Protecting against hopelessness and suicidality in sexually abused American Indian adolescents

A Systematic Review of Community-Level Protective Factors in Children Exposed to Maltreatment

Childhood maltreatment and neglect are associated with a host of negative outcomes. Yet, some children show resilience despite their exposure to these traumatic events. Several protective factors have been documented in the literature, but few studies focus on protective factors in the child's community that can promote resilience. The purpose of this review was to provide a comprehensive portrait of the impact of community protective factors on the resilience of abused and neglected children. The databases PsycNet and PubMed were used to screen the literature relying on the following inclusion criteria: (1) published in English or in French; (2) report empirical and quantitative data; (3) include a minimum sample size of 30 participants; (4) rely on a sample of maltreated children or adolescents under the age of 24; (5) examine the associations between community protective factors and indicators of psychological adaptation; and (6) include outcome measures that assessed either positive adaptation or the absence of symptomatology in participants. Of the 9,553 articles identified, 44 studies met the eligibility criteria for inclusion in this review. Although many protective factors show significant results, several methodological limitations remain to be examined to affirm that these community variables have a significant impact on the level of resilience of maltreated children. Since child maltreatment is a systemic issue, it remains important to fully understand how community protective factors operate on the resilience of these children as it can greatly inform practitioners and community institutions on how to intervene with populations at risk of maltreatment.

Attachment to Peers and School: Longitudinal Moderators of the Relation Between Caregiver Psychological Distress and Adolescent Hopelessness

Research has yet to determine how relationships outside of the family system may buffer negative outcomes associated with hopelessness among racial minority youth. In a sample of Black American youth (N = 512; 49% females) and their parents or caregivers, this study used longitudinal growth models to explore whether youth relationships (attachment to peers and attachment to school) moderated the association between caregiver distress (depressive symptoms and traumatic stress), and youth hopelessness. Adolescents' gender was examined to determine if there were gender differences present in these associations. Four linear growth models showed a significant change in levels of hopelessness over time for youth and a significant positive relation between caregiver distress and youth level of hopelessness. Attachment to peers and attachment to school did not equally moderate the relation between caregiver psychological distress and youth hopelessness. The type of caregiver distress had a differential effect on youth hopelessness in the context of the moderation models and based on gender. The type of caregiver distress had a differential effect on youth hopelessness in the context of the moderation models and based on gender. Implications for the importance of non-familial attachments among Black American youth with distressed parents are discussed.

Preventing Youth Suicide: A Review of School-Based Practices and How Social-Emotional Learning Fits Into Comprehensive Efforts

Schools in the United States increasingly incorporate social-emotional learning (SEL) as a part of comprehensive youth suicide prevention programs in schools. We reviewed the literature to investigate the inclusion of SEL in youth suicide prevention efforts. We identified several known risk factors to youth suicide, namely, hopelessness, anxiety, substance use, and child sexual abuse, then cross-walked that review to SEL competencies shown to mitigate each of those known risk factors. We found all SEL competencies, to some extent, across all the evidence-based, school-based youth suicide prevention programs we identified. Further, we found that all five SEL competencies are shown directly to address and mitigate the major, known risk factors for youth suicide. These findings suggest that SEL can play a productive role in upstream youth suicide prevention. State-level policy makers and school administrators should consider the inclusion of evidence-based SEL in efforts to address youth suicide prevention.

Development of "CULTURE FORWARD: A strengths and culture-based tool to protect our native youth from suicide"

OBJECTIVE

Indigenous knowledge and practices promote American Indian/Alaska Native (AI/AN; Native) communities' health and well-being. Historical losses and continued oppression have resulted in disproportionately higher AI/AN youth suicide rates. This article describes the development of a new national resource guide titled "CULTURE FORWARD" for tribal leaders and stakeholders to support youth suicide prevention efforts through cultural strengths.

METHOD

The CULTURE FORWARD guide was developed over 6 months through a community-engaged process. We conducted nine roundtables and eight interviews with a wide variety of community members, leaders, and providers representing 36 diverse tribal communities and geographic regions. Participants discussed AI/AN youth risk and protective factors, successful community efforts to prevent suicide, and content and dissemination ideas. A comprehensive literature review complemented qualitative findings. A diverse and representative National Advisory Editorial Board guided content and design throughout development.

