American Indian and Alaska Native Mental Health Research最新文献

Experiences of discrimination are linked to mental health in American Indians. Less is known about how place of residence (i.e., living on or off a reservation) relates to discrimination frequency and whether the strength and nature of the relationship between discrimination and mental health varies as a function of different living environments. In the current study, we examined frequency of discrimination, main reasons for discrimination, and relationships between discrimination for American Indians living both on and off a reservation. Relative to American Indian adults living off a reservation, American Indian adults living on reservation reported more experiences of discrimination (F(1, 846) = [15.94], p<.01, η² = .02) and identified more reasons for discrimination (F(1, 846) = [17.789], p<.001, η² = .02). Across residential contexts, race-related discrimination was most common, followed by gender discrimination. The relationship between discrimination and anxiety was significant in both residential contexts, while the relationship between discrimination frequency and depressive symptoms was only significant for those living outside of a tribal reservation. These findings highlight the importance of understanding how environmental context may affect patterns of discrimination and the relationship between discrimination and mental health in American Indians. Future research should elucidate resilience factors that are specific to living environments to reduce the negative impacts of discrimination on mental health for American Indian adults.

Gardening for Health Utilizing Traditions (GHUTS) is a new diabetes prevention intervention for urban American Indian and Alaska Native (AI/AN) adults receiving mental health treatment in Los Angeles County. The two main objectives of this study are to: 1) further our understanding of diabetes prevention and the role of gardening for urban AI/AN adults receiving mental health treatment and 2) finalize the development of GHUTS. To inform the feasibility of the intervention and to gain perspective, three focus groups were conducted among urban AI/AN adults receiving mental health treatment (n = 7), providers who serve urban AI/AN people (n = 7), and the GHUTS Community Advisory Board (n = 5). Three overarching conceptual themes emerged: 1) Diabetes is an important issue among urban AI/AN people receiving mental health treatment, 2) AI/AN traditional practices have an important role in diabetes prevention among urban AI/AN adults receiving mental health treatment, and 3) Gardening is beneficial for AI/AN people. Feedback on the GHUTS curriculum featured diabetes education, cultural elements, concerns specific to AI/AN people in Los Angeles County, cooking, physical exercise and diet, prayer and mindfulness, community sharing, and field trips. This study highlights the process of developing a community-grounded diabetes prevention intervention for urban AI/AN adults receiving mental health treatment.

The community mental health center era in the United States was based on delivering services cataloged in three areas of behavioral health needs; (1) primary prevention of mental illness: the prevention of illness before it develops; (2) secondary prevention services: the early treatment of mental illness to reduce the severity of illness, and (3) tertiary prevention: treatment aimed at the reduction of the burdens of chronic mental illness. To attain these goals in a particular state in the United States has been very difficult, and Alaska, which has only been a state since 1959, is not close to attaining these goals. As a matter of fact, this paper will demonstrate that Alaska has had more trouble than most states in providing even rudimentary services in several of these areas. Yet, because of a curious constellation of factors, this paper presents the reader with a hopeful possible alignment of programs which, if more fully developed and linked in Alaska, can become an integrated public behavioral health system open to all the residents in the state.

American Indians and Alaska Natives (AI/ANs) were disproportionately affected by the COVID-19 pandemic, experiencing excess hospitalization, mortality, and economic losses compared to the non- Hispanic Whites. This study sought to document the Indigenous determinants of health (IDOH) in AI/AN communities that shaped mental wellbeing for four groups: educators, traditional knowledge holders/practitioners, first responders, and substance abuse recovery community, during the pandemic. This work was a collaboration with and had research approval from three Native nations in Arizona. In-depth interviews were conducted from May to November 2021; 92 participants were interviewed. The most prevalent IDOH and associated themes included strategies to cope with emotional and social stressors and the impact on physical and mental health, relationships, kinship, cultural continuity, and self-determination. The groups experienced differences in mental wellbeing aligned with their occupation. For example, first responders experienced disruption and social dissonance in the workplace due to varying political views, and traditional knowledge holders/ practitioners experienced a revitalization of cultural strategies to maintain health. Although the differences between occupational groups are striking, the similarities that did exist were grounded in Indigenous identity and worldview that emphasize relationships and connection to the natural environment.

