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En sammanfattning av rapporten finns på svenska, nord- och lulesamiska. En sydsamisk översättning utgår på grund av återbud med kort varsel där ingen ersättare kunnat hittas inom tidsfristen. 

Syfte: Fokusgruppstudiens syfte var att möjliggöra för samer att delta i öppna samtal om hälsotillstånd och hur levnadsvillkor och livsstil kan påverka hälsan och att låta denna kunskap berika utformningen av en enkät och en klinisk studie om hälsotillstånd som nästa steg av HALDI-studien.

Metod: Elva fokusgrupper med samiska deltagare geografiskt fördelade från södra delarna till norra delarna av Sápmi genomfördes under hösten 2018-våren 2019. Deltagarnas ålder sträcker sig från 23-77 år, med en medelålder på 53 år. Två över-gripande frågeområden avhandlades vid fokusgruppdiskussionerna; samisk hälsa och hälsoforskning med fokus på samernas hälsa. Samtalen ljudinspelades och transkriberades till text. Texterna analyserades av tre oberoende forskare med hjälp av kvalitativ innehållsanalys.

Resultat: Deltagarna beskriver en holistisk syn på hälsa, det vill säga att allt hänger samman. De lägger stor vikt vid upplevelser/tillstånd av andlighet, vistelsei naturen, fysisk aktivitet och harmoni för att uppnå en god hälsa. Andligheten kopplas inte samman med religion utan förknippas starkt med naturen. Det framkom att en kulturell norm ”ieš birget” kan påverka benägenheten att söka vård. Denna norm innebär en strävan efter att klara sig själv, att vara stark, inte visa sig svag och att inte belasta andra med problem. I fokusgruppdiskussionerna framkom även att det både är svårt och ovanligt att öppet prata om psykisk ohälsa och missbruksproblematik. Detta kan på sikt påverka hälsan och benägenhet att söka vård negativt. Deltagarna har negativa erfarenheter av bristfällig kulturförståelse och okunskap om samiska livsvillkor i mötet med hälso- och sjukvården. Utsatthet i form av diskriminering, rasism och okunskap om samisk historia och samiska livsvillkor framkommer som vanligt förekommande och beskrevs vara en risk för ohälsa och ansågs ha en negativ inverkan på hälsotillståndet. Det uttrycktes skepsis och misstroende mot forskning generellt. Detta grundades på upplevelse av brist på delaktighet, bristfällig information och utebliven återkoppling av resultat men även på historiska erfarenheter kopplade till bland annat rasbiologi. Samtidigt påtalades att ökad kunskap avseende samernas hälsa behövs och därför ansåg deltagarna att det ändå var viktigt att delta i forskningsstudier. Vikten av att tydliggöra forskningens syfte och dess nytta betonades särskilt.

Slutsatser: Fokusgruppstudien har gett värdefulla bidrag om viktiga forskningsområden och hur kommande hälsostudier som involverar samisk befolkning bör utformas och genomföras. Det går att konstatera att inom samisk hälsoforskning i Sverige finns många områden som går att förbättra och tydlig-göra exempelvis kring etik, information, återkoppling, datahantering och utformning av studier 

This chapter provides information about the social and emotional wellbeing of Indigenous Sami children and young people living in Sweden with a focus on health-related quality of life indicators, education and government policies regarding provision and support. The intention is also to highlight the current need for further research to support Indigenous Sami children and young people. We argue that provision of services to support the social and emotional wellbeing of Sami children and young people needs to be improved with better education and policy provision. It is hoped that through a stronger focus on advocacy, Swedish policies can be improved and stronger support networks provided.

BACKGROUND: Evidence suggests socially disadvantaged people or those who live in socially disadvantaged areas experience more harm per gram of alcohol consumed than people with greater social advantages. In the Sami group, probable associations between alcohol use and several areas of health have been explored, but there are no studies regarding the drinking habits of young Sami in Sweden.