RESULTS

Qualitative data were analyzed iteratively and thematically. Across all listening sessions, culture was identified as a key protective factor against AI/AN youth suicide. Five themes related to cultural strengths informed guide chapters. Each chapter includes an introduction; how that theme helps prevent Native youth suicide; a review of academic literature, community stories and programs; action steps; and additional resources.

CONCLUSIONS

CULTURE FORWARD honors and empowers communities by weaving strands of knowledge, stories, and practical resources highlighting Native communities' strengths to protect against Native youth suicide. The guide is free online and print copies are being distributed nationally. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents

American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = -0.88, 95%CI [-1.55, -0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.

Family as the Conduit to Promote Indigenous Women and Men's Enculturation and Wellness: "I wish I had learned earlier"

The purpose of this article is to explore how food and other cultural traditions promote wellness, cultural continuity, enculturation, and family resilience within tribal communities in the U.S. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), this critical ethnography examines Indigenous peoples' perspectives on and experiences with food and cultural traditions. Thematic analysis of data from 436 participants (approximately 2/3rds of which were women) across two Southeastern tribes revealed a theme of "fostering the transmission of tribal knowledge and intergenerational family bonding." Traditions such as dancing, food, sewing, beadwork, basket-weaving, music, and tribal sports were some important facets of tribal culture that participants described. Food and cultural practices promoted wellness, pro-social values, and health by fostering physical activity, traditional food practices, enculturation, and social support. Cultural practices offset historical oppression and health disparities. Programs that utilize the strengths of experiential learning through family and cultural practices are highly recommended.

Statewide collaborative partnerships among American Indian and Alaska Native (AI/AN) communities in California to target the opioid epidemic: Preliminary results of the Tribal Medication Assisted Treatment (MAT) key informant needs assessment

American Indian and Alaska Native (AI/AN) communities have disproportionately been impacted by the opioid epidemic with the second highest opioid-related overdose death rates compared to other ethnic groups. The diversity among California AI/AN tribes, including regional differences in economic opportunities, tribal affiliation and organization, resources and infrastructure, requires a strong community-based partnership approach to assess global statewide patterns in service availability, acceptability, and utilization, as well as capturing the unique challenges and service needs within each region. This article describes a statewide community-based needs assessment of strengths and weakness among key informants in CA to identify facilitators and barriers to treatment of substance use disorders (SUD) and opioid use disorders (OUD). We conducted structured interviews of 21 healthcare professionals from Urban Indian Health Programs, Tribal clinics and community-based organizations throughout California. The interview assessed (1) barriers to accessing services; (2) risk factors; (3) protective factors; (4) community substance use description; (5) SUD and OUD services available; and (6) service system needs. Findings indicate an overall increase in SUD and OUD in AI/AN communities. Key informants discussed the importance of comprehensive and culturally centered care, wrap-around services, such as treatment of mental health issues alongside substance abuse, and the need for AI/AN-specific treatment facilities that integrate traditional and cultural activities into western health services.

"Let our Apache Heritage and Culture Live on Forever and Teach the Young Ones": Development of The Elders' Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth

The White Mountain Apache Tribe have developed an innovative curriculum that connects youth through Elders to their heritage, traditions, and culture, which has been proven to be a protective factor for native Americans. The development process took 4½ years and included community stakeholder buy-in, Elders' Council group formation, extensive formative work to identify content, iterative feedback between curriculum writers and Elders, and Elder training prior to implementation. Members of the Elders' Council have been visiting the local schools to teach youth about the Apache culture, language, and way of life since February 2014 reaching over 1000 youth. This approach demonstrates a promising upstream suicide prevention strategy. We discuss the process of development, implementation, and lessons learned, as this curriculum has potential for adaptation by other Indigenous communities.

Employing a Harm-Reduction Approach Between Women and Girls Within Indigenous Familial Relationships

It is important to recognize that experiences of racial and gendered violence are a sad legacy of colonialism. The experiences of historical trauma are on-going. These affect the mental and physical wellbeing of individuals, families and communities. Addressing historical trauma through community-informed practices is central to creating space for meaningful change. This paper outlines results from a seven-week activity-based research workshop conducted on three separate occasions with urban-based First Nations and Metis women and girls (aged 8-12). Using a decolonizing theoretical framework, this paper examines data collected within three specific arts-based activities: empowerment bracelets, "I'm proud of you" charm bracelets and "Who I am" pictures. Women were hesitant to discuss future plans, as many were not confident that their daughters would be in contact with their maternal families when they become teenagers. Girls observed and mimicked the thoughts and actions of their mothers, step-mothers, aunts, older sisters and grandmothers. They demonstrated the role they already play within the discourse of what it means to be female living within their communities. This paper concludes with the implicit harm reduction approach women and girls used when exploring the impacts of trauma while envisioning a healthier future.

