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Original Research

Racial Discrimination, Cultural Resilience, and Stress

Discrimination raciale, résilience culturelle et stress

Nicholas D. Spence, PhD1, Samantha Wells, PhD2,3,4,5, Kathryn Graham, PhD2,3,6,7, and Julie George, PhD2,8

Abstract Objective: Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome).

Methods: Data were collected from October 2012 to February 2013 (N¼ 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression.

Results: The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R2¼ 0.21 and adjusted R2¼ 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively.

Conclusions: In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.

Abrégé Objectif : La discrimination raciale est un déterminant de la santé pour les peuples des Premières nations. La résilience culturelle a été considérée comme étant une ressource potentiellement positive pour les résultats sociaux. À l’aide d’un modèle compensatoire de résilience, cette étude cherchait à déterminer si la résilience culturelle (facteur compensatoire) neutralisait ou compensait l’effet adverse de la discrimination raciale (facteur de risque social) sur le stress (résultat).

1 Harvard Medical School, Harvard University, Boston, MA, USA 2 Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada 3 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 4 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada 5 School of Psychology, Deakin University, Australia 6 Department of Psychology, Western University, London, Ontario, Canada 7 National Drug Research Institute, Curtin University, Perth, Western Australia 8 Mental Health and Addiction Services, Kettle & Stony Point Health Services, Kettle & Stony Point First Nation, Ontario, Canada

Corresponding Author:

Nicholas D. Spence, PhD, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.

Email: [email protected]

Canadian Psychiatric Association

Association des psychiatres du Canada

The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie

2016, Vol. 61(5) 298-307 ª The Author(s) 2016

Reprints and permission: sagepub.com/journalsPermissions.nav

DOI: 10.1177/0706743716638653 TheCJP.ca | LaRCP.ca

Méthodes : Les données ont été recueillies d’octobre 2012 à février 2013 (N ¼ 340) auprès de membres adultes de la communauté des Premières nations Kettle and Stony Point, en Ontario, Canada. Le résultat a été stress perçu; facteur de risque, discrimination raciale; et facteur compensatoire, résilience culturelle. Les variables de contrôle incluaient les res- sources de résilience individuelles (éducation, sociabilité) et familiales (état matrimonial, statut socioéconomique) et les données démographiques (âge et sexe). Le modèle a été testé par la régression séquentielle.

Résultats : Le facteur de risque, la discrimination raciale, augmentait le stress dans toutes les étapes du modèle séquentiel tandis que la résilience culturelle avait un effet opposé modeste sur les niveaux de stress. Dans le modèle final contenant toutes les variables, l’âge et le sexe étaient significatifs, l’âge ayant un effet négatif sur le stress et les femmes déclarant des niveaux de stress plus élevés que ceux des hommes. L’éducation, l’état matrimonial, et le statut socioéconomique (revenu du ménage) n’étaient pas significatifs dans le modèle. Le modèle avait R2 ¼ 0,21 et R2 ¼ 0,18 ajusté, et une corrélation semi- partielle (au carré) de 0,04 et 0,01 pour la discrimination raciale et la résilience culturelle, respectivement.

Conclusions : Dans cette étude, la résilience culturelle compensait modestement l’effet adverse de la discrimination raciale sur le stress. Ces résultats peuvent soutenir l’élaboration de programmes et de services favorisant la culture des Premières nations, en attendant d’autres études.

Keywords racial discrimination, stress, health, resilience, culture, Aboriginal, First Nations

Clinical Implications

� As a social determinant of health, racial discrimina- tion experienced by First Nations people has a detri-

mental effect on stress.

� First Nations cultural resilience may play a modest role in compensating for the negative effects of racial

discrimination on stress, but it must be understood

alongside other key social factors.

� Strategies aimed at building cultural resilience could modestly reduce stress and improve health outcomes

given the experience of racial discrimination.

Limitations

� The nonvalidated measure of cultural resilience must be interpreted with caution as it captured individual

perceptions of cultural community strengths and did

not assess personal engagement in cultural activities.

� This study design was cross-sectional and cannot dis- tinguish temporality of relationships in the model.

� Data captured one level of analysis (individual) despite cultural resilience and racial discrimination

being multilevel concepts.

� The sample was from one First Nation community and not applicable to all Aboriginal peoples (e.g.,

First Nations off-reserve, Métis, Inuit).

The social determinants of health are emphasized in under-

standing health inequality.1 There remain decisive gaps in our

understanding of health inequality founded on race: previous

research has been unable to explain away effects, taking into

account factors, such as gender, age, poverty, residential

locale, and health risk behaviours.2-6 The effect of racial dis-

crimination is likely an integral part of the process driving

racial inequality, with evidence linking it to manifold out-

comes, such as poor self-rated health, immune dysregulation,

hypertension, obesity, sleep difficulty, preterm birth, frequent

colds, mental health, and substance use disorders.7-19

A social construction, the concept of race is premised on

the erroneous belief of meaningful genetic or biological dif-

ferences of groups in the population based on arbitrary phys-

ical markers, such as skin color.20,21 Racism is an ideology

using race to frame social relations; it often results in pre-

judice or negative attitudes, beliefs, and opinions, directed at

racialized groups, as well as discrimination or differential

treatment of group members to accord rights, privileges, and

resources at multiple levels in society.21-24 Racialization

emphasizes the social and historical mechanisms underlying

how groups come to be defined based on supposed biological

differences (race), the power dynamics and oppression

inherent in the process across time and space, institutionali-

zation of this ideology in society, and ways it contributes to a

system of social inequality.22,24,25

Racial discrimination is an upstream or fundamental

determinant of health, causing proximate health risk factors,

health ailments, and diseases, across time, through a number

of pathways.1,26-28 One mechanism driving the adverse

effect of racial discrimination on health is the experience

of acute and chronic stress.29-37

Nevertheless, internationally, there is limited work on racial

discrimination, health outcomes, and determinants, such as

stress, using representative quantitative data at the population

level.10,28,38 This includes Indigenous (Aboriginal) peoples

globally, a heterogeneous group, yet sharing many common

experiences, such as racial discrimination, historical trauma,

poor health, and low socioeconomic outcomes.39-42 Recent

contributions have attempted to address this gap in Canada

among Aboriginal peoples, with limitations including the

non-Aboriginal-specific measure of racial discrimination,

La Revue Canadienne de Psychiatrie 61(5) 299

paucity of quantitative approaches, small nonrandom samples,

or focus on the off-reserve population.43-45 Advancing research

in this area requires the analysis of inter- and intraracial group

experiences of racial discrimination,46 including the unique

historical circumstances of Aboriginal peoples in Canada, a

diverse, young, rapidly growing population, with subgroups,

First Nations (on/off-reserve), Métis, and Inuit.40,47

In addition to assessing the link between racial discrimi-

nation and stress, understanding the ways people are able to

be resilient in light of such circumstances has research, clin-

ical, and policy significance. The history and debates sur-

rounding resilience have been detailed in the literature,48,49

but most agree that it is the ability to thrive, succeed, or

return back to an original state in the face of exposure to

risk, adversity, challenges, or demands.50,51

Resilience has been conceptualized in many ways, but the

traditional focus has been on personal qualities or traits, with

recent work emphasizing not only the individual but the role

of family, community, physical, and social ecology as

well.52-55 For example, resilience resources at different lev-

els can include the following: individual (constitutional resi-

lience, sociability, intelligence, communication skills, and

personal attributes), family (supportive families and socio-

economic status), and community (school experiences, sup-

portive communities, and cultural resilience).52,56

Beyond the traditional constructs in resilience research,

the body of work on Aboriginal resiliency has begun to

receive consideration, emphasizing Aboriginal-specific con-

structs (traditional activities and lands, environment, spiri-

tual factors, degree of integration within Aboriginal culture,

or enculturation) and their contribution to a host of out-

comes, both positive and negative.44,56-72 Resilience centred

on culture highlights the value of having a shared set of

common beliefs and values, with core elements such as lan-

guage, conventions, socialization, social institutions, enhan-

cing survival, comfort, and psychological needs for meaning

and significance.70,71,73 The loss of culture associated with

colonialism and assimilation policies among Aboriginal peo-

ples in Canada have been the subject of great focus.40,74,75

Given the well-documented gap in well-being across a

number of indicators for the Aboriginal population,40 iden-

tifying the sources of cultural resiliency that enable success

in the face of specific adverse conditions is particularly use-

ful. This process requires strict attention to the idea that

Aboriginal enculturation and cultural orientation are far

from fixed; in fact, despite commonalities, culturally distinc-

tive strategies of resilience reflect the diversity of Aboriginal

peoples given their varied histories, environments, and life-

ways.58,76 In this respect, the development and application of

universal, standardized measures of cultural resilience across

Aboriginal communities is not the way to proceed.70,71,77

Moreover, resiliency does not necessarily apply to all aspects

of life and in positive ways78,79; for example, some evidence

has found higher enculturation is associated with more racial

discrimination.44,69 Therefore, theoretical models must be

tested empirically to identify those contexts or domains in

which resiliency factors operate to assist and protect people

and which ones they do not. This work contributes to the

body of research in this regard using the compensatory

model of resilience within the scope of racial discrimination.

Well established in the resilience literature, the compen-

satory model of resilience captures the manner in which

resilience resources may neutralize exposure to a social risk

factor given a specific outcome.80 In other words, a social

risk factor has a detrimental effect on the outcome, and the

compensatory factor has a positive effect on the outcome,

with the 2 effects relatively independent of one another.

Statistically, in this framework, both social risk factor and

compensatory factor combine additively in a regression

model, with independent effects on the outcome of interest

but in opposite ways.

In sum, using a compensatory model of resilience, this

theoretically driven study aimed to examine racial discrim-

ination (risk factor) and cultural resilience (compensatory

factor) as predictors of stress (outcome). It was hypothesized

that in the First Nations population, cultural resilience com-

pensates for the detrimental, independent effect of racism on

stress, taking into account non-cultural-specific resilience

resources and demographic characteristics.

Methods

Sample

The sample was collected as part of Researching Health in

Ontario Communities (RHOC), funded by the Canadian Insti-

tutes of Health Research, seeking to improve understanding of

mental health, substance use, and violence in Ontario com-

munities, including First Nations.81 Data were collected from

October 2012 to February 2013 (N ¼ 340) from adult (18 years and older) members of the Kettle and Stony Point First

Nation community, with a response rate of 57.3%. The study was approved by the Research Ethics Board of

the Centre for Addiction and Mental Health and the Band

Chief and Council. Research protocols address the Tri-

Council Policy Statement on Ethics of Research Involving

First Nations, Inuit, and Métis Peoples of Canada and the

principles of Ownership, Control, Access, and Posses-

sion.82,83 Kettle and Stony Point First Nation screened this

research article for potential impact on the community and

the interests of its members.

Measures

As a highly engaged community-partnered project with the

Kettle and Stony Point First Nation, tailored, community-

specific questions and measures were developed.

In the compensatory model of resilience, the outcome

variable, stress, was measured using the Perceived Stress

Scale (Cronbach’s a [sample] ¼ 0.76), asking respondents how often they felt or thought a certain way across a series of

situations in one’s life over the past month, using 10 items

scored as never (0), almost never (1), sometimes (2), fairly

300 The Canadian Journal of Psychiatry 61(5)

often (3), or very often (4), ranging from 0 to 40.84 One of the

most widely used measures for psychological stress, its psy-

chometric properties have been evaluated cross-culturally

and in numerous countries.85

The risk factor, perceived racial discrimination, was indi-

cated by the Measure of Indigenous Racism Experience

(MIRE) Interpersonal Racism Scale (Cronbach’s a [sample] ¼ 0.89), using 10 items addressing respondent perceptions about the frequency of experiencing racism across different

contexts, with no restriction of the time period in which it

occurred, scored as never (0), almost never (1), sometimes

(2), fairly often (3), or very often (4), ranging from 0 to 40.86

Created in Australia, this is the first validated instrument to

capture the unique experience and multiple facets of racism

among Indigenous peoples. As a comprehensive measure of

the various settings where interpersonal racism may occur,

its relevance is high for all individuals.86 Self-reported

experiences of racial discrimination have been the subject

of greatest study in racism research, with members of racia-

lized groups aware of at least some of the experiences of

discrimination, resulting in elevated stress levels.23,87 The

traumatic experience of racial discrimination can have

long-lasting effects over time.23,86,87

The compensatory variable was a measure of individual

Aboriginal cultural resilience. Across research foci, theore-

tical approaches, levels of analysis, ages of respondents,

outcome measures, and social/geographical contexts, there

are a wide range of ways Aboriginal cultural resilience has

been defined and measured across studies, with the majority

of measures not validated.71 While this diversity limits gen-

eralizability, one advantage is that the assorted nature of this

construct can be captured, as it varies with respect to geo-

graphic, economic, social, and historical context.71 This arti-

cle and the larger project were not specifically designed to

assess the validity of a cultural resilience measure; it was

created for this study based on the availability of cultural

measures, but as noted earlier, as a community-partnered

project, the questions were tailored, community specific, and

the analysis developed with, and screened by, the commu-

nity. In this study, the measure was based on a question that

asked community members to identify perceived strengths of

the community: ‘‘What are the main strengths of Kettle &

Stony Point First Nation?’’ followed by a list of response

options, including 4 items of cultural relevance (traditional

language, traditional ceremonial activities and awareness of

First Nations culture, elders, and the natural environ-

ment),55,58,75 scored as no (0) and yes (1), with the scale

ranging from 0 to 4. Internal consistency was acceptable

(Cronbach’s a [sample] ¼ 0.66).88 Individuals who perceive different aspects of Aboriginal culture as strengths of the

community may be more likely to be racially socialized, cul-

turally aware, and have higher levels of cultural pride and

enculturation as evidenced in other contexts.89 Note that the

level of measurement and unit of analysis is the individual.

Individual resilience resources included education (less

than high school, completed high school, or any

postsecondary education) and sociability, measured by the

Social Support Scale (Cronbach’s a [sample] ¼ 0.81), using 5 items scored as strongly disagree (1), disagree (2), agree

(3), or agree strongly (4), ranging from 5 to 20.90,91

Family resilience resources were marital status (married

or living with partner; widowed, divorced, or separated; or

single) and socioeconomic status, operationalized as house-

hold income (less than $20,000, $20,000-$39,999, $40,000-

$59,999, or $60,000 and over).

Finally, the demographic variables were age and gender.

Statistical Analysis

Analyses were conducted using SPSS Statistics 21 (SPSS,

Inc., an IBM Company, Chicago, IL). Missing data were

handled using multiple imputation.92-95 The amount of miss-

ing data was relatively low, with household income (24%) the highest followed by perceived stress (14%) and the remaining variables less than 2%. Descriptive statistics were followed by a sequential linear regression to assess the com-

pensatory model of resilience hypothesized.80 First, the risk

factor, MIRE Interpersonal Racism Scale, was added to the

model to provide an unadjusted estimate of its effect on

stress. Second, the compensatory factor, Aboriginal cultural

resilience, was added to the model to assess its unique

Table 1. Characteristics of the Study Sample (N ¼ 340).a

Characteristic Value

Outcome, mean (SD) Perceived Stress Scale (0-40) 17.4 (6.38)

Risk factor, mean (SD) Measure of Indigenous Racism Experience (MIRE)

Interpersonal Racism Scale (0-40) 15.2 (8.7)

Compensatory factor, mean (SD) Cultural Resilience Scale (0-4) 1.2 (1.0)

Demographics Age, y, mean (SD) 41.2 (14.4) Gender, %

Female 54.9 Male 45.1

Individual resilience resources Education, %

Less than high school 34.6% High school 16.9% Attended postsecondary 48.4%

Sociability—Social Support Scale (5-20), mean (SD) 15.8 (3.1)

Family resilience resources Supportive families—marital status, %

Married or living with partner 50.6% Divorced, separated, or widowed 22.6% Single 26.7%

Socioeconomic status—household income <$20,000 36.1% $20,000-$39,999 29.5% $40,000-$59,999 12.4% $60,000þ 22.0%

aPercentages may not add up to 100 due to rounding.

La Revue Canadienne de Psychiatrie 61(5) 301

additive effect on stress. Last, the effects of the risk factor

and compensatory factor were examined in the full model,

with other resilience resources and demographic variables.

The significance level was set at P < 0.05.

Results

Descriptive statistics are provided in Table 1. The sequential

regression analysis presented in Table 2 shows that the

MIRE Interpersonal Racism Scale increased stress levels

in a relatively consistent manner across all 3 steps of the

model while cultural resilience had the opposite effect on

stress levels. With all variables in the model, the MIRE

Interpersonal Racism Scale had about a 2.0% increase in stress for every 5-point increase on the 40-point scale. The

effect of cultural resilience was a 1.5% decrease in stress for a 1-point increase on the 4-point scale.

As well, in the final adjusted model with all variables,

both demographic variables, age and gender, were signifi-

cant, with the former having a negative effect on stress or a

2.7% decrease in stress for every 10 years and women report- ing a 4.3% higher level of stress than men. Social support was significant in the model and decreased stress by about

1% for a 1-point increase on the 15-point scale. The individ- ual resilience resource, education, and none of the family

resilience resources, marital status and socioeconomic status

(household income), were significant in the model.

The standardized regression coefficients in the final

model illustrated that among the continuous variables, MIRE

Interpersonal Racism had the strongest impact on stress,

followed by social support and cultural resilience.

Table 2. Sequential Linear Regression Model Predicting Stress (Perceived Stress Scale) Scores (N ¼ 340).

Variable B SE b P sr2 Block Change Statistics

Step 1 D R2 ¼ 0.07, D F ¼ 24.16 (1, 337),

P ¼ 0.000 Constant 14.50 Risk factor Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale 0.19 0.04 0.26 0.000 0.07

Step 2 D R2 ¼ 0.02, D F ¼ 4.69 (2, 335),

P ¼ 0.009 Constant 15.48 Risk factor Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale 0.19 0.04 0.25 0.000 0.07 Compensatory factor Cultural Resilience Scale –0.81 0.27 –0.16 0.003 0.02

Step 3 D R2 ¼ 0.12, D F ¼ 4.77 (10, 325),

P ¼ 0.000 Constant 25.68 Risk factor Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale 0.15 0.04 0.21 0.000 0.04 Compensatory factor Cultural Resilience Scale –0.60 0.26 –0.12 0.022 0.01 Individual resilience resources

Education <0.01 Less than high school (reference) High school 1.12 0.97 0.07 0.258 Attended postsecondary 0.34 0.73 0.03 0.663

Social support –0.39 0.11 –0.19 0.000 0.03 Family resilience resources

Supportive Families—Marital Status <0.01 Divorced, separated, or widowed (reference) Married or living with partner –0.43 0.84 –0.03 0.605 Single 0.23 1.02 0.02 0.822

Socioeconomic status (household income) 0.01 <$20,000 (Reference) $20,000-$39,999 0.35 0.82 0.03 0.672 $40,000-$59,999 –0.81 1.09 –0.04 0.518 $60,000þ –1.44 0.90 –0.09 0.183

Demographics Age –0.11 0.03 –0.03 0.000 0.04 Gender 0.02

Male (reference) Female 1.73 0.66 0.14 0.011

302 The Canadian Journal of Psychiatry 61(5)

Overall, the model was significant at each step of the

sequential regression. R2 ¼ 0.21 and adjusted R2 ¼ 0.18, with about one-fifth of the variance in stress explained by

the model. The semipartial correlation (squared) values in

Table 2 indicate that MIRE Interpersonal Racism explained

uniquely 4% of the variance in stress, and cultural resilience accounted for 1%. In addition, social support (3%), gender (2%), and age (4%) contributed uniquely a combined 9% of the variance in stress to the model.

Discussion

Using a compensatory model of resilience, this research

examined the protective effect of Aboriginal cultural resili-

ence on stress in the context of an important risk factor for

Aboriginal peoples, racial discrimination. The link between

racial discrimination and stress was supported in this study,

which is congruent with work examining other racialized

populations.29-34 The positive role of cultural resilience was

not a unique finding,64-66 but its demonstrated compensatory

role in protecting First Nations from stress in the presence of

the social risk factor, racial discrimination, while taking into

account a host of other resilience resources and demographic

factors is a new contribution to the literature. That being

said, it played a minor role in explaining stress relative to

other factors, and its effect was modest.

The measure of cultural resilience used in this work

reflected individual perceptions of cultural strengths of the

community, including traditional language, traditional cere-

monial activities and awareness of First Nations culture,

elders, and the natural environment. While the data were not

amendable to teasing out the way cultural resilience operates

to protect against stress, we speculate that this may be a prod-

uct of several direct and indirect processes associated with

core elements of enculturation: transmitting cultural tradi-

tions; increasing bonding and racial socialization, including

the development of racial pride, unity and heritage, cultu-

rally relevant adaptive coping strategies and skills, a stable

and positive racial identity, personal continuity and agency,

meaning, sense of purpose, and self-esteem; and enabling

community members to actuate cultural resili-

ence.52,61,75,77,89,96 Moreover, Aboriginal culture cannot

be understood in the absence of a people’s land and natural

environment; the two are synonymous as there is a deep

physical, spiritual, and emotional relationship with the land

that is the foundation of the self and existence and lifeblood

of Aboriginal well-being.55,58,75 Despite the proposed

mechanisms of the compensatory factor, we caution that the

reduction in stress observed requires further efforts to clarify

the protective role of cultural resilience in the presence of

social risk factors, such as racial discrimination.

Although not of central interest in this study, the reduc-

tion in stress from social support was strong and consistent

with earlier work examining its role in other contexts and

populations.97,98 In fact, this finding shows that as a resi-

liency resource, the reciprocal relationships characterizing

Aboriginal cultures serve a protective role for health and

well-being.55,99

Family resilience resources were not important in this

analysis. The measure of supportive families, marital status,

did not assess the quality of family relationships, including

partnerships (married or living with partner), which is a

potential resilience resource.100 Socioeconomic status

(household income) had no effect in this study; in fact, this

result contrasts with previous work on the general population

finding more stressful events and less coping resources

among individuals with decreasing levels of socioeconomic

resources.101,102

With respect to gender, similar to other research, the dif-

ferent social experiences of males and females contributed to

varying amounts of stress with higher levels found among

the latter.101 The findings reflect evidence that First Nations

females are particularly likely to be disadvantaged in numer-

ous ways: poverty of subsistence, sexual and reproductive

health, identity, safety and security, mental health, social

participation, power, and knowledge.103

Finally, consistent with previous studies,101,104 improved

coping mechanisms, higher self-efficacy, and positive out-

look likely account for lower stress as individuals age.

Clinical Implications

Moving forward, facilitating cultural resilience for individuals

in Aboriginal communities may be a somewhat helpful strat-

egy in improving outcomes among people suffering from stress

rooted in racial discrimination. This relationship, however,

requires further clarification, but this level of intervention may

mitigate stress-related effects on health and associated beha-

viours given the well-documented research on the poor health

and well-being of First Nations people.2,39,41,105,106 The utility

of cultural resilience is tempered by the modest size of the

effect and importance of understanding it within the context

of other stronger determinants of stress, including racial dis-

crimination, age, gender, and social support.

Failure to address adequately racial discrimination as a

fundamental social determinant of health will leave us

unable to reduce health inequalities founded on race.28,87

The trans-generational consequences of racial discrimina-

tion and evidence of the effects of racial discrimination on

maternal stress and preterm birth,29,107 coupled with rapid

growth of the Aboriginal population in Canada,47 make this

a particularly important social issue. The identification and

fostering of resilience resources must not take away the spot-

light from social structure, producing patterns of racial

inequality and racial discrimination, to ultimately eliminate

gaps in health outcomes.

Strengths and Limitations

This study has several strengths. It was a highly engaged

community-partnered project in which community-specific

issues were addressed as seen in all aspects of the research

La Revue Canadienne de Psychiatrie 61(5) 303

design and analysis. The study was quantitative from a rep-

resentative random sample of one on-reserve First Nation

community. Although the data were drawn from a single

First Nation community, limiting generalizability nation-

wide, this eliminated the issue related to homogenization

of resilience within this population by pooling together sev-

eral communities.58,70,71,77 The Kettle and Stony Point First

Nation advisory committee provided guidance and screened

this research article for potential impact on the community

and the interests of its members. Finally, this research used 2

key validated measures: 1) the PSS, which is a powerful

measure of stress associated with health and well-being, and 2)

the MIRE Interpersonal Racism Scale that is specific to Indi-

genous peoples.

There are some key limitations associated with this work.

The measure of cultural resilience was internally consistent

but not psychometrically validated. This article and the larger

project were not specifically designed to assess the validity of

the cultural resilience measure. This is, however, an impor-

tant focus moving forward. The scale was created for this

study based on the availability of cultural measures for this

specific community. Also, the measure of cultural resilience

captured individual perceptions of Aboriginal community

strengths but did not measure personal engagement in cultural

activities. The assumption was that individuals who perceive

different aspects of Aboriginal culture as strengths of the

community may be more likely to be racially socialized, be

culturally aware, and have higher levels of cultural pride and

enculturation as evidenced in other contexts.89 This, however,

may or may not be the case; for example, individuals who are

highly enculturated may be more likely to perceive the level

of community cultural strengths as weak or individuals who

are more likely to be stressed may also be the type of people

who do not feel positive about their community and more

likely to perceive racial discrimination. Next, the sample was

from one First Nation community, limiting the generalizabil-

ity beyond this specific group, and the data were not multi-

level, disallowing us to disaggregate multiple levels of

influence from one another, a central issue across studies in

this area. Finally, the cross-sectional research design under-

mined causal inferences—longitudinal research is needed to

distinguish relationships between social risk factors, protec-

tive factors, and outcomes, as well as the long-term impact of

racial discrimination on stress. Thus, these findings should be

interpreted within the context of these constraints.

Conclusion

As a driver of social and health inequality, this work showed

a positive effect of racial discrimination on stress in the

Aboriginal population. A compensatory model of resilience

illustrated the unique but modest benefits of cultural resili-

ence in offsetting the experience of stress resulting from

racial discrimination. In addition, a non-Aboriginal-

specific source of resilience, social support, figured promi-

nently in reducing stress. However, the cross-sectional

research design and measure of cultural resilience indicate

that additional research is needed before developing large-

scale recommendations for clinical practice or policy. Future

research should look at specific pathways by which racial

discrimination affects stress and health outcomes within the

Aboriginal population (First Nations on/off-reserve, Métis,

Inuit) and across racialized groups in Canada, given their

varied histories and experiences, coupled with the contexts

and manner in which resilience resources, both cultural and

noncultural, play a fundamental role.

Acknowledgments

We extend our sincere appreciation and thanks to the many indi-

viduals and groups that have contributed to the development of this

article. We are grateful to Kettle & Stony Point First Nation Chief

& Council for allowing us to conduct the Researching Health in

Ontario Communities (RHOC) project and the staff of Kettle &

Stony Point Health Services, who helped recruit participants and

promote the project. We also extend our sincere gratitude to the

project’s Research Advisory Committee—Shirley Fowler, Tracey

Williams, Vince George, Dianne George, Janet George, and Rox-

anne White. Your guidance and understanding taught us patience

with a complex process—resulting in findings we are confident will

make a valuable contribution to Kettle & Stony Point First Nation

and beyond. Thank you to those individuals who served as research

assistants for the project in Kettle & Stony Point—Margaret Pep-

per, Sara George, Leigh George, and Katie Big-Canoe. We also

thank Barb Shipley for her logistical support and the staff of Chip-

pewa Technical Services for setting up electrical requirements of

the lab. We would also like to acknowledge Roseanne Pulford for

preparing and processing research materials. We thank Peter Few-

ster for his assistance with Checkbox and Sharon Bernards for also

assisting with Checkbox and her expertise in data management.

Also, we are very grateful to all of the community members who

participated in the project. Your experiences have and will continue

to provide valuable insight that will improve programs and ser-

vices. Finally, we thank the 3 anonymous reviewers for their

thoughtful and insightful comments and suggestions.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect

to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support

for the research, authorship, and/or publication of this article: This

research was made possible with funds from a Canadian Institutes

of Health Research (CIHR) Emerging Team Grant: Co-morbidity

of Brain Disorders and Other Health Problems (CBG—101926).

All authors report no conflicts of interest..

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