AIMS: To investigate alcohol use in young Sami in Sweden, and in a reference group from the general young Swedish population in the same area; to evaluate likely associations between gender, education, family situation and alcohol use.

METHODS: The Alcohol Use Disorder Identification Test was used in a cross-sectional study comprising 516 Sami (18-28 years), and a reference group (18-29 years, n = 218).

RESULTS: No significant differences in hazardous/harmful alcohol drinking in young Sami and Swedes were found. Nearly half the men and ~35% of the women reported risky alcohol use. Gender differences were reported only in the Sami. Sami men had 1.6 times higher odds of hazardous/harmful drinking compared to Sami women. Only in the Sami were lower education levels associated with higher odds of hazardous/harmful drinking. Experiences of "often forgetting important things", seldom "looking forward with joy", and self-perceived ethnicity-related negative treatment were associated with hazardous/harmful drinking.

CONCLUSIONS: Although alcohol use in young Sami appears to be similar to alcohol use in young non-Sami Swedes, important risk factors for hazardous/harmful drinking are identified, e.g. ethnicity-related negative treatment. These should be taken into account when planning for preventive interventions.

AIM: To investigate health-related quality of life (HRQOL) in indigenous Sami schoolchildren in Sweden and its associations with sex, age, enculturation and ethnicity-related negative treatment.

METHODS: The study population was comprised of all children in grades 6-12 (ages 12-18 years) who attended specific Sami school programmes in Sweden. HRQOL was measured by the Kidscreen-52 self-report form, which was filled in at school (n = 121).

RESULTS: The indigenous Sami children in Sweden experienced lower HRQOL than Swedish children in general, with regard to their school situation, financial resources, parents' relations, physical well-being and social support from peers. In Sami children, functioning and well-being generally decreased by older age group and girls reported lower physical well-being, more negative feelings and more negative self-perception than boys. Finally, more than half of the Sami children had experienced ethnicity-related negative treatment, and these children reported a robustly lower functioning and well-being compared with those without this experience.

CONCLUSION: In some aspects of HRQOL, indigenous Sami schoolchildren with an explicit ethnic identity experienced less favourable functioning and well-being than Swedish children in general, which is worrisome. A high degree of ethnicity-related negative treatment may partly explain this lower HRQOL in Sami children.

Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.

Background

The Sami are the indigenous people in Scandinavia. They have a long history of discrimination, racism and conflict which has had a significant impact on Sami self-esteem and possibly also on their health, especially mental health. There are some recent studies on the mental health of reindeer herding Sami in Sweden showing a high prevalence of self reported depression and anxiety compared to other Swedes in the area. Also a moderately elevated risk of suicide amongst reindeer herding male Sami exists. Several studies on the health of young Norwegian Sami have not found any major differences between the young Sami and young Norwegians in the majority population. This is the first study on the health and living conditions of young Sami in Sweden with a special reference to mental health.

Subjects and methods

Two groups of young Sami have been approached; schoolchildren aged 13-18 years participating in special school programs for Sami children (N=121) and a national sample of young adult Sami aged 18-28 years (N=516) with an explicit Sami identity. The schoolchildren responded to questions about wellbeing and functioning measured by a self report version of Kidscreen-52 and some questions about enculturation and experience of being badly treated because of ethnic background. The young adults responded to a questionnaire about living conditions, Sami identity, health and suicidal expressions, and about experiences of bad treatment because of ethnic background. Data were compared with data from other Swedish youngsters.

Main findings

Being a young Sami in Sweden – Living condition, identity and life satisfaction (Paper I)

A majority of the young adult Sami were proud of being Sami, they had a positive self perception and expressed a wish to preserve their culture. Bad treatment because of Sami background was frequent, about half of all respondents reported this experience and among reindeer herders seventy percent. The Sami experienced that they had to explain and defend the Sami culture and Sami way of living to a high degree, it become obvious that there is lack of knowledge about Sami and Sami culture among Swedes.