Understanding Indigenous Suicide Through a Theoretical Lens: A Review of General, Culturally-Based, and Indigenous Frameworks

Many American Indian/Alaska Native (AI/AN) communities throughout North America continue to experience the devastating impact of suicide. Theoretical explanations of suicide from a psychological, sociological, cultural, and Indigenous perspective all differ in focus and applicability to AI/AN communities. These diverse theoretical frameworks and models are presented herein to examine the potential applicability, strengths, and limitations in understanding AI/AN suicide. In providing these perspectives, continued discussions and empirical examinations of AI/AN suicide can guide informative, culturally-informed suicide prevention and intervention efforts.

Educational and emotional health outcomes in adolescence following maltreatment in early childhood: A population-based study of protective factors

Although childhood maltreatment is associated with long-term impairment, some children function well despite this adversity. This study aimed to identify the key protective factors for good educational attainment and positive emotional health in adolescents who experienced maltreatment in early childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children, a large UK prospective cohort study. The sample was defined by maternally reported exposure to physical or emotional maltreatment by a parent prior to 5 years. 1118 (8.0%) children were emotionally maltreated and 375 (2.7%) were physically maltreated before the age of 5. There were too few cases of sexual abuse to be considered. Positive outcomes were operationalized as achieving 5 or more grade A*-C GCSE exam grades at 16 years and scores above the cohort median on the self-report Warwick-Edinburgh Mental Wellbeing Scale and Bachmann Self-Esteem Scale at 17.5 years. The associations of individual, family and community covariates with successful adaptation to the adversity of maltreatment were investigated using logistic regression. School related factors, including engagement in extracurricular activities, satisfaction with school and not being bullied were the most important in facilitating resilience in educational attainment, self-esteem and wellbeing. Good communication and social skills was the most protective individual trait. There was insufficient evidence to suggest that family factors were associated with resilience to maltreatment. School-based interventions are recommended to promote positive adaptation following parental maltreatment. Future research should evaluate outcomes across the life-course to understand whether the protective influences of school persist into adulthood.

Identifying Protective Factors to Promote Health in American Indian and Alaska Native Adolescents: A Literature Review

Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent's environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents.

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis

Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. (PsycINFO Database Record

Moderator Factors in First Nation Students at Risk for Psychosocial Problems

In this study the authors sought to examine the determinants of psychological well-being and risk in First Nation students residing in their home community. The participant sample was drawn from students who resided in a First Nation community and were served by their tribal council in a central western province. All students, Grades 1 to 12, who were registered in a First Nation or provincial school were included. The results of the study indicate that, because academic performance continues to be such a strong predictor of psychosocial well-being, it underscores the importance of the school as an ameliorative factor in the prevention and treatment of behavioral problems. Given this finding, the authors recognize the significance of intervention as a preventive measure for all age groups and the responsibility of federal and provincial funding agencies to continue to make available appropriate educational resources to First Nation communities.

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature

OBJECTIVE

This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization.

METHODS

A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample.

RESULTS

In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment.

CONCLUSIONS

Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.

Connectedness and suicide prevention in adolescents: pathways and implications

Adolescent suicide is a major public health concern. Stressing the need for public health-based solutions, the Centers for Disease Control and Prevention identified "connectedness" as one means of pursuing this agenda. To advance this effort in suicide prevention with adolescents, (1) consistencies and variation in the literature overtly linking connectedness to suicide thoughts and behaviors (STB) are reviewed, (2) three more specific mechanistic pathways are proposed whereby connectedness may influence STB, and (3) several implications related to use of connectedness as a public health framework for adolescent suicide prevention and intervention are outlined.

The role of hope and optimism in suicide risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.

