@article {HajizadehE215, author = {Mohammad Hajizadeh and Min Hu and Yukiko Asada and Amy Bombay}, title = {Explaining the gaps in psychological distress and suicidal behaviours between non-Indigenous and Indigenous adults living off-reserve in Canada: a cross-sectional study}, volume = {9}, number = {1}, pages = {E215--E223}, year = {2021}, doi = {10.9778/cmajo.20200177}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background: Indigenous people are disproportionately affected by mental health issues in Canada. We investigated factors underlying the difference in psychological distress and suicidal behaviours between non-Indigenous and Indigenous populations living off-reserve in Canada.Methods: We conducted a cross-sectional study using data from the 2012 Canadian Community Health Survey {\textemdash} Mental Health. Respondents were aged 18 years and older. We measured the variation in psychological distress (10-item Kessler Psychological Distress Scale scores, ranging from 10 [no distress] to 50 [severe distress]) and the prevalence of lifetime suicidal ideation and suicide plan between the Indigenous and non-Indigenous populations and explained these differences using the Blinder{\textendash}Oaxaca approach.Results: The overall response rate for the survey was 68.9\%, comprising 18 300 respondents (933 Indigenous and 17 367 non-Indigenous adults). We found lower mean psychological distress scores among non-Indigenous people than among Indigenous people (15.1 v. 16.1, p \< 0.001) and a lower prevalence of lifetime suicidal ideation (9.2\% v. 16.8\%, p \< 0.001) and plan (2.3\% v. 6.8\%, p \< 0.001). We found that if socioeconomic status among Indigenous people were made to be similar to that of the non-Indigenous population, the differences in mean psychological distress scores and prevalence of lifetime suicidal ideation and suicide plan would have been reduced by 25.7\% (women 20.8\%, men 36.9\%), 10.2\% (women 11.2\%, men 11.9\%) and 5.8\% (women 7.8\%, men 8.1\%), respectively.Interpretation: Socioeconomic factors account for a considerable proportion of the variation in mental health outcomes between non-Indigenous and Indigenous populations in Canada. Improving socioeconomic status among Indigenous people through plans like income equalization may reduce the gap in mental health outcomes between the 2 populations in Canada.}, URL = {https://www.cmajopen.ca/content/9/1/E215}, eprint = {https://www.cmajopen.ca/content/9/1/E215.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }