“It’s so hard to put tangible figures to it:” Examining Climate Change Impacts on Inuit Mental Health in Nunatsiavut, Labrador by Jacqueline Middleton A Thesis presented to The University of Guelph In partial fulfilment of requirements for the degree of Doctor of Philosophy in Population Medicine Guelph, Ontario, Canada © Jacqueline Middleton, August, 2020 ABSTRACT “IT’S SO HARD TO PUT TANGIBLE FIGURES TO IT:” EXAMINING CLIMATE CHANGE IMPACTS ON INUIT MENTAL HEALTH IN NUNATSIAVUT, LABRADOR Jacqueline Middleton Advisors: University of Guelph, 2020 Dr. Sherilee L. Harper Dr. Ashlee Cunsolo Dr. Andria Bitton-Jones Transformational climate change across the Circumpolar North is disrupting Indigenous Peoples’ access to land, sea, and ice, leading to emotional distress, interpersonal stress, anxiety, depression, substance use, and increased use of mental health services. While there are strong theoretical understandings of the mechanisms that link climate and mental health, there is relatively little known about how the mental health of the most climate-sensitive populations is being impacted. Therefore, this research used a community-driven population health approach to examine how weather and seasonality impacts Inuit mental health in Nunatsiavut, Labrador, Canada in the context of climate change. First, a scoping review explored global Indigenous climate-mental health relationships. This review characterized the ways in which the emotional and psychological impacts of climate are connected to changing place attachment, disrupted cultural continuity, forced human mobility, and intangible loss and damages. Then, to characterize the lived experiences of climate impacts on Inuit mental health, in-depth interviews from across Nunatsiavut (n=116 interviews) were analysed. Results indicated that weather impacted mental wellness through: shaping daily lived experiences including connection to place; altering mood and emotion on a transient basis; and seasonally influencing individual and community wellbeing. To examine these climate-mental health interconnections in Nunatsiavut, a regional time series analysis examined quantitative associations between temperature and mental health clinic visits. Mental health clinic visits significantly increased following warmer temperatures and decreased following temperature ranges that allow land use and access. These results demonstrated the important role that temperature plays in Inuit mental health; however, these impacts on mental health will not be uniformly distributed across communities. To understand the distribution of weather-mental health associations among communities, time series regression examined how place modified the effect of temperature on mental health clinic visits. No two communities had the same weather-mental health associations, demonstrating the extent to which place matters in the context of Inuit mental health and climate change. This work provides new insights into climate change impacts on mental health and has important research, policy, and planning implications for regions such as Nunatsiavut, which are already experiencing the fastest rates of warming on the planet. iv ACKNOWLEDGEMENTS My graduate studies have been the most challenging and rewarding experience of my life. Although my name is on this thesis, the following people have helped me immensely. First and foremost, I would like to thank the individuals, communities, and governments of Nunatsiavut that have gifted me with their time, stories, and experiences. I am immensely grateful for the warmth and energy with which I was welcomed to Nunatsiavut. I was granted a profound privilege and responsibility to communicate this research to a broader community and I am humbled by and grateful for your trust. To Sherilee Harper and Ashlee Cunsolo; you are a dynamic duo. I frequently tell others that I hit the jackpot when it comes to supervisors. I am indebted to you both for not only trusting me to explore such transformative research ideas, but for being my biggest supporters and believers throughout this process. You have invested immense intellectual and emotional labour in me and my work, helping me grow and surprise myself. Thank you. Thank you to Andria Jones-Bitton for joining this powerhouse advisory team. Andria – you taught me, and countless others, the ABCs of epidemiology. Moreover, thank you for the insights, feedback, and compassion throughout the years. To my advisory committee as a whole – you are amazing. Every interaction with you made me feel empowered and supported as a young female researcher. Thank you to my Inuit colleagues and mentors who I have gotten to work closely with over the years and have guided me and this research process. Michele Wood – for the passion and thoughtfulness that you bring to your work and have inspired me with – it has been a pleasure and privilege to learn from you (and to enjoy your homemade treats) and witness the v transformative work that you do. To community research leaders Charlie Flowers and Inez Shiwak. Charlie – your passion for your community is exemplified by your depth of knowledge of it and through the beautiful imagery and history you share with others. Thank you for your patience in answering all my questions about weather, ice, and the land; these discussions have been integral to this research. Inez – I have had so much joy in being one of your students. Thank you for always telling it to me like it is and mentoring me through example as you balance your diverse talents and expertise as an artist, researcher, and Inuit- and community-health advocate. To Nathaniel Pollock – thank you for taking me under your wing in Goose Bay, connecting me with people and resources, and generously sharing your expertise and time with me; your friendly check-ins throughout the years have given me lovely hits of motivation to see me through to the end. They say it takes a village, and part of that village has been both past and current members of the amazing Climate Change and Global Health Research Group: Amreen Babujee, Katherine Bishop-Williams, David Borish, Laura-Jane Brubacher, Amy Caughy, Shaugn Coggins, Lindsay Day, Matthew Pike, Sharon Edmunds-Potvin, Crystal Gong, Jen Jones, Amy Kipp, Steven Lam, Danielle Julien-Wright, Anna Manore, Stephanie Masina, Katherine Neale, Kaitlin Patterson, Manpreet Saini, Alexandra Sawatzky, Jamie Snook, Paola Torres Slimming, Vivienne Steele, and Carlee Wright. Each of you have given me laughs, insights, motivation, and inspiration. I could not have gotten through this without you. I would also like to thank those who have helped me feel settled and secure despite being far away from ‘home.’ To both Stephanie Masina and Deron Caplan, you have been the dearest friends throughout this journey, thank you for helping me transition to and love my time in Guelph. To those from Edmonton, Kate and Julien Landry, Carlee Wright, Amreen Babujee, and vi Toma Carmel; you have all been a family to me in Alberta and deeply enriched my Edmonton experience. I am happier and healthier because of you. Thank you to the women’s rugby community that has given me a home and has been a source of strength and wellness in every city I lived. Notably, thank you to the Toronto YeoLions, Guelph Gryphons, and Edmonton Clanswomen. Also, to Ashlee Cunsolo and Jamie Snook – you have been the finest hosts whenever I am in Labrador; making feel welcome and filling me with tea, chocolate, and laughter. You have made Labrador all that more special to me. Lastly, a heartfelt thank you to my friends and family who have supported me in becoming the person that I am today. To my sisters; Stephanie – thank you for setting ridiculously great examples growing up and encouraging me to pursue my PhD among some of my other better life choices; Colleen – you have been my conspirator and on this journey with me for years without expectation, thank you. And, to my mom and dad, Louise and David, thank you for setting me up to succeed in more ways than you could ever realize, for giving me a happy and healthy life. I have always felt loved. vii TABLE OF CONTENTS ABSTRACT ................................................................................................................................... ii ACKNOWLEDGEMENTS ........................................................................................................ iv LIST OF FIGURES ..................................................................................................................... xi LIST OF TABLES ...................................................................................................................... xii TABLE OF APPENDICES ....................................................................................................... xiii STATEMENT OF WORK ........................................................................................................ xiv POSITIONALITY STATEMENT ........................................................................................... xxi PREFACE: BEGINNINGS ARE SUBTLE THINGS ........................................................... xxv Chapter One │ Introduction ........................................................................................................ 1 1.1 Global climate change and mental health ............................................................................. 1 1.2 Climate change and mental health in the Circumpolar North............................................... 5 1.3 Approaches to climate change and mental