Perceptions of social support, empowerment and youth risk behaviors

This study examined the association of perceived social support and community empowerment among urban middle-school students living in Matamoros, Mexico and the risk behaviors of fighting, alcohol and tobacco use, and sexual activity. Middle school students (n = 1,181) from 32 public and private Mexican schools were surveyed. Weighted multiple logistic regression analyses were conducted. Among girls, lack of parent/teacher interactions regarding school increased odds for fighting, alcohol and tobacco use. Among boys, lack of empowerment increased odds of alcohol and tobacco use and lack of parent/teacher interactions regarding school increased odds for sexual activity. Community empowerment and perceived social support are uniquely associated with risk behaviors for girls and boys. Additionally, perceived social support from individuals most immediate to the youth are associated with protection against risk for some behaviors, while perceived social support from individuals more removed from youth have mixed association with risk behaviors.

Suicidal Ideation and Alcohol Use Among Ethiopian Adolescents in Israel

Recent figures point to alarming rates of suicidal tendencies and risk behaviors among Ethiopian adolescents (first and second generation) in Israel. This study tries to understand this phenomenon through an examination of the relationship between ethnic identity (Israeli and Ethiopian) and parental support with suicidal ideation and alcohol use. Two hundred adolescents aged 15–18 years from the Ethiopian community in Israel completed questionnaires examining the degree to which they felt a sense of (positive) Israeli and Ethiopian identity and parental support as well as suicidal ideation, drinking behavior, and depression. Results showed significant correlations between both Israeli and Ethiopian identities and suicidal ideation and alcohol use and a significant relationship between suicidal ideation and parental support. Regression analysis highlighted the pivotal role of a strong and positive heritage (Ethiopian) identity in lower levels of suicidal ideation and alcohol use. Results suggest the important role of ethnic identity for well-being among immigrant and minority youth, in particular in the ability of minority youth to consolidate a coherent ethnic identity incorporating a positive connection to their heritage culture as providing a protective role against suicidal tendencies and risk behaviors.

The relationship between internalizing and externalizing symptoms and cultural resilience factors in Indigenous Sami youth from Arctic Norway

OBJECTIVES

To examine whether enculturation factors, like cultural activities, ethnic pride and native language competence, are related to decreased internalizing and externalizing symptoms in Indigenous Sami youth from Arctic Norway. The impact of self-efficacy on the relationship between enculturation factors and mental health problems was also examined.

STUDY DESIGN

Population-based, cross-sectional questionnaire study.

METHODS

The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in north Norway during 2003-2005. The study sample consisted of 450 Indigenous Sami youth, aged 15-16 years. Internalizing symptoms were measured with the Hopkins Symptom Check List-10 (HSCL-10), while externalizing symptoms were measured by two subscales of the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

For boys, self-efficacy and participation in cultural activities were associated with decreased internalizing symptoms. Additionally, self-efficacy interacted with Sami language competence and cultural activities: when self-efficacy increased, these enculturation factors were related to symptom reduction. For girls, self-efficacy had an independent effect on internalizing symptoms and also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms. Sami language competence was related to the reduction of both internalizing and externalizing symptoms in girls.

CONCLUSIONS

In the present study, several enculturation factors as well as self-efficacy were identified as potential protective factors against mental health problems. In order to develop theoretical models that explain the mechanisms between cultural resilience and mental health, there is a need for both qualitative studies and longitudinal studies.

Religion and suicide: Buddhism, Native American and African religions, Atheism, and Agnosticism

Research has repeatedly demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior. A clear understanding of the influence of religion on suicidality is required to more fully assess for the risk of suicide. The databases PsycINFO and MEDLINE were used to search peer-reviewed journals prior to 2008 focusing on religion and suicide. Articles focusing on suicidality across Buddhism, Native American and African religions, as well as on the relationship among Atheism, Agnosticism, and suicide were utilized for this review. Practice recommendations are offered for conducting accurate assessment of religiosity as it relates to suicidality in these populations. Given the influence of religious beliefs on suicide, it is important to examine each major religious group for its unique conceptualization and position on suicide to accurately identify a client's suicide risk.

Social connections, trajectories of hopelessness, and serious violence in impoverished urban youth

Youth living in impoverished urban neighborhoods are at risk for becoming hopeless about their future and engaging in violent behaviors. The current study seeks to examine the longitudinal relationship between social connections, hopelessness trajectories, and subsequent violent behavior across adolescence. Our sample included 723 (49% female) African American youth living in impoverished urban neighborhoods who participated in the Mobile Youth Survey from 1998 through 2006. Using general growth mixture modeling, we found two hopelessness trajectory classes for both boys and girls during middle adolescence: a consistently low hopelessness class and an increasingly hopeless class with quadratic change. In all classes, youth who reported stronger early adolescent connections to their mothers were less hopeless at age 13. The probability of later adolescent violence with a weapon was higher for boys and was associated with the increasingly hopeless class for both boys and girls. Implications for new avenues of research and design of hope-based prevention interventions will be discussed.

