Abstract
BACKGROUND:
The Indigenous workforce in Canada is challenged by a history of Euro-Canadian colonialism that has presented deleterious health outcomes, including those in the workplace.
OBJECTIVE:
The aim of this study was to describe the mental health of Indigenous workers in the workplace.
METHODS:
We used the Canadian Community Health Survey (CCHS) between 2015 to 2016. Data were analyzed using the Public Use Microdata Files to profile the workplace mental health characteristics of First Nation Canadians (n = 6,297) and Canadians (n = 84,155). We utilized secondary data analysis design. The analyses included descriptive statistics (e.g., means and standard deviations) of self-reported mood disorders (depression, bipolar, mania, dysthymia), anxiety (phobia, OCD, panic) and occupational factors (e.g., demographic, days off work due to an acute mental health condition, job type, and job stress) in indigenous peoples living off-reserve and other Aboriginal settlements in the provinces.
RESULTS:
We examined the indigenous cohort between the ages of 18–64 who were employed. The sample was 53.1% male, married (34.8%), and obtained a post-secondary diploma or university degree (57.9%). The study reported statistically significant gender and age differences across mood and anxiety disorders (p < 0.05), job stress (p < 0.05) and workload (p < 0.05).
CONCLUSION:
To the best of our knowledge, this is the first study to describe the work profile of indigenous populations in Canada across various occupational mental health (e.g., mood disorders, anxiety) and demographic (e.g., age, education attainment) outcomes.
Introduction
In Canada, mental health inequality in terms of access, delivery and outcomes among Indigenous people is a significant concern [1]. A study by Kolahdooz et al. highlights that lack of research, knowledge and information about intersecting identities and factors such as income, barriers to accessing education, and social circumstances perpetuate lower health status and work-related [2] outcomes among Indigenous peoples in Canada.
Mental health hospitalization rates are higher among indigenous communities in Canada [3]. The forced assimilation of indigenous people into mainstream Canadian society has contributed to the existing mental health disparities. The damage inflicted by Canada’s colonial systems is emblematized by the residential school system, where indigenous children were forcefully separated from their families, forbidden from engaging in cultural practices and speaking their native languages.
The mental health and well-being of adolescents living on reserves are important as they prepare to enter the workforce. While outdoor activities focusing on adventure and leadership have been shown to foster resiliency based on self-reported health and well-being, there is a need for future research to investigate the long-term impact and retainment of these benefits. It is also important to critically reflect on how culturally compatible these common interventions developed surrounding the needs of the Canadian population are [9]. This is another indication that Indigenous Canadians experience barriers to accessing health care and other needs from all age groups; those currently in the workforce and future generations to come. Such barriers include workplace discrimination for indigenous people who may work along with employees and employers who hold discriminatory perspectives and exclude indigenous people in the labor force [4–6]. Furthermore, the discriminatory perspectives held by co-workers may impact an indigenous worker’s mental health [6, 7].
Similarly, the residential school system’s impact on Indigenous peoples includes distress and trauma, leaving long-lasting psychological and intergenerational impacts that cannot be overlooked for affected individuals [8, 9]. Despite this, existing research regarding the mental health of Indigenous workers comprises uneven representations of populations, and in general, it appears to be lacking [10]. Given that Canada’s indigenous population is growing rapidly [11], there is a compelling need for additional research regarding indigenous workers’ mental health outcomes.
In addition to mental health disparities, indigenous peoples in Canada persistently experience socio-economic inequities. For example, they experience higher unemployment rates and poverty and have lower per capita incomes than non-First Nations Canadians [14]. The Mental Health Strategy for Canada emphasizes mental health in everyday settings, including the workplace. [12] Despite this, there is a dearth of current research on occupational mental health outcomes. Understanding indigenous workers’ occupational mental health outcomes will help policymakers address the persistent disparities affecting indigenous workers and bring Canada closer to health equity.
The abovementioned research aligns with the hope of this paper to address one of the many aspects that contribute to the success of Indigenous workers in the workforce: workplace mental health. Accordingly, this paper aims to profile the workplace mental health of indigenous workers in Canada using the 2015–2016 Canadian Community Health Survey (CCHS).
Methods
The 2015–2016 CCHS was a cross-sectional study that collected information related to health status, and the Canadian population’s health determinants. The CCHS was created and distributed by Health Canada, the Public Health Agency of Canada, Statistics Canada, and the Canadian Institute for Health Information (CIHI) [16]. The CCHS surveys a large sample of respondents and is targeted to provide reliable estimates at the health region level [14]. For this study, data was acquired from the most recent and available self-reported CCHS between 2015 to 2016 using the Public Use Microdata Files (PUMF) [13]. The CCHS survey collected data from approximately 130,000 Canadians aged 12 and older, and the collected content included a wide range of health-related topics. Respondents living on Indian Reserves and on Crown Lands, institutional residents, full-time members of the Canadian Forces, youth aged 12 to 17 living in foster homes, and residents of certain remote regions were excluded from the survey [14]. The CCHS survey includes approximately 98% of the Canadian population over 12 [14]. All analyses were performed using data from the PUMF provided by Statistics Canada using descriptive statistics.
Variables
The study’s primary outcomes were self-reported according to the 2015–2016 CCHS annual component and user guide definitions of mood disorders (depression, bipolar, mania, dysthymia) and anxiety disorders (phobia, OCD, panic) among indigenous workers in Canada [14]. The variables included in this analysis included: age, sex, days off work due to an acute mental health condition, job type, job stress, occupation type, full- or part-time employment status, reasons for missing work, the number of workdays lost due to a mental health condition in the previous three months, working status in the last week, number of days missed due to an acute mental health condition, perceived stress at work and workload as a barrier to improving self-reported health. The perceived stress at work is rated on a five-point scale ranging from 1 (Not at all stressful) to 5 (Extremely stressful).
Ethics
Secondary analysis of the CCHS data (Statistics Canada) does not require informed consent at our institution and may be used under the Statistics Act for research purposes.
Data analyses
The Stata svyset command was used to operationalize the sampling design features in the PUMF files using Stata version 11.0 [15]. The sample weights were applied to obtain estimates and 95% confidence intervals (svy: proportion). The variables x1 (i =1, 2) follow binomial distributions with parameters n
i
and p
i
, where p
i
is the proportion of respondents of the CCHS in population i confirming a specific outcome. The purpose was used to compare both these proportions by means of a test of H0 = p1 = p2. Since under H0 the probability of a 2×2 table is represented by:
When the sample sizes are large, as in the case of the CCHS PUMF, it is feasible in substituting p by its estimator in the joint sample
Results
Demographic results
We examined the indigenous population between the ages of 18–64 who were employed. The sample was 53.1% male, 34.8% married 34.8% and 57.9% had obtained a post-secondary diploma or university degree (See Table 1). In terms of employment, 40.3 % of First Nation females worked in management, sciences, health, education, arts, culture, 33.8% in sales and service, business, 20.2% in finance, administration, 3.0% in the primary industry, processing, manufacturing and utilities and 2.7% in the trades, transportation and equipment operator. Thirty-five percent of indigenous men were employed in trades, transportation and equipment operator, 25.2% in management, sciences, health, education, arts, culture, 19.3 in sales and service, 13.7% in the primary industry, processing, manufacturing and utilities and 6.5% in business, finance, administration. The breakdown by sex is shown in Table 2.
Demographic profile of indigenous peoples and overall Canadian populations
Demographic profile of indigenous peoples and overall Canadian populations
Occupational profile of Indigenous and overall Canadian populations
In the indigenous sample, 9.5% self-reported a mood disorder and 11.9% reported an anxiety disorder. In the overall sample, 7.5% of Canadians self-reported a mood disorder and 7.49% reported an anxiety disorder. Differences in sex and age were also observed (see Table 3). Specifically, 5.5% of indigenous men and 13.3% of women self-reported a mood disorder, while 7.6% of men and 16.1% of women self-reported an anxiety disorder. We also found higher percentages of self-reported mood disorders in all but three age categories for indigenous men when compared to the overall sample. For anxiety disorders, indigenous men of all age groups reported higher self-reported anxiety disorders when compared to the overall sample. For women, we found a similar trend, with more indigenous women reporting mood disorders in all but two categories compared to the overall sample. All indigenous women, irrespective of the age group, reported higher self-reported anxiety disorders compared to the overall sample. In the overall sample, 4.98% of Canadian men and 10.2% of women self-reported a mood disorder, while 5.1% of men and 9.96% of women self-reported an anxiety disorder.
Self-reported mental health conditions among employed Indigenous and overall Canadian populations
Self-reported mental health conditions among employed Indigenous and overall Canadian populations
Note. *Not statistically significant at p = 0.05.
Regarding work stress, 18.6% of First Nation Canadians reported that most days at work were ‘Quite a bit stressful,’ and 4.1% reported that they were ‘Extremely stressful’. In the Canadian sample, 22.9% reported their day at work as ‘Quite a bit stressful,’ and 3.9% reported that they were ‘Extremely stressful.’ We also found sex and age differences between both cohorts (See Table 4). Among indigenous men, 15.8% reported that most days at work were ‘Quite a bit stressful,’ and 3.36% reported that they were ‘Extremely stressful.’ Among indigenous women, 21.1% reported their day at work as ‘Quite a bit stressful,’ and 4.8% reported ‘Extremely stressful.’ On average, 3.8% of indigenous workers missed 4.9 days of work each year due to an acute mental health condition. In the overall sample, 1.9% of Canadians reported missing 3.5 days. We also found higher percentages of self-reported job stress and workload in all but one age category for indigenous men when compared to the overall sample. For indigenous women, the differences for self-reported job stress were found in all but three age groups and among all age groups for self-reported workload levels compared to the overall sample.
Self-reported stress at work and workload among working Indigenous and Canadian populations
Note. ¥Self-reported that most days at work were ‘Quite a bit stressful’. *Not statistically significant at p = 0.05.
