Transcultural Psychiatry最新文献

American Indian (AI) people experience disproportionate exposure to stressors and health inequities, including type 2 diabetes (T2D) and mental health problems. There is increasing interest in how historical trauma and ongoing experiences of discrimination and marginalization (i.e., historical oppression) interact to influence AI health. The purpose of this study is to examine the relationships between historically traumatic experiences (i.e., boarding schools, relocation programs, and foster care), current reports of historical cultural loss, microaggressions, and their relationship to internalizing symptoms among AI adults living with T2D. This community-based participatory research study with five AI tribal communities includes data from 192 AI adults with T2D recruited from tribal clinics. Results from structural equation modeling revealed that personal experiences in foster care and ancestral experiences in boarding schools and/or relocation were associated with increased reports of historical loss, and indirectly associated with internalizing symptoms through racial microaggressions and historical losses. The findings highlight the importance of considering multiple dimensions of historical trauma and oppression in empirical and practice-based assessments of mental health problems.

Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.

American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.

Cultural identity is associated with positive emotional and behavioral health. However, colonialism and its forces, past and present, have led to cultural loss in many Indigenous communities, contributing to health disparities. And yet, Indigenous peoples actively resist colonialism and work to maintain and revitalize their cultures around the globe. This study sought to understand how Alaska Native university students from diverse cultural backgrounds are presently developing and constructing their cultural identities. Transformational grounded theory methods were used to analyze seven focus groups with 20 Alaska Native university students from diverse cultural regions, now living in an urban center. Results revealed that identity was constructed as a series of nested and intersecting identities that centered on relations, place, and time across cultural groups. Cultural practices and values were often drawn upon to understand identity. Cultural identity was developed through storytelling, experiential learning, connection, personal exploration, and sharing with others. Relatives, particularly grandparents and Elders, and communities played a critical role in shaping cultural identity. The construction of cultural identity and its development diverged by setting of upbringing (rural, urban). Results have implications for the modification of structures and the development of cultural identity promotion programming to support Alaska Native young peoples' identity development in an effort towards emotional and behavioral health.

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Research on self- and cultural continuity has contributed to our understanding of resilience processes in Indigenous communities, as connecting oneself to the past, present, and future of one's family, community, and traditional culture has been found to protect against deleterious developmental outcomes. To examine factors associated with self-continuity for Indigenous youth in the current study, Indigenous youth from six rural Ojibway and Métis communities in Treaty 2 Territory completed self-report questionnaires aimed at understanding the relationship between the concept of oneself across time and protective and risk factors at different systemic levels (family, community, culture, and colonial). The concept of oneself across time was measured by self-efficacy (global self-worth) and future orientations (optimism and sense of self in the future). The findings indicated that connectedness to caregivers, siblings, friends, neighborhoods, and culture was associated with higher self-efficacy, seeing oneself as more connected to the future, and seeing the future more positively. These findings support the notion that familial, community, and cultural connectedness are associated positive self-concepts in the present and future, which aligns with our understanding of self- and cultural continuity in Indigenous communities.

We investigated how satisfaction of the basic psychological needs at work was associated with the psychological and physical wellbeing of Indigenous and non-Indigenous employees both within and outside of the workplace. Participants included 1,146 Indigenous (n = 559) and non-Indigenous Australians (60.9% female), aged 18 to 81 years (M_age = 43.54) who were recruited through their employer or online advertisements. Structural equation modelling (SEM) was used to analyse the data, and Indigenous status and occupation type were investigated as moderators. Results revealed that independent of income, autonomy satisfaction was related to better physical and psychological health, satisfaction of the need for relatedness was associated with increased family and community thriving, and competence satisfaction was linked to decreased psychological distress. Results also showed that autonomy, competence, and relatedness need satisfaction was lower among Indigenous employees compared to non-Indigenous employees. Moderation analyses suggested that relatedness at work was especially important for non-Indigenous employees' connection with their community, as were high levels of competence satisfaction for Indigenous employees. These findings are discussed in the context of self-determination theory and the implications for organizations wanting to improve the wellbeing of their Indigenous and non-Indigenous workforce.

Research on the effects of collective trauma tends to take a psychocentric approach, focusing on the impact of being geographically near the traumatic event (physical proximity) or personally knowing a victim (social proximity). We theorize that this approach falls short in describing the effect of collective trauma among interdependent cultural groups, such as Indigenous Peoples, for whom the self and one's group are inextricably tied. Using a concurrent embedded mixed-methods design (N = 545), the current study explores the influence of cultural proximity (having a shared cultural connection to victims) in the wake of a fatal school shooting involving students from both a Native American tribe and a predominantly White city. After controlling for physical and social proximity, student distress behaviors and staff support behaviors, but not staff members' own psychological distress, were significantly higher in schools with higher Native student populations, where a larger proportion of students shared cultural connections with the victims. We discuss implications regarding the importance of providing adequate support for Indigenous Peoples, and interdependent cultural groups in general, following collective trauma.

Sociocultural, mental, behavioral, and physical factors are interrelated associates of chronic health conditions-such as diabetes, obesity, and cardiovascular disease-all of which are disproportionally high and drive much of the mortality and morbidity for Indigenous peoples. Indigenous worldviews conceptualize health holistically, with inseparability across social, spiritual, cultural, familial, mental, behavioral, physical, and social dimensions of wellness. Food, family, and culture are fundamental to Indigenous wellness. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) conceptualization of relational wellness to honor urban and rural U.S. Indigenous perspectives that highlight the intersections of family, culture, physical health, spiritual, and mental health to promote resilience and wellness. This research focused on interconnections between wellness, culture, health, and family. Thirty-one critical ethnographic interviews used a life-history approach with methodology following an Indigenous toolkit for ethical and culturally sensitive research strategies, such as building upon cultural strengths, engaging in long-term, relational commitments with communities, incorporating storytelling and oral history traditions, centering Indigenous methodologies and preferences, working with cultural insiders, and prioritizing the perspectives of Indigenous peoples. Emergent themes included: (a) roots of Indigenous wellness: cultural values promoting balance and connection; (b) practicing resilience: family transmission of health information; and (c) wholistic mental wellness and resilience, with the subtheme culture and wellness. Interventions can be developed in collaboration with tribes for optimum efficacy and cultural relevancy and can approach wellness holistically in culturally relevant ways that center foodways, culture, family, and spirituality.

By imposing non-Inuit ways of doing within households and communities, colonization has created a rift between generations and impacted the transmission of Inuit practices and knowledge. Inuit care-providers continue to support their fellow community members with individual and collective approaches to wellbeing. The objectives and design of the current project were developed with community members who play an active role in mobilization and wellness. Inuit and non-Inuit research assistants conducted 14 individual interviews and 2 group interviews (total of 19 participants) with key informants involved in community wellness work. Then an Elder (third author) shared her knowledge regarding traditional practices. In this study we describe three underlying principles regarding wellness practices as well as five approaches and the mechanisms by which these approaches seem to impact personal and collective wellbeing. This study highlights how Inuit culture and knowledge can support children, family and community wellbeing in the ways of being together and of taking care of each other. The study responds to an expressed desire named by our partners to document Inuit approaches as well as the principles and practices underlying such approaches and how they are related to self-determination.