Concept analysis of Diné Hózhó: a Diné wellness philosophy

American Indian Alaska Native people of the United States face challenges in attaining physical, mental, spiritual, and environmental health. This article presents a concept analysis of Diné Hózhó, a complex and misunderstood wellness concept the Diné (Navajo) strive to attain. Findings from a literature review are presented to explore anthropological definitions and uses of the concept Hózhó. The method of concept analysis of Walker and Avant is utilized, model cases are presented. Recommendations for application in nursing practice are presented.

Protective factors and suicide risk in adolescents with a history of sexual abuse

OBJECTIVE

To test the hypothesis that certain protective factors will reduce the risk of suicide behaviors in youth who are sexually abused.

STUDY DESIGN

Survey data come from 83,731 students in the 6th, 9th, and 12th grades in Minnesota. Four childhood sexual abuse groups were created: a) no history of sexual abuse; b) abuse by non-family member; c) abuse by family member; and d) abuse by both. Dependent variables included suicidal ideation and attempts. Four protective factors included: family connectedness, teacher caring, other adult caring, and school safety. Logistic regression was used in detecting differences in suicide behaviors across the 4 childhood sexual abuse categories.

RESULTS

Four percent of students reported sexual abuse by a non-family member, 1.3% by a family member, and 1.4% by both. Although youth with a history of childhood sexual abuse were at increased risk for suicide behaviors compared with other youth, when protective factors were accounted for, the predicted probabilities of suicide behaviors for childhood sexual abuse youth were substantially reduced. Family connectedness was the strongest of the 4 protective factors.

CONCLUSION

Modifying select protective factors, particularly family connectedness, may reduce suicide risk in adolescents with childhood sexual abuse.

Reviewing suicide in Native American communities: situating risk and protective factors within a transactional-ecological framework

The alarming prevalence of suicidal behaviors in Native American communities remains a major concern in the 21st-century United States. Recent reviews have demonstrated that prevention programs and intervention efforts using transactional-ecological models have effectively reduced suicidal behaviors in the American Indian and Alaska Native populations sampled. As a result, this article adopts a transactional-ecological framework for conceptualizing suicidality and identifying points of intervention. Drawing on the most current empirical reports, the epidemiology of Native American suicidal behaviors is reviewed, while situating risk and protective factors within a biopsychosocial framework. Opportunities for intervention are discussed with a focus on the interactions between individuals and their environments, and the antecedent conditions leading to zones of heightened suicide risk.

Social support and social undermining as correlates for alcohol, drug, and mental disorders in American Indian women presenting for primary care at an Indian Health Service hospital

The purpose of this study was to determine the relationship of two types of social support (emotional and instrumental) and two types of social undermining (critical appraisal and isolation) with five categories of alcohol, drug, or mental disorders (ADM; any mood, any anxiety, any substance abuse, any disorder, and two or more disorders) in 169 American Indian women presenting for primary care at an Indian Health Service facility. Social support and social undermining are often treated as opposite poles, but in fact they are distinct factors with independent effects. The findings illustrate that social support and undermining variables have a significant relationship with ADM outcomes even when controlling for confounding demographic variables. Any substance abuse was associated with all four social variables, while two or more disorders were associated with instrumental support and isolation. Any anxiety (isolation), any mood (critical appraisal), and any disorder (isolation) were each associated with one social variable. Overall, social undermining appears to have a stronger relationship with mental health than with social support.

The Relationship Between Psychological Buffers, Hopelessness, and Suicidal Ideation

Abstract. In this study we examined the role of psychological buffers (life satisfaction, self-esteem, perception of family cohesion, and perception of social support) in the development of hopelessness and suicidal ideation. The participants were 314 university students, 71 males and 243 females, who were asked to complete a battery of instruments measuring the psychological buffers mentioned above. The results of a set of hierarchical multiple regression analyses suggested that life satisfaction and self-esteem are independent predictors of lower levels of hopelessness, while perception of social support seems to be the major predictor of lower levels of suicidal ideation independent of depression and hopelessness severity. Thus, hopelessness seems to be minimized by the level of life satisfaction and level of self-esteem exhibited by the individuals, while the key factor to the mitigation of suicidal ideas seems to be perception of social support.

