Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Geography, University of Winnipeg, Winnipeg, Manitoba, Canada.
BMJ Open. 2019 Apr 8;9(4):e024748. doi: 10.1136/bmjopen-2018-024748.
Indigenous people in Canada are not only over-represented among the homeless population but their pathways to homelessness may differ from those of non-Indigenous people. This study investigated the history and current status of Indigenous and non-Indigenous people experiencing homelessness and mental illness. We hypothesised that compared with non-Indigenous people, those who are Indigenous would demonstrate histories of displacement earlier in life, higher rates of trauma and self-medication with alcohol and other substances.
Retrospective data were collected from a sample recruited through referral from diverse social and health agencies in Winnipeg and Vancouver.
Eligibility included being 19 years or older, current mental disorder and homelessness.
Data were collected via interviews, using questionnaires, on sociodemographics (eg, age, ethnicity, education), mental illness, substance use, physical health, service use and quality of life. Univariate and multivariable models were used to model the association between Indigenous ethnicity and dependent variables.
A total of 1010 people met the inclusion criteria, of whom 439 self-identified as Indigenous. In adjusted models, Indigenous ethnicity was independently associated with being homeless at a younger age, having a lifetime duration of homelessness longer than 3 years, post-traumatic stress disorder, less severe mental disorder, alcohol dependence, more severe substance use in the past month and infectious disease. Indigenous participants were also nearly twice as likely as others (47% vs 25%) to have children younger than 18 years.
Among Canadians who are homeless and mentally ill, those who are Indigenous have distinct histories and current needs that are consistent with the legacy of colonisation. Responses to Indigenous homelessness must be developed within the context of reconciliation between Indigenous and non-Indigenous Canadians, addressing trauma, substance use and family separations.
ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.
加拿大的原住民不仅在无家可归者中所占比例过高，而且他们无家可归的途径可能与非原住民不同。本研究调查了经历无家可归和精神疾病的原住民和非原住民的历史和现状。我们假设，与非原住民相比，原住民在生命早期会有更多的流离失所经历，创伤发生率更高，并且更倾向于用酒精和其他物质进行自我治疗。
从温尼伯和温哥华的各种社会和卫生机构的转介样本中收集了回顾性数据。
入选标准为年龄在 19 岁及以上，目前患有精神障碍和无家可归。
通过访谈收集数据，使用问卷收集社会人口统计学信息（例如年龄、族裔、教育程度）、精神疾病、物质使用、身体健康、服务使用和生活质量。使用单变量和多变量模型来模拟原住民族裔与因变量之间的关联。
共有 1010 人符合纳入标准，其中 439 人自我认定为原住民。在调整后的模型中，原住民族裔与年轻时无家可归、终生无家可归时间超过 3 年、创伤后应激障碍、精神障碍较轻、酒精依赖、过去一个月更严重的物质使用以及传染病有关。与其他人相比，原住民参与者的子女年龄在 18 岁以下的可能性几乎高出一倍（47%比 25%）。
在加拿大无家可归和患有精神疾病的人群中，原住民有着独特的历史和当前需求，这与殖民化的遗留问题相一致。必须在加拿大原住民和非原住民之间的和解背景下，通过解决创伤、物质使用和家庭分离问题，来应对原住民的无家可归问题。
ISRCTN42520374、ISRCTN57595077、ISRCTN66721740。
