The Cedar Project : understanding the relationship between child apprehension, cultural connectedness and trauma among young Indigenous mothers who have used drugs in two Canadian cities

Background: Indigenous leaders are deeply concerned about the overrepresentation of Indigenous children in Canada’s child welfare system. However, few studies have addressed the relationship between family disruption, cultural connectedness, substance use and mental health among Indigenous families within the context of historical and intergenerational trauma. Objective: First, a scoping review examined culturally safe services and interventions to support Indigenous families involved in substance use. Second, the incidence of child apprehension and association with suicide attempt was investigated among young Indigenous mothers who have used drugs. Methods: A scoping review was conducted of the empirical literature examining interventions for Indigenous families involved in substance use in Canada, Australia, New Zealand and the United States. For longitudinal analysis, we utilized data collected every 6 months between 2008 and 2016 by the Cedar Project, a prospective cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, British Columbia, Canada. A recurrent event Cox proportional hazards model was used to estimate the independent effect of child apprehension on suicide attempt among female participants. Unadjusted and adjusted hazard rations (HRs) were reported with 95% confidence intervals. Results: There were few studies in the research literature evaluating culturally safe services and interventions for Indigenous families involved in substance use. We found an independent association between child apprehension and suicidal behaviour: young Indigenous mothers who reported recent child apprehension were twice as likely to attempt suicide over the study period. We discovered other risk factors for suicidal behaviour, including having a parent attend residential school, sexual assault, violence, and overdose. Young Indigenous mothers who had a traditional language spoken in the home growing up were almost half as likely to attempt suicide. Conclusion: Our results provide evidence to suggest the child welfare system perpetuates intergenerational trauma among Indigenous communities. Young Indigenous mothers in this study were more likely to attempt suicide after their children were apprehended, which was compounded by historical and lifetime trauma. However, cultural connectedness may protect against suicidal behaviour in this population. Indigenous jurisdictional control over child welfare and more culturally safe services are urgently needed to keep families together.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat