"Breaking the silence" Interpersonal violence and health among Sami and non-Sami - A populations-based study in Mid- and Northern Norway

Abstract This doctoral thesis is based on a sub-study of the SAMINOR 2 questionnaire study. The SAMINOR 2 study is a population based, cross-sectional questionnaire study on health and living conditions in areas with both indigenous Sami and non-Sami settlements in Mid- and Northern Norway. The SAMINOR 2 study was designed as a follow-up study of issues addressed in the original SAMINOR 1 study from 2003-2004, but was expanded to include additional health issues such as interpersonal violence and questions on post-traumatic stress (PTS). All inhabitants aged 18-69 in selected municipalities registered in the Norwegian National Population Register by 1 December 2011 were invited to participate. All data were collected in 2012. Purpose Our aims were twofold, namely (1) to investigate the prevalence of lifetime interpersonal violence and its association with socio-economic and demographic factors in two different ethnic groups: the indigenous Sami and non-Sami, and (2) to investigate and compare the association between childhood violence and psychological distress, symptoms of post- traumatic stress, and chronic pain in adulthood in these two groups. Results Sami ethnicity was found to be a risk factor for any lifetime interpersonal violence for both genders, except for sexual violence among men. The results remained significant after adjusting for socio- economic and demographic factors, as well as for alcohol consumption. A robust and positive correlation was found between childhood violence and indicators of mental disorders (psychological distress and symptoms of PTS), as well as chronic pain in adulthood, regardless of ethnicity and gender. However, the association between childhood violence and adult chronic pain was weaker and turned out to be non-significant among Sami men. Finally, a higher level of psychological distress and more symptoms of PTS were found among the Sami than the non-Sami. Childhood violence was found to mediate some of these ethnic differences in mental health problems. Conclusion The findings indicate that Sami ethnicity is a risk factor for exposure to lifetime interpersonal violence. Moreover, a consistent association between childhood violence and mental health problems and chronic pain in adulthood indicates that childhood violence represents an important risk factor for poorer health in adulthood, irrespective of ethnicity. In clinical practice, addressing childhood violence should be more focused and part of the diagnostic process for patients with adult mental health problems and unexplained chronic pain. Culturally sensitive public health preventive strategies targeting interpersonal violence in communities with both Sami and non-Sami inhabitants are warranted.