The health of young Swedish Sami with special reference to mental health (Paper II)

A majority of the young adults reported feeling healthy but close to half of the group often had worries, often forget things and often experienced lack of time for doing needed things. Women and those living alone reported more negative health. Sami with experience of bad treatment due to Sami background also reported a worse health i.e. more worries, more lack of time to do needed things and not feeling calm and relaxed.

Healthrelated quality of life in Sami schoolchildren in Sweden (Paper III)

The Sami children reported lower health-related quality of life (HRQL) compared to Swedish children in general. Girls had lower physical and psychological wellbeing than boys. Sami school children with experience of ethnicity related bad treatment reported a lower HRQL compared to those without this experience.

Suicidal expressions in young Swedish Sami (Paper IV)

Both young adult Sami and a reference group of young Swedes from the same geographical area (N=218) reported suicidal ideation, life weariness and death wishes to a high degree (30-50 %) but this was more common among Sami. The prevalence of suicide attempts did not, differ between Sami and other young Swedes, but subgroups of the Sami (reindeer herders and those being badly treated due to ethnicity) reported a higher degree of suicide attempts and having had plans to take own life compared to Sami without this experience.

Conclusion

The less favourable wellbeing (HRQL) of the Sami children in this study compared to Swedish children in general is worrisome and might partly be explained by experiences of ethnic related bad treatment, which can be especially troublesome in the turbulent adolescent years. The young adult Sami however seem to have a rather good or even better health compared to other young Swedes. They are proud of being Sami, have a close connection to the Sami community and strong connections to family and relatives. These are possible protective factors partly explaining the wellbeing of this group in spite of the high degree of ethnic related bad treatment reported.

Objectives. To investigate the health of young Sami in Sweden and the relationship between health and experience of negative societal treatment due to ethnicity, as well as socio-demographic background factors.

Study design. Cross-sectional population-based questionnaire study.

Methods. A total of 876 persons aged 18-28 and involved in Sami associated activities were addressed, and 516 (59%) responded to a questionnaire investigating physical health, mental health, and stress. Data were analyzed with regard to gender, family situation, occupation, education, enculturation factors and experience of being badly treated because of ethnicity.

Results. A majority of the young Sami reported feeling healthy, but close to half of the group reported often having worries, often forgetting things and often experiencing lack of time for doing needed things. Women and those living alone reported a more negative health. Furthermore, half of the group had perceived bad treatment because of Sami ethnicity, and this was negatively associated with some aspects of mental health.

Conclusion. The young Sami had a rather good and possibly slightly better health than other young Swedes, except regarding worries and stress. A high degree of bad treatment due to Sami ethnicity and its negative association with health, may partly explain the high degree of some health problems.

Objective: The aim of the present study was to illuminate the contemporary cultural reality of being a young Sami in Sweden, with special reference to issues such as identity/self-perception, autonomy, and experiences of being ill treated and discrimination.

Design: The study comprises a qualitative and a quantitative part. The qualitative part includes meetings, discussions and dialogues with young Sami and others. The quantitative part includes a questionnaire on socioeconomic conditions, Sami ethnicity, experiences of being ill-treated because of a Sami background, specific questions on identity and self-perception, questions about self-determination, and thoughts and expectations of the future. The sample consists of 876 young Sami aged 18–28, of whom 516 (59 per cent) responded to the questionnaire.

Results: A majority are proud to be Sami and wish to preserve their culture. 71 per cent have a close connection to a Sami community. Most of the young Sami have had to explain and defend their culture and way of life. Nearly half had perceived discrimination or ill-treatment because of their ethnicity, with reindeer herders reporting a higher degree of ill-treatment (70 per cent). Reindeer herders exist in a severe environment with an insecure legacy. Most of the young Sami in this study have a positive self-perception and think that their lives are meaningful. Very few dropped out of school and very few are unemployed.

Conclusion: We believe that there are protective factors that potentially explain the well-being of this group; a strong feeling of belonging among the Sami, strong connections to family, relatives and friends and good sociocultural adaptation (to have a job, completed school).