American Indian and Alaska Native Mental Health Research最新文献

Positive youth development approaches with American Indian/Alaska Native (AI/AN) youth have been particularly successful and promising. Utilizing a survey with 3,736 AI/AN students, we investigated the associations between risk and protective factors and significant mental distress of AI/AN youth. The protective factors were studied within the positive youth development framework, which includes positive developmental assets reflecting aspects of the Circle of Courage, a prior framework embodying core indigenous values for youth development and education to support youth at risk. Risk factors in the study included having experienced trauma, being bullied by peers, substance use, and skipping school; protective factors were social supports, out-of-school-time activity participation, healthy eating, and healthy sleeping behaviors. Through logistic regressions, we found that risk factors were associated with more mental distress, consistent with prior research. However, students who participated in out-of-school-time activities at least three times a week, were sleeping at least eight hours daily, and those reporting social supports, particularly family/community support and sense of empowerment, had lower likelihood of mental distress. In fact, the presence of these protective factors reduced the associations of risk factors and risky behaviors with mental distress.

Inequities in access to health care create barriers to physical and mental health treatment for the rapidly aging American Indian population in the United States. This study uses concept mapping-a participatory, mixed-methods approach to understanding complex phenomena-to examine the perceived impacts of multilevel factors influencing Elders' ability to access and use health care and how these perceptions vary according to gender and age, with the aim of identifying tailored strategies to address inequities. Using data from a purposive sample of American Indian Elders (n = 65) in two states, we compared ratings of thematic clusters and individual factors perceived to impact Elder health care across four participant subgroups: women aged 55-64, women aged 65+, men aged 55-64, and men aged 65+. Provider Issues and Relationships and Tribal/National Policy were themes perceived to have a particularly high impact on Elder health. Key variations between subgroups regarding individual health care access factors reflected unique interpersonal and accessibility challenges among older women, problems stemming from lack of familiarity with health care among younger Elders and men, and challenges navigating complex bureaucracies and tribal decision-making processes among older Elders. Findings underscore the need to address multilevel gender- and age-specific factors contributing to health disparities for Elders.

This article discusses a community-based participatory research project with university researchers, an urban inter-tribal center, and other community partners to develop, administer, and deliver a community needs assessment of an urban American Indian (AI) community. In the development process, community focus groups identified major domains of inquiry for a needs assessment survey: mental health and substance abuse, medical care, and social services, including cultural programming. Results are presented and discussed in each domain. Overall, this community needs assessment contributes to a better understanding of American Indian and Alaska Native (AI/AN) urban challenges by providing information about the AI/AN population in a large southwest metropolitan area. Specifically, it highlights the relevance of local and state contexts for understanding issues facing AI/AN populations. A growing body of research indicates that AI/AN populations demonstrate some similar challenges in terms of health, social service needs, and mental health and substance abuse needs due to shared histories of colonization and misguided or underfunded government programs, among other factors. It remains true that AI/AN communities nonetheless are each distinctive and face unique challenges and opportunities within the local, state, and regional contexts in which they reside. The process described in this paper will inform policy, practice, and research communities interested in understanding the unique realities of an urban community representing many different AI tribes.

This paper examines the ethical issues underlying research with urban American Indians and Alaska Natives (AI/ANs) through the lens of tribal sovereignty. There are 574 federally recognized tribes within the United States. Each of those tribes is recognized by the federal government as having sovereign status, an important political designation that ensures that decisions impacting tribal peoples must be made after consultation with those nations. Most AI/AN people live away from their designated tribal lands, yet their sovereign rights are frequently only recognized when living on tribal lands. These urban AI/ANs are still considered citizens of their sovereign nations, yet they lack the protections afforded to those who live on tribal lands, including protections surrounding research with their tribal communities. We explore the Belmont Report and related documents and demonstrate their inadequacy in considering the cultural and ethical concerns specific to protecting urban AI/ANs. We also provide several solutions to help guide future institutional policies regarding research with urban AI/ANs that honors Indigenous data sovereignty, including consultation, partnership with community advisory boards, employment of data use agreements, and ensuring informed consent.

In this study, positive aspects of self-compassion (i.e., self-kindness, common humanity, and mindfulness of one's thoughts and feelings) were explored in relation with suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) in a community sample of 242 self-identified American Indian/Alaska Native (AI/AN) adults. Participants completed a survey packet including a demographic form, the Interpersonal Needs Questionnaire, and the Self-Compassion Scale at several Indian Health Service clinics and tribal centers in the Great Plains of the United States. Results indicated that positive aspects of self-compassion (i.e., self-kindness, common humanity, and mindfulness) were associated with and predictive of less suicide risk (i.e., less perceived burdensomeness and thwarted belongingness) among AI/AN adults. Of those with a history of suicidal ideation (n = 89), positive aspects of self-compassion were predictive of less perceived burdensomeness, but were not predictive of thwarted belongingness. Implications for prevention and intervention programs that emphasize self-compassion, mindfulness, and culturally relevant practices, as well as mental health advocacy, including suicide prevention, for AI/AN people are highlighted.

Historical trauma has contributed to the reality that addiction disproportionately affects tribal communities, including American Indian youth. We sought to understand American Indian youths' own experiences and perceptions of the environments to which they return after completing residential treatment for substance use disorder. We recruited three cohorts of American Indian residents of a substance use disorder treatment facility (N = 40). These residents completed a survey that measured risk and protective factors, as well as actual risk behaviors, including drug use, gambling, and violence. Participants were at risk not only for substance use disorders, but for other negative outcomes, and had elevated scores on several community, family, and school risk factors, including perceived availability of drugs, community disorganization, family history of antisocial behavior, favorable parental attitudes toward drug use, academic failure, and low school commitment. At the same time, they were exposed to community-level and family protective factors, and they engaged in many tribal cultural activities. When compared to a national sample of American Indian students of similar age, youth in our sample scored similarly on protective factors, including indicators of community, family, and school opportunities and rewards for prosocial involvement, as well as family attachment, suggesting potential resources and strengths for supporting recovery.

Reservation communities are among emerging communities for gang activity, in which reports of a rise in youth and/or criminal gangs began occurring after the 1980s. Gang membership has been found to pose a public health risk, strain community resources, and risk a number of individual negative life outcomes. Perceived increases in reservation gang activity have been observed by law-enforcement and community stakeholders, but comparatively little empirical research has focused specifically on these communities. Utilizing data from an existing public dataset, analysis of variance and regression analysis were utilized to examine cross sectional trends in gang involvement among 14,457 American Indian adolescents in reservation communities between 1993-2013. Results of this study failed to establish a consistent pattern of either growth or decline in gang membership across time when examining all reservations communities, with data suggesting that consistent trends may exist only within specific communities. Gang members were found to endorse significantly more alcohol and marijuana use, anger, depressed mood, and victimization as a whole. Only alcohol and marijuana use, violent behavior, and depressed mood demonstrated a significant interaction with time and gang membership. Finally, self-reported substance use, criminal behavior/delinquency, and violence perpetration significantly increased as gang affiliation increased.

While progress has been made in learning more about American Indians and Alaska Natives (AI/ANs) who reside in Hawai'i, much more research is needed regarding adolescents' mental health and the major life events that they encounter. Utilizing a large cross-sequential epidemiologic design (N = 7,214; 1992-1996), this study found AI/AN-Hawaiian youth self-reported higher risk of predominantly negative major life events and mental health symptoms than for the non-Indigenous adolescent ethnic group, with the AI/AN and Native Hawaiian ethnic groups falling generally in between. However, when statistically controlling for covariates, overall, Native Hawaiian youth self-reported higher mental-health-symptom risk than the other three ethnic groups. Implications are discussed, including protective factors, prevention, and future research.

Utilizing data collected by the Monitoring the Future project between 2005-2015, this study assesses the effect of risk and protective factors in shaping the graduation expectations of urban American Indian/Alaska Native (AI/AN) students as compared to their non-Hispanic White (NHW) peers. The responses of nearly 150,000 8th- and 10th-grade students reveal that single race and multi-race AI/AN students experienced 13 of 15 risk factors at higher proportions than NHW students, and 12 of 15 risk factors corresponded to single race AI/AN students and a third of risk factors corresponded to multi-race AI/AN students having higher odds of expecting not to graduate. Additionally, for the majority of the 14 protective factors analyzed, both single race and multi-race AI/AN students showed lower odds of expecting to graduate compared to their NHW peers.

Resilience and stress are important factors in the caregiving experience, but research has yet to examine their association among American Indian (AI) caregivers. This study examines resilience and stress in a group of Hopi female caregivers. Data came from the Hopi Adult Caregiver Survey (2017), which conducted interviews with 44 Hopi women who were providing care without remuneration to an adult family member. Measures included the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), the Perceived Stress Scale (PSS-10), and questions about caregiver characteristics, care recipient characteristics, social support/ community support, and cultural factors. Stress and resilience were looked at above the median (higher stress or higher resilience) and below the median (lower stress or lower resilience). Caregivers who reported relatively lower resilience were more likely to report that they lived separately from their care recipients and that all Hopis are expected to be caregivers. Caregivers who reported relatively higher stress reported a higher total number of caregiver difficulties, a poorer self-perception of their own health, use of a traditional healer in the past 5 years, and that females are expected to be caregivers. A regression analysis adjusting for age, education, and employment status indicated that higher resilience among the caregivers was significantly associated with lower stress. In light of these findings, programs working with AI caregivers may wish to explore whether supporting the resilience of these caregivers is a means towards limiting their stress.