Keynote: Proven Strategies to Advance Integrated Care in the Latino Community
Cancer Rates & Distress Among Descendants of Indian Residential School Survivors
1. Cancer among descendants of
Indian Residential School Survivors
Maike van Niekerk & Amy Bombay
Dalhousie University, Nova Scotia, Canada
2. Dr. Amy Bombay
• Assistant Professor, Dalhousie University
• Supervisor & co-investigator
• Objibway (Rainy River First Nation) researcher
3. Objectives
• Intergenerational Trauma
• Canadian Historical Traumas
• Indian Residential Schools (IRS) as an example
• Clinical Implications
• Familial IRS attendance: Cancer Diagnosis & Psychological Distress
• Indigenous Groups in Canada
• First Nations focus
4. Indigenous Populations in Canada
Aboriginal
Canadians
• 4.3% of population; 1.4 million
• Umbrella term used to include 3 Aboriginal groups
First Nations
( ~ 60.8%)
50% of “Registed” First
Nations living off-reserve
Inuit
( ~ 4.2%)
Metis
( ~ 32.3%)
8. Intergenerational Trauma
Generation 1: Indian Residential School survivors
Physical, psychological, and sexual abuse
Development of poor appraisals, cognitive styles and coping
strategies
Increased stressor
experiences Poor mental health
Increased reactivity
to stressors
Parenting Deficits
Generation 2: Adverse Childhood Experiences
Recapitulates generation 1
(Bombay et al., 2011; Bombay et al., 2014)
10. Historical Trauma Cancer
Historical
Traumas
Poverty
Poor diet
Physical
inactivity
Alcohol and
substance
abuse
Smoking
Cancer
Diagnosis
Major
stressor
Contemporary
Traumas
(Marrett & Chaundhry, 2003; McIntyre & Shah, as cited in Marret & Chaundhry, 2003; Young & Sevenhuysen, as cited in Marret & Chaundhry, 2003).
11. Cancer Diagnosis Psychological Distress
Major
Stressor:
Cancer
Diagnosis
• Quality of
Life
• Treatment
adherence
• Cancer
screening
adherence
• Disease
outcomes
Psychological
Distress???
Effects of
Intergenerational
Traumas (i.e.,
IRS)
(Watson et al.,1999; Watson, Homewood, Halivand, & Bliss, 2005; Arrieta et al., 2013; Shelby et al., 2012; Giese-Davis et al., 2011)
12. Past Studies Intergenerational Trauma &
Response to Cancer
(Baider et al., 2000)
Second –
generation
Holocaust
survivors
Vulnerable to
psychological
distress
Trauma
(i.e. breast
cancer)
React with
extreme
psychological
distress
IRS +
psychological
distress in
cancer ??
14. Methodology: Participants
2008-2010 First Nations Regional Health
Survey
• Representative cross-sectional survey
• First Nation’s living on-reserve
• Across Canada (excluding Nunavut)
• N=4934
(FNIFC, 2012)
15. Methodology: Measures Assessed
Level of Psychological DistressCancer Diagnosis
Q: Have you been diagnosed
with cancer?
A: Yes or No
Kessler (K-10) Scale
Anxiety Symptoms Depressive Symptoms
0 (none of the time) – 4 (all of the time)
Scores: 0-40 (higher score = greater distress)
Low: 0-5
Moderate: 6-19
High: 20+
Familial IRS Attendance
Non-IRS
Parent and
grandparent
Parent or
grandparent
(FNIFC, 2012)
16. Results 1: Proportion of Cancer Diagnosis
Summary
First Nations who
had at least one
parent who attended
IRS reported LOWER
RATES of cancer
diagnosis compared
to First Nations
whose parents did
not attend.
Potential Explanations
• Familial IRS history = various
risk factors that place them
at risk for lower life
expectancy
• Cancer = disease that
increases with age
• May not have lived long
enough to be diagnosed with
cancer?
These findings should be
further explored!
17. Results 2: Level of Psychological Distress
Result One
First Nations who
had at least one
parent who attended
IRS reported HIGHER
LEVELS of
psychological
distress compared
to First Nations
whose parents did
not attend.
Result Two
First Nations adults who
1) Received a cancer diagnosis
2) Had least one parent who
attended IRS reported
HIGHER LEVELS of
psychological distress
when compared to those whose
1) Parents did not attend IRS
AND
2) First Nations adults who did
not receive a cancer diagnosis
(regardless of IRS attendance)
Inuit (~4.2%): Northern Canada/Arctic
Metis (~32.3%): decedents of distinct cultural groups from particularly groups of mixed First Nations and European
controversy over who qualifies as Métis
http://www.cbc.ca/8thfire/2012/01/what-is-a-metis.html
First Nations
-- Refers to the ancestors of the original inhabitants who are classed by the term “Indian”
-- Replaces the term ‘Indian’ except in reference to the Indian Act
-- Status Indian: a person who is registered as an Indian under the Indian Act
Low: 0-5
Moderate: 6-19
High: 20+
When trained and supported, physicians are better able to:
bridge barriers such as language, social challenges, and institutional racism
recognize and develop the necessary advocacy skills to work collaboratively with these clients, their communities, and other members of interdisciplinary teams in achieving better health outcomes.
