Cultural interventions that target mental health and wellbeing for First Nations Australians: a systematic review

Abstract

ABSTRACT Objective The continuity of Australian First Nations (Aboriginal and Torres Strait Islander) culture has been threatened by colonisation and effects of this continue to have devastating impacts on their social emotional wellbeing [SEWB], especially mental health. This review analyses cultural interventions aiming to improve mental health outcomes for First Nations Australians (e.g., mood, self-esteem, suicide-attempts, self-harm, risky behaviours) to uncover the effectiveness and key components of such interventions. Method Databases PsycINFO, CINAHL, EMBASE, EMCARE, LIt.search tool from Lowitja Inst, Australian Indigenous Health InfoNet and Google Scholar were searched. Studies published between 2000 and 2021 which reported the impact of cultural interventions on the mental health of First Nations Australians were included. Results From 172 studies, only eight studies met inclusion criteria and all improved measured domains of SEWB. Six studies evaluated culturally adapted interventions (i.e., Western interventions adapted to be culturally appropriate) and two evaluated culturally grounded interventions (i.e., interventions developed by First Nations Australians). Participants called for more cultural components in culturally adapted interventions. The most successful studies used collaborative and participatory approaches in the designs, included First Nations members in their research teams and presented culturally grounded interventions. Conclusions The paucity of literature limit findings. There was a limited ability to identify key mechanisms of change across some intervention studies, and large outcome variations across studies meant some aspects could not be compared. Nonetheless, this review concludes that culturally grounded interventions are the most promising and successful mental health interventions currently available for First Nations Australians which has many implications for practice and funding. Key Points What is already known about this topic: First Nations Australians experience poorer mental health and wellbeing than non-indigenous Australians. Previous attempts to improve the mental health of First Nations Australians utilising Western therapeutic interventions have been largely unsuccessful. More recent attempts to improve mental health for First Nations Australians utilising culture appear promising, that is, culturally adapted and culturally grounded therapeutic interventions. What this paper adds: (1) Culturally grounded interventions are effective, preferable over culturally adapted interventions, and best to use for improving the mental health and wellbeing of First Nations Australians. (2) Limited evaluations of cultural interventions have been conducted that provide empirical data showing the effectiveness of the intervention on mental health and wellbeing for First Nations Australians. (3) Successful forms of intervention evaluations with First Nations Australians utilise participatory and collaborative research approaches.