Eagle Soaring: The Power of the Resilient Self

Adversity can be an opportunity to focus on strengths and nurture resiliency. Cultural understanding and awareness can be easily incorporated into therapy through empathic listening, a therapeutic alliance, and supportive understanding. Patients should not subscribe to "victim" labels. Resilience should be celebrated.

Environmental, social, and personal correlates of having ever had sexual intercourse among American Indian youths

OBJECTIVES

We examined the correlates of having ever had sexual intercourse among American Indians aged 13 to 18 years in Minnesota.

METHODS

To assess key environmental, social, and individual correlates of sexual experience, we analyzed data from 4135 American Indian youths who participated in the 1998 and 2001 Minnesota Student Surveys.

RESULTS

Forty-two percent of those aged 13 to 15 years and 69% of those aged 16 to 18 years reported that they had ever had sexual intercourse. Correlates of sexual experience varied by age and gender. School connections had the strongest negative associations with sexual experience in young girls, and living with a father had negative associations with sexual experience for younger, but not older, youths. Sexual experience was most strongly and positively associated with risk behaviors such as substance use, violence exposure, and violence perpetuation.

CONCLUSIONS

The strongest correlates of sexual experience for American Indian youths were high-risk behaviors and exposure to violence. Future work is needed to develop and employ measures that reflect youth assets and that specifically reflect the experiences of American Indian youths.

Knowledge and perceptions of parents regarding child sexual abuse in Botswana and Swaziland

This study sought to explore the phenomenon of child sexual abuse by investigating the knowledge and perceptions of parents regarding this problem in Botswana and Swaziland. Although there are no published studies on child sexual abuse in Botswana and Swaziland, literature elsewhere has indicated that child abuse and prostitution prevail in Southern African Development Community countries and that children still continue to be rape victims within and outside the family structure [Muwanigwa, V. (1996). Child Abuse Demands More Preventive Measures. Harare: Zimbabwe. (Southern Africa News Features Southern African Research and Documentation Center)]. In Botswana in 1998, there were 300 cases of child abuse reported, of which 33 were sexual abuse cases. The same year in Swaziland, >50% of child abuse cases were sexual abuse related. In addition, the same year in Swaziland, >50% of sexual abuse case patients reporting for counseling were children younger than 21 years. Respondents of the study included 8 men (1 from Swaziland and 7 from Botswana) and 10 women (3 from Swaziland and 7 from Botswana) who were parents aged between 26 and 70 years; they were determined by way of purposive sampling. A focused interview guide with open-ended questions was used to collect data, and measures to ensure trustworthiness and ethical considerations were adhered to. Analysis of data was facilitated by categorization of themes and concepts and coding systems. The results of the study showed that the respondents acknowledged the prevalence of child sexual abuse in Botswana and Swaziland and further demonstrated their knowledge of the predisposing factors, perpetrators of the problem, and effects of sexual abuse on children. They placed major emphases on community involvement in fighting against the problem; appropriate education of children, parents, families, and community members about child sexual abuse; and improvement on the laws that protect children against sexual abuse to successfully curb the problem.

Suicidal ideation among American Indian youths

This study examined correlates of suicidal ideation among 212 American Indian youth who lived on or near three reservations in the upper Midwestern United States. The youths were, on average, 12 years old, and 9.5% reported current thoughts about killing themselves. Females were over 2 times more likely than males to think about suicide. Multivariate logistic regression results indicated that gender, enculturation, negative life events, perceived discrimination, self-esteem, and drug use were related to the likelihood of thinking about suicide. Drug use was the strongest correlate of suicidal ideation, and both enculturation and perceived discrimination emerged as important culturally specific variables. It was suggested that suicide prevention programs should draw on the strengths of American Indian culture.

Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care

OBJECTIVE

To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services.

METHODS

A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire.

RESULTS

Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4).

CONCLUSION

CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.

The impact of perceived child physical and sexual abuse history on Native American women's psychological well-being and AIDS risk

The impact of perceived child abuse history on 160 adult, Native American women's emotional well-being (i.e., depressive mood and anger) and AIDS risk was examined. How sense of mastery and social support might lead to women's greater resiliency was also investigated. Child physical-emotional abuse was found to have greater impact on depressive mood and anger and AIDS risk than did child sexual abuse. This finding was independent of current stress in women's lives. Women who were physically-emotionally abused as children had 5.14 times greater odds of having a sexually transmitted disease in their lifetimes than did women who experienced only marginal or no physical-emotional abuse. Moreover, consistent with the communal culture of Native Americans, social support was found to contribute more to resilience than sense mastery did. Reasons for the greater predictive power of child physical-emotional abuse compared with child sexual abuse in a growing number of studies are discussed.

