Anxiety is a normal and expected reaction to a pandemic; however, too much anxiety can be problematic and negatively affect peoples’ mental health and well-being. Our study showed that while 10% of individuals in this First Nations community reported an existing mental health condition, approximately 20% screened positive for depressive and anxiety symptoms during COVID-19 and while reacting to its associated public health measures, indicating the need for further assessment by health professionals.
In comparison, the 2014 Survey on Living with Chronic Diseases in Canada showed an estimate of 11.6% of general Canadians reported a mood and/or anxiety disorder(Canada, 2014). Similarly, 10% of our participants reported having an existing mental health condition in our sample; however, fully 20% also screened positive for depressive and anxiety symptoms. Indeed, previous studies/reports on the First Nations peoples in Canada show consistent evidence that the intergenerational effects from the historical trauma have resulted in higher depression, suicides and other mental health disparities in this population, compared to the general population(Kirmayer, 2000). The First Nations Regional Longitudinal Health Survey (2002/2003) and the National Aboriginal Health Organization (2006) both have reported that 25.7%-34.5% of First Nations women living on reserved felt sad or depressed for two weeks or more. Likewise, individuals living off reserve also showed increased levels of depression compared to the general population (13.2% vs. 7.3%)(Kirmayer, 2000). Indeed, social determinants of health such as unemployment, food security, health, social exclusion, discrimination – all play a significant role in the mental health challenges that the First Nations people face in Canada(Boksa, 2015). Thus, knowing these pre-existing mental health disparities in the First Nations population, supports the inference that communities may experience higher rates of anxiety and depression during times of elevated stress (such as the COVID-19 pandemic). Approximately 50% of respondents were unaware of available mental health supports in this community. As such, more outreach efforts are needed to ensure mental health supports are known and accessible to community members.
Although there is little evidence on the self-efficacy of adult First Nations populations, studies on other vulnerable populations have examined the impact of self-efficacy on anxiety and depression. According to Bandura (2010), self-efficacy is typically defined as one’s ability to execute behaviors and/or have control over one’s motivation and environment (Bandura, 2010). Research conducted by Allenden et al. (2018)(Allenden, 2018) found self-efficacy to be a predictor of depression among older adults; those with higher self-efficacy were less likely to have depression. Additionally, for those living with chronic health conditions requiring self-care behaviours and lifestyle adjustments, like diabetes, low self-efficacy may compound with anxiety and depressive symptoms, and lead to poorer health outcomes(Anderson, 2016; Cherrington, 2010; Johnston-Brooks, 2002). In relation to the previous Influenza A pandemic in 2009, factors associated with taking preventive measures and intent to comply with government-advised preventive measures included high self-efficacy(Bults, 2011). However, this does not strictly indicate that non-compliance to these measures results in lower self-efficacy in First Nations communities. As we found in our study, those experiencing symptoms of anxiety and depression may have a harder time adjusting in periods of stress, hence, following public health advice. Although we did not measure self-efficacy, the underlying construct is evident. When behaviours, thoughts, and emotions are unpredictable and outside of one’s control, such as in a pandemic, good psychological adjustment is challenging for everyone. Those with more pessimistic outlooks, feeling that bad outcomes cannot be avoided, like people with symptoms of anxiety and depression, this emotional distress may lead people to require professional help(Maddux, 1995).
While approximately one-fifth of respondents reported anxiety and depressive symptoms, many respondents focused on positive consequences during COVID-19 and its associated public health measures, including reassessing priorities, more leisure time to pursue meaningful activities and strengthen relationships, and prosocial behaviours, such as kindness and compassion and a sense of community. Indeed, our study showed signs/indications of “post-traumatic growth” for some people in this community. Post-traumatic growth is positive changes, including increased appreciation for life, changed priorities, more meaningful relationships, and increased personal meaning, that result from highly challenging life situations(Tedeschi, 2004). There is an opportunity to capitalize on people’s experiences of post-traumatic growth proactively supporting/maintaining their well-being (and possibly in the development of messaging on public health advice). This, in turn, may alleviate some of the mild anxious and depressive feelings.
Overall, this study provides insight about mental health experiences among people in a First Nations community during COVID-19 intended to inform health managers within the community (and similar communities). Studies, such as this one, that can characterize the influence of the COVID-19 pandemic on mental health among FN people, are urgently needed because of increasing demands on healthcare systems due to the pandemic and potential delays in the care of patients living with pre-existing mental health conditions. Thus, this study may serve as a key demonstration of future population-based health services research, with the capacity of studying both healthcare and personal experiences. Further, health leaders and policy makers of this community can utilize this study to inform effective health messaging and service delivery. Lastly, a major strength of this study is that it is one of the first studies on the mental health experiences of people in a First Nations community in relation to COVID-19.