American Indian and Alaska Native Mental Health Research最新文献

Mental health and substance use are pressing public health concerns among Indigenous adolescent populations. This systematic review analyzed interventions focusing on mental health and substance use that utilize the Positive Youth Development (PYD) framework, incorporate culturally tailored programs, and are geared toward Indigenous adolescents. In total, 474 articles were retrieved from PSYCInfo and PubMed databases. Eight articles were eligible for analysis, with six focusing on AI/AN populations in the U.S. Most programs reported positive or expected outcomes. All the programs incorporated PYD variables, while all but one were culturally grounded or included deep structure adaptations. Implications are further discussed.

Using Community-based and Tribal Participatory Research (CBPR/TPR) approaches, an academic-tribal partnership between the University of Washington Alcohol and Drug Abuse Institute and the Suquamish and Port Gamble S'Klallam Tribes developed a culturally grounded social skills intervention to promote increased cultural belonging and prevent substance abuse among tribal youth. Participation in the intervention, which used the Canoe Journey as a metaphor for life, was associated with increased hope, optimism, and self-efficacy and with reduced substance use, as well as with higher levels of cultural identity and knowledge about alcohol and drugs among high school-age tribal youth. These results provide preliminary support for the intervention curricula in promoting positive youth development, an optimistic future orientation, and the reduction of substance use among Native youth.

The purpose of the review was to assess substance abuse prevention (SAP) efforts in American Indian and Alaska Native (AI/AN) communities from 2003-2013. In the past, many SAP programs were unable to meet the unique cultural needs of AI/AN communities adequately. It has been suggested that a disconnect may exist between the theories that are used to guide development of prevention programs in AI/AN communities and culturally appropriate theoretical constructs of AI/AN worldviews. To explore this possible disconnect further, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to assess a total of 18 articles (N = 31 programs) on program location and method, participant characteristics, described program cultural elements, use of theory, program outcomes, program measures, and future recommendations. Results indicated that SAP programs in AI/AN communities vary widely in their use of theory, implementation strategies, view and definition of cultural constructs, overall evaluational rigor, and reporting methods. Future research is needed to integrate appropriate theory and cultural elements into SAP programs to tie them to measurable outcomes for AI/AN communities.

American Indian (AI) adolescents who attempt suicide are heterogeneous. A latent class analysis was used to identify subgroups of reservation-based AI adolescents with recent suicide attempts. Indicators of class membership were substance abuse and aggressive behaviors; clinical correlates of subgroup membership included risky sexual behavior and recent exposure to suicidal behavior. Three subgroups were identified, representing low, medium, and high substance use and aggressive behavior. Suicide exposure was associated with membership in the lowest risk behavior subgroup; risky sexual behavior was associated with membership the highest risk behaviors subgroup. Findings suggest a continuum of risk behaviors in reservation-based AI youth who attempt suicide.

Arrestee Drug Abuse Monitoring program data were used to consider the effects of two methods of racial classification upon estimates of illicit drug use and alcohol abuse among American Indian/Alaska Native (AI/AN) arrestees. Overall, compared to arrestees who self-identified as Black, White, Asian/Pacific Islander, or Hispanic, arrestees self-identifying as AI/AN were most likely to be identified administratively as something other than AI/AN. Results of 'difference of difference' analyses indicate that differences in estimates of AI/AN versus non-AI/AN arrestees' illicit drug use and alcohol abuse were much more extreme when identification was based on administrative records than when based upon arrestees' self-reports.

Since the 1940s, American Indians (AIs) have increasingly urbanized, moving off of reservations in large part due to federal policies of tribal termination and relocation. Though previous AI research has largely focused on reservation-associated challenges, many of these same challenges persist among urban AI populations. One mutual concern is the growing prevalence and incidence of type II diabetes mellitus (T2DM). While behavioral, genetic, and socioeconomic determinants of T2DM have been explored, much less is known about the influence of cultural and psychosocial factors. Recent studies suggest that the way AIs perceive diabetes may affect their health trajectory and explain their poor prognosis. Through the use of the Illness Perception Questionnaire, we explored this hypothesis in a pilot study of urban AI with T2DM living in Los Angeles County. We found that the majority of participants have a neutral perception about their diabetes: They view their condition to be long lasting yet treatable and indicate reasonable understanding of its symptoms and progression. We also identified "personal control," the level of perceived control one has over his or her disease, as a strong correlate of overall illness perception and, thus, a potentially useful psychological metric.

Although bullying has been linked to suicide among youth, little is known about bullying in American Indians, a population at high risk for suicide. Qualitative data from focus groups with Lumbee Indian youth (N = 31, 16 males, 15 females, 12-17 years of age) and in-depth interviews with gatekeepers in the Lumbee community revealed that bullying is common, and is perceived to contribute to depression and suicide. Youth expressed powerlessness to overcome bullying. Survey data (N = 79, 32 males, 47 females, 11-18 years of age) showed that bullied youth (11.5%) had lower self-esteem and higher levels of depressive symptoms. Interventions are needed to address this behavior that contributes to poor psychosocial health in Lumbee youth.

Commercial tobacco use rates remain disproportionately high among American Indians (AIs). Tailored cessation programs such as the Wiidookowishin (Help Me) program implemented at the Fond du Lac Reservation in Minnesota have demonstrated that such programs can be successful and achieve quit rates similar to mainstream programs. This paper presents findings from a qualitative process evaluation of the Wiidookowishin program and discusses elements that underlie its success at recruiting and enrolling participants, including individualization, flexibility, accessibility, ongoing outreach, and inclusion of traditional tobacco teachings. Lessons learned can be applied to the development of tailored programs to reduce tobacco-related disparities among AIs.

The Menominee Indian Tribe of Wisconsin has the highest smoking rate in the state. To address the resultant health disparities, the tribe conducted a qualitative pilot project to examine tobacco use. The findings indicated mainstream models of addiction did not capture the tribe's context well; the Indigenist Stress-Coping Model was most applicable. Participants suggested that Menominee-centric ways of knowing related to commercial and sacred tobacco use should be included in all levels of prevention as a key strategy. Recommendations include primary prevention targeted specifically to youth, pregnant women, and adults who care for children, as well as access to commercial tobacco products.

We examined the association of resilience with measures of mental and physical health in a sample of older American Indians (AIs). A validated scale measuring resilience was administered to 185 noninstitutionalized AIs aged>=55 years. Unadjusted analyses revealed that higher levels of resilience were associated with lower levels of depressive symptomatology and chronic pain, and with higher levels of mental and physical health. Resilience remained significantly associated with depressive symptomatology after controlling for demographic and other health measures. Our findings suggest that resilience among older AIs has important implications for some aspects of mental and physical health.