This study sought to understand indigenous Canadians’ mental health, well-being and perceived occupational stress compared to the overall population, using the most recent CCHS data. Our results revealed that indigenous Canadians consistently report higher mood and anxiety-related disorders than the broader Canadian population. This finding is consistent with previous data within this population, suggesting that indigenous peoples continue to face poorer mental health outcomes than their non-indigenous counterparts [4].
Psychological disorders, including mood and anxiety-related disorders, are the leading cause of disability in Canada and are estimated to double the cost of physically related disabilities [22–24]. With this in mind and while considering the growing indigenous population in Canada [15], it is unsurprising that mental health disorders are higher in the indigenous population.
When considering Canadian social determinants of health [25], it would appear that indigenous Canadians are at a significant disadvantage. Specifically, with a history of intergenerational trauma, lateral violence, stigma, and poor health disparities, indigenous peoples are highly vulnerable. Statistically, those suffering from a mood or an anxiety disorder are likely to self-medicate with drugs or alcohol [26, 27]. These methods may have adverse outcomes from job loss to homelessness or death by suicide [28]. In the occupational health and safety context, this study contributes an overview of indigenous workers’ mental health and well-being in Canada. It provides future research opportunities to examine and address mental health, workload and well-being in the work environment.
The research on health disparity and lower health status in Indigenous communities, it is essential to understand that factors identified in this study have both direct and indirect impacts on mental health related outcomes in the workplace. It is reported that experience in the workplace especially with respect to mental health, can be improved when the workplace fosters a sense of identity, respect for indigenous culture, and values relationship building [29–33]. Furthermore, it is important to be mindful of other socio-economic and cultural factors associated with access to post-secondary education as just over half of the study participants had obtained a post-secondary diploma or university degree. Indigenous peoples’ educational attainment may translate to work performance, productivity and mental health. Based on the current employment market, post-secondary education is crucial for securing and maintaining a job. Thus, it would be helpful for future studies to explore if and how stress, anxiety, frustration and other mental health concerns associated with obtaining work impact securing and maintaining employment in Indigenous people in Canada.
Participants reported that improving client and worker empowerment and sharing knowledge fostered a positive work environment while time pressures, lack of support, and high staff turnover were barriers [33]. To our surprise, indigenous peoples experienced less occupational stress than their Canadian counterparts. However, our findings may also point out a much larger problem. In context, with several challenges that could be surrounding the individual, the workplace might not be perceived as an area of great concern. Instead, poor mental health could be due to issues occurring in their personal lives that are surfacing at work. This study used a cross-sectional design, thus making it difficult to fully identify why indigenous people experience lower occupational stress yet report poorer mental health and have higher lost-time rates.
The study had several limitations that should be noted. Firstly, we examined the data for participants who were employed or self-employed. However, there was a high rate of missing data (50%). While some of the results are consistent with previous trends, results should be interpreted with some degree of caution, nonetheless. Secondly, and as previously noted, this study’s cross-sectional nature prevents us from identifying causal relationships of the results provided. The generalizability of the findings and conclusion will be limited to the Indigenous workforce in Canada, who are currently employed or self-employed, as we did not follow their journey to explore other contributing factors and their impact. The CCHS is not administered to First Nations peoples living on-reserve and thus the findings should be interpreted with caution and has been noted as a challenge when considering different First Nations contexts (e.g., on or off-reserve and status or non-status First Nations) [17].
Conclusion
As our findings reveal that Indigenous peoples continue to struggle with mental health illnesses, we recommend an upstream approach to mitigate this issue. Specifically, a preventative approach, where individuals at risk of facing mental illnesses can seek mental health support through their community mental health agency or their work benefits programs (e.g., employee and family assistance program). Understanding the risks and acquiring strategies could help prevent mental illnesses and bolster participation in the workplace. Notably, these supports should be delivered in a way that is culturally aligned with Indigenous values. Thus, it is essential to increase collaborative consultation with Indigenous workers to ensure that such programs are created and delivered appropriately. Such an approach can also help gather accurate information about the accessibility and effectiveness of programs and policies implemented from those on the receiving end of these decisions. A cross-cultural collaborative approach will help identify gaps in knowledge, allocate resources and support to needed areas, improve health equity (including mental health), and be instrumental for workplace performance.
We recommend future research further examining occupational stress among Indigenous peoples regarding their mental health and work status. These studies should also consider exploring workplace characteristics and employment in traditional Indigenous lands (e.g., reserves) compared to settler areas (e.g., urban regions). Such studies will help dissect if and how many social determinants of health, education, health status, accessibility to resources, including professional and personal development towards a career, varies between varying roles and location.
Conflict of interest
The authors have no conflict of interest to declare.
Funding
This study received no funding.
Data availability
The data used in this research is available through Statistics Canada’s PUMF.
Author contributions
BNK wrote the paper with the help of BS and RS. BNK performed the statistical analyses and reviewed the work with BG and RS. All authors reviewed the final version of the paper and supported its publication.
Informed consent
Secondary analysis of the CCHS data (Statistics Canada) does not require informed consent at our institution and may be used under the Statistics Act for research purposes.