between social capital from Indigenous-specific sources and two mental health outcomes—self-rated mental health (SRMH) and heavy episodic drinking (HED).
SRMH and HED are both potential indicators of a persons overall mental health, and are helpful when studying populations that, like many Indigenous populations, face significant systemic barriers in accessing formal mental health services [
4]. In this case we have elected to study both outcomes to help account for the different manifestations of mental health among Indigenous men and women. Based on previous literature, we predict that Indigenous women will on average report worse SRMH and Indigenous men will report higher incidences of HED [
2,
5]. Studying both outcomes allows us to assess the relationship between social capital and mental health outcomes that are both more common and less common among each gender. Examining the influence of gender on the relationship between social capital and mental health also helps acknowledge and account for the significant gender-specific in experiences with colonialism present in the Indigenous populations of Canada [
6,
7].
The significance of self-rated mental health and heavy episodic drinking
SRMH and HED are useful tools for broadly examining mental health, since they are both indicative of a persons’ overall mental health, but the presence of poor SRMH or HED does not necessarily conclude a mental health disorder. This is especially helpful when studying Indigenous populations that often face systemic barriers in accessing health services, such as discrimination or geographically inaccessible services, which may impact rates of medically diagnosed mental illness [
3,
8].
SRMH measures offers a more holistic approach to studying mental health, which is especially important in research on Indigenous populations, as several Indigenous scholars stress the importance of holistic health to many Indigenous peoples [
9‐
12]. Furthermore, poor/fair SRMH ratings are significantly more likely among those reporting a diagnosed mental disorder and those meeting the criteria for past-month depression [
9], which makes the measure a useful proxy for mental health disorders that may be under diagnosed among Indigenous populations due to systemic barriers. Low SRMH is also linked to other negative mental health outcomes, including distress and suicidal ideation, that are currently prevalent in serious numbers in the Indigenous populations of Canada, further supporting the measures’ significance among the Indigenous population [
1,
10,
11]. Overall, SRMH allows for a more holistic assessment of mental wellbeing, without requiring respondents to have a medically diagnosed disorder.
HED—typically operationalized as five or more drinks on one occasion—is also a potentially useful tool for examining mental health among the Indigenous population, as it is associated with many of the same negative mental health outcomes that are prevalent in some Indigenous communities. For example, excessive alcohol use correlates with rates of suicidal ideation and attempts, as well as self-reported feelings of depression and anxiety [
13‐
16]. HED is also generally more prevalent than diagnosed mental health disorders [
13‐
16], and can therefore serve as a useful indication of overall mental wellbeing in contexts where systemic barriers may lead to an under diagnosis of mental health disorders. Overall, both SRMH and HED can offer insight into wellbeing and overall mental health, albeit in different ways.
Social capital as a predictor of mental health outcomes
Social capital can be broadly defined as relationships, networks, and norms that individuals can access to serve their interests [
17]. Previous research on a variety of different populations and contexts has linked social capital variables—community participation, trust, cohesion, family connections, etc.—to self-rated mental health, psychological wellbeing, and other mental health outcomes [
18‐
21]. Several studies have also examined the link between social capital and alcohol consumption, although many of these studies focused exclusively on adolescent populations and those that examined adult populations revealed conflicting results [
22‐
27]. Overall, there is substantial evidence that social capital can be a salient predictor of mental health outcomes, including alcohol consumption, in a variety of contexts.
Although the relationship between social capital and mental health outcomes has not been thoroughly studied among the Indigenous populations of Canada, community integration is known to be integral to understandings of wellbeing among many of these populations. Traditional Indigenous conceptualizations of health are often holistic, encompassing not only physical wellbeing but also mental, emotional, and spiritual wellbeing [
12]. Connections to the land, the use of language, cultural food practices, and the strength of interpersonal relationships are all important components of many Indigenous people’s understanding of health [
12]. Throughout the last few centuries, colonialism in Canada has contributed to many of the aforementioned mental health problems that Indigenous communities face today through directly undermining these communities’ access to Indigenous networks, cultural norms, and relationships [
12,
28]. For example, colonial instruments such as forced relocation and residential schooling created physical barriers separating Indigenous individuals from communities, while also decreasing the transmission of Indigenous cultural norms and practices, such as the use of Indigenous languages, cultural food preparation, or traditional healing practices, that were central to many Indigenous people’s wellbeing [
12,
28]. Taken together, the importance of community integration in many Indigenous people’s conceptualization of health, and the continued degradation of this integration by colonialism, illustrate the potential role of social capital as a predictor of mental health outcomes among Indigenous populations.
