Abstract
Intervention
In 2014–2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of the research is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing.
Methods
A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1–6 months before rehousing, and 15–18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change.
Results
A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001).
Conclusion
Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.
Résumé
Intervention
En 2014-2015, plus de 400 logements sociaux ont été construits au Nunavut et au Nunavik, deux des quatre régions inuites du Canada, permettant ainsi d’évaluer l’impact de l’amélioration des conditions de logement sur la santé. Cette étude vise à examiner les associations entre les changements dans les conditions de logement et les changements dans la détresse psychologique avant et après le déménagement, dans 12 communautés inuites où les besoins en logement étaient les plus criants.
Méthodes
Une étude pré-post non contrôlée a été menée en collaboration avec des organisations du Nunavut et du Nunavik. Les participants figurant en tête des listes d’attente pour le logement social ont rempli les questionnaires de recherche 1-6 mois avant le déménagement et 15-18 mois après. Les changements de la détresse psychologique ont été mesurés à l’aide de l’échelle Kessler 6-item. Les changements des trois conditions de logement suivantes ont été examinés : le nombre d’adultes par ménage, le nombre d’enfants par ménage et le sentiment d’avoir un chez-soi. Pour chaque condition de logement, une variable catégorielle a été créée pour stratifier les participants ayant rapporté des changements (référence) et les participants n’ayant rapporté que peu ou pas de changement. Les associations ont été testées avec des modèles de régression linéaire multiniveaux.
Résultats
Un total de 102 adultes Inuit ont complété l’étude. Une réduction du nombre d’adultes par ménage (vivre avec 2 adultes ou moins après le déménagement) et une augmentation du sentiment d’avoir un chez-soi étaient associées à une baisse significative de la détresse psychologique (p < 0,001).
Conclusion
Des investissements accrus menant à de telles améliorations des conditions de logement représentent une avenue prometteuse pour promouvoir la santé mentale dans les régions inuites.
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Notes
In Trocmé et al. (2004), there was insufficient information to provide stratified estimates by Indigenous identity (Métis, Inuit, and First Nations). Based on 2016 Census data, Caldwell and Sinha (2020) highlighted the important gaps that remain in out-of-home placement rates among Indigenous children, although Inuit-specific data tended to parallel Indigenous national patterns (Caldwell & Sinha, 2020, pp.483 and 485); Caldwell and Sinha (2020) did not examine associations with housing predictors.
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Acknowledgements
This study was conducted in collaboration with the following organizations: Kativik Municipal Housing Bureau, Kativik Regional Government, Nunavik Regional Board of Health and Social Services, Société d’habitation du Québec, Nunavut Housing Corporation, Government of Nunavut Department of Health, Nunavut Tunngavik Incorporated. The project was approved and supported by mayors of the communities involved, the Nunavik Nutrition and Health Committee, and the Nunavut Research Institute. Results reported in this article have been provided to representatives of the abovementioned partners before their publication. We acknowledge the collaboration of Inuit research assistants, local housing committees and managers, and mayors without whom this study would not have been possible. We thank participants who generously gave their time to participate in the project. We acknowledge the contribution of other co-researchers on this project, and the contribution of research assistants who collected data.
Funding
The project Housing, health and well-being in Nunavik and Nunavut was funded by the Institute of Indigenous Peoples Health of the Canadian Institutes of Health Research (Grant #GIR134230) and by ArcticNet, a Network of Centres of Excellence of Canada. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program (CIHR 950-231678) and from the SSHRC-CMHC Partnership Grant At Home in the North (1004-2019-0007). Potvin holds a Canada Research Chair in Community Approaches and Health Inequalities (CIHR 950-232541). Perreault is supported by a Doctoral Research Award from the Canadian Institutes of Health Research.
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All authors read and approved the final manuscript. KP: substantial contributions to the conception of the article and methodology, data analysis and interpretation, writing — original draft preparation. PD: data collection, creation and maintenance of the database, interpretation of data and statistical support, critical revision for important intellectual content. LP: interpretation of data and critical revision for important intellectual content. MR: substantial contributions to the conception of the article and methodology, interpretation of data, writing — editing and critical revision for important intellectual content, funding acquisition, supervision of the work leading to the article.
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The project was approved and supported by mayors of all communities involved, the Nunavik Nutrition and Health Committee, and the Nunavut Research Institute. It received ethical approval from the Comité d’éthique de la recherche du CHU de Québec and from McGill University Internal Review Board.
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Perreault, K., Dufresne, P., Potvin, L. et al. Housing as a determinant of Inuit mental health: associations between improved housing measures and decline in psychological distress after rehousing in Nunavut and Nunavik. Can J Public Health 114, 241–253 (2023). https://doi.org/10.17269/s41997-022-00701-0
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DOI: https://doi.org/10.17269/s41997-022-00701-0
Keywords
- Housing
- Population health intervention research
- Health promotion
- Mental health
- Psychological distress
- Inuit
- Indigenous peoples