Protective factors associated with American Indian adolescents' safer sexual patterns

OBJECTIVES

This paper presents findings from a research partnership with rural American Indian communities to identify protective factors associated with their adolescents' health-related behaviors including 1) delay of sexual debut; 2) not having had intercourse in the past 3 months; 3) birth control use among sexually active adolescents in the past 3 months; 4) condom use in the past 3 months. Our goal was to identify salient characteristics of students and their perceptions of family, school, and friends which could be incorporated or supported in future program planning for adolescents.

METHODS

A written survey was administered to 484 Indian students in Grades 6-12 from five rural schools. The survey measured several potential protective factors identified by Problem Behavior Theory, along with self-efficacy and cultural interest and knowledge. Logistic regression assessed the relationship of the protective factors and positive sexual behaviors.

RESULTS

Factors significantly associated with abstention from intercourse and/or consistent use of birth control included perceived lower health-risk behavior of friends, higher perceived parental support, higher perceived parental knowledge and monitoring of the adolescent's activities and friends, a higher value on scholastic achievement, higher reported academic performance, and higher self-efficacy for safer sexual behaviors.

CONCLUSIONS

This research suggests that Indian adolescents have several protective factors indigenous to their communities which are modifiable. Building on the unique cultural heritage of Indian communities, many of these factors may be addressed through community planned prevention programs.

The family as a protective asset in adolescent development

Adolescents are considered at high risk for engaging in such negative health behaviors as drug and alcohol use, unprotected sexual intercourse, and violence. Conventional wisdom has long upheld the belief that the peer group exerts the strongest influence on adolescent behavior. However, recent research has shown that in fact the family remains a strong factor in moderating teen risk behavior. Holistic nursing acknowledges the crucial relationship between environment and health; the environment is composed of everything that surrounds the individual, which by definition includes the family. The purpose of this article is to examine the evidence supporting the concept of the family as a protective external asset in adolescent development, to explore the way the family helps defend young people from risk, and to review briefly the implications for nursing research, practice, advocacy, and education.

Child maltreatment in American Indian and Alaska Native communities: integrating culture, history, and public health for intervention and prevention

This article addresses child maltreatment intervention and prevention among American Indians and Alaska Natives. The authors argue that history and culture must be included as context and variables for developing and implementing prevention programs in Indian Country. They propose that the public health violence prevention model would benefit from incorporating tenets of the history and culture(s) of diverse groups, in this instance American Indians and Alaska Natives. The authors offer an approach that focuses on population- and individual-level risk and protective factors for child maltreatment intervention and prevention in American Indian/Alaska Native communities. They include suggestions and examples for doing the work in Indian Country.

Guilt, isolation and hopelessness among female survivors of childhood sexual abuse: effectiveness of group work intervention

OBJECTIVE

This study explores the effects of group work intervention on female survivors' senses of guiltlessness, affiliation and hopefulness.

METHOD

Secondary comparative analyses of a large quasi-experiment-based clinical data base were accomplished (Richter, Snider, & Gorey): group work intervention (N = 78) and a waiting-list condition (N = 80).

RESULTS

Group work was found to have beneficial effects on adult female survivors' appropriate sense of guiltlessness for their childhood sexual abuse, as well as on their sense of affiliation and hopefulness. Consistent across the three outcome measures of guilt/guiltlessness, isolation/affiliation and hopelessness/hopefulness, 16 to 18 of every 20 such women who participated in group work did better than the average woman in the waiting-list comparison group. Moreover, these apparent clinical benefits were maintained for 6 months (all p < .01).

CONCLUSION

Such effects may be characterized as very large, and are generally larger than those previously observed in this field of practice that have typically been based on more general measures of depression, self-esteem or global symptoms.

Secondary data analysis: new perspective for adolescent research

Adolescents are at high risk for preventable health problems, but realities of research funding and obtaining data from large samples make it difficult for many researchers to answer important questions. Secondary analysis of existing data sets is described as a reasonable alternative in spite of its limitations. Methods and available resources are identified along with suggestions for research priorities with adolescents.