This study utilized interpretive phenomenological analysis to explore the experiences of three American Indian/Alaska Native counselors working on federal Indian reservations. Data analysis yielded four themes: the worth and weight of counseling on a reservation, the impact of culture and community on counseling, four forms of trauma impacting the counselor, and the effects of personal and professional wellness. This research contributes valuable insights into the nuanced experiences of American Indian/Alaska Native counselors working within reservation contexts and highlights the importance of addressing the unique challenges they face in delivering counseling services to their communities. Future research, support infrastructure, and counselor training initiatives should prioritize specialized training and systemic support for counselors tailored specifically to address the needs of American Indian/Alaska Native counselors and the communities they serve.

A mixed methods community-based participatory research study was conducted with Native American Lifelines of Baltimore to: (1) understand prevalence, correlates, and lived experiences with food insecurity and (2) explore the effects of and potential solutions to food insecurity. An online survey was completed by 250 American Indian and Alaska Native adults, and a subset of survey respondents (N=11) completed interviews. Quantitative analysis revealed food insecurity prevalence of 28% and increased odds of food insecurity with higher levels of food stress and COVID-19 hardships. Qualitative inquiry revealed harmful long-term effects of food insecurity on eating behaviors and several food sovereignty-oriented solutions to food insecurity.

Rates of opioid use and overdose in the United States increased during the COVID-19 pandemic, while opioid use disorder (OUD) treatment facilities faced disruptions to services during this time. American Indian and Alaska Native (AI/AN) communities were amongst those most affected by the pandemic, while also experiencing some of the highest rates of opioid-related overdose deaths. As such, this study aimed to investigate the ways in which AI/AN-servicing OUD treatment centers and their communities were impacted by the pandemic. Semi-structured interviews were conducted with ten service providers working at AI/AN-servicing OUD treatment centers between January and April 2021. Treatment centers were located in the Pacific Northwest, the North Midwest, and the South Atlantic regions, and all provided medications for OUD. Using thematic content analysis, three broad domains were identified: (1) impacts to the AI/AN communities; (2) impacts to family and social life; and (3) impacts to OUD treatment services. Our findings indicate that AI/AN clientele and communities were negatively impacted by the suspension of AI/AN traditional practices. The importance of family and community support within treatment was emphasized and how this was impacted during the pandemic, while positive changes to services brought about by the pandemic were also reported.

American Indian and Alaska Native (AI/AN) youth have the highest commercial tobacco smoking rate of any group in the United States. Unified by the aim to reduce AI/AN youth commercial tobacco use, six separately funded tobacco prevention programs serving Southern California tribes formed the Southern California Tribal Tobacco Coalition (SCTTC). Since joining forces, the SCTTC has hosted various activities and events that encourage community involvement, youth leadership, and commitment to tradition. The SCTTC's pinnacle event, the annual Inter-Tribal Tobacco Prevention Youth Summit, is an inspiring example of the organization's collaborative efforts, as it features youth- and elder-led activities and presentations by local tribal members. These community events have grown in participation from year to year and are widely supported by the surrounding AI/AN communities. This paper includes narratives from several coalition members, including youth activity organizers, that showcase the power of collaboration through the SCTTC's partnership and its success to date. The purpose of this paper is to share the SCTTC's positive impact in Southern California tribes and encourage similar programs across the nation to amplify their program impacts by forming a coalition of their own and embracing youth-led interventions.

This article releases the Gathering of Native Americans (GONA) Fidelity Tool to the public. The paper describes the methods in the development of the GONA Fidelity Tool and how it is used in planning, implementing, evaluating, and in further tailoring the GONA process more precisely to the community's needs and strengths. Development and revision of the tool occurred over 10 years with participation and input from 7 Urban Indian Health Organizations funded under Title V of the Indian Health Care Improvement Act, using the tool to advance local GONAs across the state of California. Participating organizations used the tool in partnership with Indigenous evaluators to measure GONA implementation. Process evaluations were conducted to support tool advancements over time and an Annual GONA Training of Facilitators provided a forum for consensus building of GONA best practices for tool revisions. Results indicate that the tool is useful in the planning, implementation, and quality improvement to advance local GONAs over time. The most effective use of the tool is when the items are adapted to the local culture, context, and spiritual practices of the community(ies) served. The tool is now being used nationally and has become an important resource for measuring practice-based evidence and community-defined evidence in the implementation of GONA for Indigenous communities.