In this paper we adopt an operationalization of social capital that allows for an analysis of Indigenous-specific social capital—that is, social capital coming from Indigenous relationships, networks, and norms. Proxies for Indigenous-specific social capital include factors like participation in traditional Indigenous activities and involvement in Indigenous communities [
17]. Currently these proxies are often included in models individually—e.g. examining if speaking an Indigenous language predicts heavy drinking [
2]. This can lead to conflicting results where participation in Indigenous communities and activities sometimes appears to be a protective factor against disease and other times not [
1,
2,
29]. Social capital offers a different way of conceptualizing the relationship between these proxies and mental health outcomes, which could overcome the weaknesses of examining them individually. Therefore, we adopt here a holistic view to look at overall levels of immersion in Indigenous communities and networks—i.e. social capital—as opposed to whether or not participation in a single traditional Indigenous activity is correlated with a single outcome.
Gender variations in health among indigenous populations
Gender is increasingly recognized as a key social determinant of health, as there are significant gender differences in many predictors of health [
30,
31]. For example, women are on average more socioeconomically disadvantaged and face more job precarity than men [
31,
32]. However, young men typically engage in more risky behaviors than women, such as recreational drug use, which can negatively impact their health later in life [
31]. Despite this increased recognition of gender as an important determinant of health, in the recent literature on the mental health of Indigenous people in Canada there is a noticeable lack of papers examining the influence of gender [
1]. This literature gap is surprising considering significant evidence that Indigenous peoples’ experiences with colonialism can be extremely gendered [
3,
33].
Colonial instruments were often specifically designed to affect Indigenous men and women in different, unique ways [
3,
6]. For example, until 1985 under Canadian law any Indigenous women who married a non-Indigenous man lost the right to membership in Indigenous communities—the same was not true for Indigenous men who married non-Indigenous women [
3]. This had the effect of directly severing community and cultural ties for many Indigenous women and their descendants, ties that are critical for many Indigenous people’s wellbeing [
3,
12]. Indigenous men, meanwhile, have been uniquely affected by the absence of fathering in many Indigenous communities, attributable in part to the legacy of the residential school system [
34]. This absence has in turn contributed to the increased prevalence of mental health problems in these same communities [
34]. The evidence on gendered experiences with colonialism and health outcomes among Indigenous populations in Canada suggests that gender may be strongly related to both social capital and the two mental health outcomes. Therefore, a significant portion of this paper focuses on examining gender variations in the relationship between social capital and the mental health outcomes of interest.
A recent review of the literature on gender and SRMH seems to suggest that women are more likely to report worse SRMH, although several papers report no difference between men and women [
5]. There is also no identifiable research specifically examining gender differences in SRMH among the Indigenous populations of Canada. Furthermore, although research on HED among the general Canadian population consistently suggests that men engage in more HED than women, research on HED among Indigenous populations is inconclusive on the relationship between gender and HED [
13,
35,
36]. A 2016 study by Ryan et al. on heavy drinking among First Nations and Métis in Canada using the Aboriginal Peoples Survey (APS) found that men had significantly higher rates of heavy drinking [
2]. As we are using the same survey as Ryan et al., we predict similar results, although we also hope to expand on their findings by examining the First Nations, Métis, and Inuit populations separately.
The First Nations, Métis, and Inuit populations have distinct cultures and histories, and have had very different experiences with colonialism. For example, Métis, and in particular Métis women, were uniquely targeted by government legislation and treaties that sought to erase the Indigenous identity of Métis communities [
34]. Despite these unique historical and cultural experiences, and the resulting unique demographics of each population [
37], few papers on the mental health of Indigenous people in Canada examine the three populations separately [
1]. In this paper, we examine the Indigenous population as a whole as well as the First Nations, Métis, and Inuit populations separately, to address this gap in the literature and allow for the possibility of unique outcomes among the different populations due to each group’s distinct histories, cultures, and demographics.
This paper further expands on the work of Ryan et al.—and other prior research examining gender variations in health among Indigenous populations—through our analysis of social capital as a predictor of SRMH and HED. Given that the literature on Indigenous health frameworks suggests gender may be related to both mental health outcomes and access to social networks, we predict that Indigenous-specific social capital will be a better protector against outcomes that are more prevalent among a certain gender. Indigenous-specific social capital should therefore have a more significant protective effect against HED among Indigenous men, since we expect HED to be more prevalent among Indigenous men than Indigenous women. Similarly, Indigenous-specific social capital should have a stronger protective effect against fair/poor SRMH among Indigenous women, as we expect that fair/poor SRMH will be more prevalent among Indigenous women than Indigenous men.