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A Rapid Review of Irish Traveller Mental Health and Suicide: a Psychosocial and Anthropological Perspective

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A Rapid Review of Irish Traveller Mental Health and Suicide: a Psychosocial and Anthropological Perspective Irish Journal of Psychological Medicine, page 1 of 11. © The Author(s), 2020. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. REVIEW ARTICLE doi:10.1017/ipm.2020.108 A rapid review of Irish Traveller mental health and suicide: a psychosocial and anthropological perspective S. McKey1, B. Quirke2 , P. Fitzpatrick2, C. C. Kelleher1,2 and K. M. Malone1,* 1 Department of Psychiatry, Psychotherapy & Mental Health Research, St Vincent’s University Hospital & UCD School of Medicine, Dublin, Ireland 2 UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland Introduction: Irish Travellers are an indigenous ethnic minority (IEM) with poor health outcomes. Whilst they constitute less than 1% of the Irish population, they account for 10% of national young adult male suicide statistics. Methods: A rapid review of scientific publications related to mental health and suicide in Irish Travellers was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches of PubMed, PsycINFO and Google Scholar were performed. Eligibility criteria included: (i) Irish Travellers/Gypsy Travellers; (ii) information on mental health/suicide/self-harm; (iii) psychosocial anthropological perspectives of mental health; (iv) publications in english. Data on studies including design, methods, participants and key findings were extracted using a spreadsheet template. Results: From 5160 scientific references over the past 20 years, 19 papers made reference to Traveller mental health, and only 5 papers made specific data-based reference to suicide in Travellers. It was only when we qualified Travellers as being ‘Irish Travellers’ in our scientific review did we detect meaningful references to their existence as an IEM, and their health and well-being. Due to sample sizes and heterogeneity in design, results were synthesised narratively. Discussion: This paper draws together strands from the disciplines of psycho/socio/anthropological perspectives to gain deeper insights into mental health and suicide in Irish Travellers. In a knowledge vacuum, it behoves the scientific community to explain the value of scientific research and rigour to both policymakers as well as Travellers, shifting the existing discourse towards new knowledge and understanding around mental health and suicide in Travellers. Received 27 May 2020; Revised 21 August 2020; Accepted 07 September 2020 Introduction discrimination, poverty and unemployment. They have known poorer outcomes and health status than the gen- Irish Travellers are an indigenous minority group eral population, as highlighted in the findings of the All in Ireland, first officially recognised by the Irish Ireland Traveller Health Study (AITHS). The overall Government in March 2017 (Joint Committee on Traveller life expectancy was 66 years, that is, 15 years Justice and Equality, 2017). They are distinct in their less for Traveller men and 11 years less for Traveller culture, language, value system originating from their women. The Traveller mortality rate is 3.5 times higher nomadic tradition (Gmelch & Gmelch, 1976;Ni and the infant mortality rate is 4 times higher than the Shuinear, 1994). The Equal Status Acts (Government general population (All Ireland Traveller Health Study of Ireland, 2016) defines Travellers as: ‘The community Team, 2010). of people who are commonly called Travellers and who Whilst several review studies have looked at the are identified (both by themselves and others) as people health of Travellers, the focus has by and large been with a shared history, culture and traditions, including on physical health, vaccine uptake and outreach pro- an affinity to a nomadic way of life on the island of grammes with little emphasis on mental health and Ireland’. suicide. Yet, the findings from AITHS show high levels Travellers are a marginalised group in Ireland of mental ill-health, and frequent mental distress (FMD) and suffer disadvantage and social exclusion due to has shown to be associated with key life events includ- ing experience of discrimination and bereavement (McGorrian et al. 2013). There has been some research *Address for correspondence: K. M. Malone, Department of done by Mac Greil (1996, 2010) which shows that Psychiatry, Psychotherapy & Mental Health Research, St Vincent’s University Hospital & UCD School of Medicine, Elm Park, Dublin 4, Irish Travellers are exposed to the risk of discrimination Ireland. on a daily basis in all aspects of their