Explaining the gaps in psychological distress and suicidal behaviours between non-Indigenous and Indigenous adults living off-reserve in Canada: a cross-sectional study

We note the missed opportunity by the authors Hajizaheh, Hu, Asada and Bombay, to substantively discuss the factors underlying their reported difference between Indigenous and non-Indigenous adults in suicide ideation and lifetime suicide planning (74.97% and 94.37% respectively). They instead categorize this difference as being a "totally unexplained component". The authors do lead with a cursory mention of impacts of colonization, and historical and ongoing collective adversities experienced by Indigenous people that negatively affect well-being. However, they resort to sidelining "numerous additional cultural, historical and contemporary factors" as a study limitation. They fail to acknowledge existing work which clearly associates structural, systemic and interpersonal racism with mental stress, mental distress including suicidal ideation, and to integrate dialogue and findings on anti- Indigenous racism which is 'in plain sight' and pertinent to their findings. This absence from discussion is even more surprising considering that this CMAJ edition includes an editorial on anti-racism, a letter calling for the elimination of racism in research and a news article profiling the first Indigenous nominee for president of the Canadian Medical Association.

While adverse socio-economic conditions, as noted in the article, certainly play a role in determining poorer health status, we submit that the true root causes of those socio-economic conditions are the adverse impacts of attempted genocide and past and present racism and colonialism, which have been exhaustively studied, repeatedly proven, and are now finally broadly accepted. We need to normalize talking about anti- Indigenous discrimination and racism as the most profound determinant of inequities experienced by Indigenous Peoples. Reconciliation demands that this is a work that non-Indigenous people need to do on and amongst themselves, including in forums such as what this journal offers.

Conflict of Interest:

None declared