Childhood violence and mental health among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study.

The main objectives of this study were to investigate the association between childhood violence and psychological distress and post-traumatic stress symptoms (PTS) among Sami and non-Sami adults, and to explore a possible mediating effect of childhood violence on any ethnic differences in mental health. This study is part of a larger questionnaire survey on health and living conditions in Mid- and Northern Norway (SAMINOR 2) which included 2116 Sami and 8674 non-Sami participants. A positive association between childhood violence and psychological distress and PTS in adulthood was found regardless of ethnicity. For women, childhood violence may have mediated some of the ethnic differences in psychological distress (53.2%) and PTS (31.4%). A similar pattern was found for men as to psychological distress (45.5%) and PTS (55.5%). The prevalence of psychological distress was significantly higher in the Sami than in the non-Sami group: 15.8% vs. 13.0% for women, and 11.4% vs. 8.0% for men. Likewise, PTS showed a higher prevalence in the Sami group, both for women (16.2% vs. 12.4%) and for men (12.2% vs. 9.1). CONCLUSION: A positive association between childhood violence and adult mental distress was found for both Sami and Norwegian adults. More mental problems were found among the Sami. Childhood violence may have mediated some of the ethnic differences.

Childhood violence and adult chronic pain among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study.

BACKGROUND: Internationally, studies have shown that childhood violence is associated with chronic pain in adulthood. However, to date, this relationship has not been examined in any indigenous population. OBJECTIVE: The main objectives of this study were to investigate the association between childhood violence and reported chronic pain, number of pain sites and the intensity of pain in adulthood in indigenous Sami and non-Sami adults, and to explore ethnic differences. DESIGN: The study is based on the SAMINOR 2 questionnaire study, a larger population-based, cross-sectional survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Mid- and Northern Norway. Our study includes a total of 11,130 adult participants: 2,167 Sami respondents (19.5%) and 8,963 non-Sami respondents (80.5%). Chronic pain was estimated by reported pain located in various parts of the body. Childhood violence was measured by reported exposure of emotional, physical and/or sexual violence. RESULTS: Childhood violence was associated with adult chronic pain in several pain sites of the body regardless of ethnicity and gender. Childhood violence was also associated with increased number of chronic pain sites and higher pain intensity compared to those not exposed to childhood violence. However, among Sami men, this association was only significant for pain located in chest, hips/legs and back, and non-significant for increased number of chronic pain sites (adjusted model), and higher pain intensity. CONCLUSION: Respondents exposed to childhood violence reported more chronic pain in several parts of the body, increased number of chronic pain sites and more intense pain in adulthood than respondents reporting no childhood violence. However, among Sami men, this association was weaker and also not significant for increased number of chronic pain sites and higher pain intensity.

Foreign doctors in Norwegian psychiatry ­ is there a need for a mentoring scheme?

BACKGROUND: In line with other Western countries, the number of foreign doctors in Norway has greatly increased in recent years. Inadequate language skills and cultural differences may give rise to challenges. The objective of this study was to investigate the views of Norwegian specialty registrars in psychiatry with regard to a mentoring scheme for foreign doctors and how such a support scheme ought to be designed. MATERIAL AND METHOD: Data were collected in focus-group interviews with specialty registrars in psychiatry. Altogether 24 Norwegian and 16 foreign doctors participated in a total of five focus groups. Thematic analysis was used as methodology. RESULTS: One consistent finding pertained to the differing views on the need for a mentoring scheme among the Norwegian and foreign doctors respectively. The foreign doctors perceived few problems in terms of language and culture, while their Norwegian colleagues had occasionally experienced considerable problems in this respect. Moreover, obstacles in terms of attitude to a mentoring scheme were revealed among the foreign doctors, as well as differing opinions regarding the organisation of such a scheme, especially in terms of its voluntariness and having peers as mentors (horizontal organisation) versus having superiors as mentors (vertical organisation). INTERPRETATION: The differences in attitude to a mentoring scheme are partly caused by perception of the problem's extent and partly by varying norms and values among foreign and Norwegian doctors respectively. We propose that various forms of mentoring scheme be tested in a pilot project, in which the foreign doctors are actively involved.

Emotional, physical and sexual violence among Sami and non-Sami populations in Norway: The SAMINOR 2 questionnaire study.

AIMS: To assess the prevalence and investigate ethnic differences of emotional, physical and sexual violence among a population of both Sami and non-Sami in Norway. METHODS: Our study was based on the SAMINOR 2 study, a population-based survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Central and Northern Norway. Our study includes a total of 11,296 participants: 2197 (19.4%) Sami respondents and 9099 (80.6 %) non-Sami respondents. RESULTS: Almost half of the Sami female respondents and one-third of the non-Sami female respondents reported any violence (any lifetime experience of violence). Sami women were more likely to report emotional, physical and sexual violence than non-Sami women. More than one-third of the Sami men compared with less than a quarter of non-Sami men reported having experienced any violence in their life. Sami men were more likely to report emotional and physical violence than non-Sami men. However, ethnicity was not significantly different regarding sexual violence experienced among men. Violence was typically reported to have occurred in childhood. Sami participants were more likely to report having experienced violence in the past 12 months. For all types of violence, the perpetrator was typically known to the victim. CONCLUSIONS: Regardless of gender, Sami respondents were more likely to report interpersonal violence. The prevalence of any violence was substantial in both ethnic groups and for both genders; it was highest among Sami women.

Opening up mental health service delivery to cultural diversity: current situation, development and examples from three northern European countries.

There are inequalities in health among migrants and local populations in Europe. Due to migration, Germany, Norway and Sweden have become ethnic culturally diverse nations. There are barriers to mental health care access for refugees, migrants and minorities, and problems with quality of culturally sensitive care in the three countries. This is despite tax-funded health care systems based on equity in service provision. There is a need to develop culturally sensitive mental health services that respond to the increasing diversity of the populations. In this chapter, we will take a closer look at cultural diversity in the countries in question, discuss challenges and give examples of current work to open up mental health services to cultural diversity. The German example will focus on the movement of Interkulturelle Öffnung (cross-cultural opening of the health care system) and work on creating national guidelines and quality standards. From Norway, the work of the National Centre for Mental Health for the indigenous Sámi population will be presented. The Swedish example will focus on the work carried out by the Transcultural Centre. The latter is a competence centre supporting development of culturally sensitive care as an integrated part of the regional health and mental health care system in Stockholm. Finally, the relevance of mental health care for a culturally diverse population, as a part of the larger social project of building tolerant multicultural societies, will be discussed.

Social competence and emotional/behavioral problems in a birth cohort of Sami and Norwegian preadolescents in Arctic Norway as reported by mothers and teachers.

In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers' and teachers' reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11-12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population.

Cross-informant correlations on social competence and behavioral problems in Sami and Norwegian preadolescents.

In a community-based birth cohort from Arctic Norway, correlations between parents and teachers on child competence and behavioral problems were determined for Sami and Norwegian 11-12 year-olds, using as instruments the child behavior checklist (CBCL), teacher report form (TRF), and the impact supplement of the extended strength and difficulties questionnaire (SDQ). Parent-teacher correlations on child behavioral problems were generally high in the Norwegian group, but low in the Sami group. Cross-cultural differences in cross-informant correlations were highest regarding externalizing and attention problems. Parent-teacher correlations on total impact of child difficulties also differed between the ethnic groups. Once again, a lower correlation was found for the Sami children. The discrepancy between parents' and teachers' perception of problems that needed attention was highest for the Sami, and lowest for the Norwegians. The Sami parents reported fewer perceived difficulties and less impact of problems than did the Norwegian parents. In contrast, no ethnic differences emerged for teachers' ratings. The paper discusses how cultural norms might influence the reports of child problems. It demonstrates the importance of combining parent and teacher reports of child behavior problems in minority and indigenous children, who often live under different cultural norms in home and school contexts.

Child-rearing in an indigenous Sami population in Norway: a cross-cultural comparison of parental attitudes and expectations.

Semi-structured interviews of 76 Sami mothers and 58 Sami fathers, and 86 Norwegian mothers and 58 Norwegian fathers of four-year olds, revealed consistent cross-cultural differences in parenting. ANCOVA results showed that parental permissiveness was higher in the Sami group. Moreover, the effect of ethnicity was different for boys and girls (mothers' reports). Co-sleeping and self-regulation of food and sleep were commonly practiced in the Sami, but not in the Norwegian families. Sami children were more socially independent than their Norwegian peers. Indirect or internal types of control were used more by Sami parents, and they were less tolerant of child aggression, in the form of temper tantrums and displays of jealousy. These patterns are similar to those found in other indigenous cultures in the circumpolar region. The results are discussed with reference to the Individualism-Collectivism dimension. The study challenges the Individualism-Collectivism construct for apparently confounding the individualism common in European liberalism with the individual autonomy commonly encountered among hunting-gathering peoples.

Parenting correlates of child behavior problems in a multiethnic community sample of preschool children in northern Norway.

A multiethnic community sample of 191 families with four-year-old children in northern Norway was used to explore whether parenting factors were associated with child behavior problems, and whether these associations differed for boys and girls or for the two main ethnic groups in this region: the indigenous Sami and the majority Norwegians. The Child Behavior Checklist (CBCL) and a semi-structured interview on child-rearing were used as instruments. As would be expected from a developmental perspective, elevated scores of child behavior problems were associated with lower levels of parental cuddling and with higher levels of physical punishment. Family demographics such as low maternal age and single parenthood were also associated with more behavioral problems. Girls seemed to be more strongly influenced by child-rearing factors than boys. Subgroup analyses suggested that for harsh treatment, patterns of correlations differed between Sami and Norwegian groups, especially for boys. A positive correlation between physical punishment and externalizing problems emerged for Norwegian boys, but not for Sami boys. Teasing/ridiculing was positively correlated with internalizing problems for Norwegian boys, but inversely correlated for Sami boys. These findings emphasize the importance of taking the child's cultural context and gender into account when assessing parenting influences on behavioral problems in children.

Parental values and ethnic identity in indigenous Sami families: a qualitative study.

The qualitative study reported in this article is part of a larger multimethod investigation of child-rearing practices and child-behavior problems in indigenous Sami and majority Norwegian populations in the Sami core area in Northern Norway. In the primary quantitative study we found significant ethnic differences between Sami and Norwegian parents in various areas of child rearing and family structure. Seeking the deeper cultural meaning underlying the parental practices and attitudes that had emerged in the indigenous Sami group, we performed additional indepth interviews. Four parents, selected from the sample of 134 Sami parents, served as subjects. Giorgi's descriptive phenomenological method was used. Data analysis of the interviews identified seven key consitituents of Sami child rearing, which in their interrelationships formed a common structure that constitutes the results of this study. These constituents were: (1) Independence, (2) Hardiness, (3) Autonomy, (4) Closeness/Love, (5) Sami Language, (6) Sami Traditions, and (7) Extended Family. The first four constituents are constituents pertaining to child-rearing values, while the latter three are contextual constituents, related to the promotion of ethnic identity. The study discusses the contemporary dilemmas and challenges that face Sami families in raising their children. It highlights the phenomenon of cultural transition in minority families as an important topic in family research.