lives. This was (Email: [email protected]) further confirmed by a recent report commissioned 2 S. McKey et al. by the Economic, Social and Research Institute where Eligibility study criteria included: they found that Travellers were 22 times more likely to experience discrimination. (McGinnity et al. 2017). (i) Individuals identifying as Irish Travellers in There is a wide range of international publications Ireland or the United Kingdom and or/Gypsy (Karlsen, 2007; Paradies et al. 2015) which highlight Travellers, (ii) Information relevant to mental health/mental the association between the experience of discri- illness/suicide/self-harm, mination and low self-esteem, suicidal tendencies, (iii) Psychosocial anthropological perspectives on mental health and psychological stress. We explore indices of mental health. the links between experience of discrimination in a. Studies were rated as having an anthropological Travellers and engagement with Mental Health perspective based on whether they referenced Services in an accompanying paper (Quirke et al. cultural or societal meaning and a holistic 2020). approach in their recruitment, design or findings. Rapid reviews are best designed for new or b. Indices of mental health are the following: emerging research topics (Ganann et al. 2010). i. Depression, Here, we present a rapid review of Traveller mental ii. Anxiety, health and suicide, exploring the extent, type and iii. Suicide, nature of research to date, from a psycho–socio– iv. FMD, anthropological perspective (as per the IJPM special v. Alcohol and substance misuse, edition brief). vi. Morbid grief. (iv) Publication in english. A flowchart of the literature screening is presented Methods in Fig. 1. Data, including study characteristics (e.g. A rapid review is described as a form of knowledge authors, date of publication), study methodology (e.g. synthesis in which components of the systematic recruitment, measures used), participant characteristics review are simplified with a rapid analysis and dissemi- and study results (e.g. prevalence or incidence data nation of the topic that still allows for a comprehensive and associations between variables of interest) were literature exploration. It speeds up the systematic extracted using a spreadsheet template (Table 1). approach by omitting some stages, making it valuable but less rigourous. The analysis broadly followed the Preferred Results Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) guidelines (Moher et al. 2009). Twenty-four papers fulfilled the criteria for inclusion Electronic searches of PubMed, PsycINFO and in the review from the initial 5160 references (Fig. 1). Google Scholar were performed with earliest records Due to the small sample size and considerable till January 2020. Search words included (‘Traveller’ heterogeneity in study design, a meta-analysis was OR OR ‘Gypsy Travellers’) and (‘Mental health’ OR not used. Results were synthesised narratively to ‘Mental illness’ OR ‘Suicide’ OR ‘Self-harm’). A further produce a descriptive, hypothesis-generating study search of ‘Irish Traveller in United Kingdom/UK’ was of mental health and suicide in Irish Travellers. also included. Given the broad initial scope, including Results were grouped into those that included a reference International Infectious Disease and Traveller health, to Traveller mental health (n = 19) (Table S1,in ‘Irish’ was added as a prefix. Supplementary material) and those that referred specifi- For PubMed publications, searches were sorted by cally to suicide amongst Travellers (n = 5), (Table 1). ‘best match’ rather than ‘most recent’ to optimise the The studies included quantitative (n = 10), qualitative search. Once read, all articles were then screened for (n = 12) and mixed-method studies (n = 2), with the search words including ‘mental health’‘mental illness’, majority being qualitative; as well as whether studies ‘suicide’, ‘depression’, ‘anxiety’, ‘stress’ and ‘nerves’. were conducted in the United Kingdom (n = 14) or Initially, three reviewers (SM, KMM, CCK) independ- Ireland-based (n = 10). ently read all identified titles and abstracts. Duplicates As shown in Table 1, participant numbers ranged were removed. Selected articles were then reviewed by from 7 to 1947, with a large range in age group across two reviewers, with disagreements being arbitrated studies, and the majority of studies ranging from teen to between three (SM, KMM, CCK) and final adjudicator older adult. Gender was commented on frequently; KMM. Reference lists of all articles were checked with the majority of participants in each study being for additional relevant publications (including grey female. One study focused primarily
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