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Groweiss Y, Blank C, Hamdan S, Neria Y, Levi-Belz Y. The mental health impact of the October 7th terror attack on Jews and Arabs in Israel: A nationwide prospective study. Psychiatry Res 2024; 337:115973. [PMID: 38776726 DOI: 10.1016/j.psychres.2024.115973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION On October 7, 2023, Israeli citizens came under an unprecedented terrorist attack that impacted the entire country. Recent research has begun to document the mental health impact of the attack but has yet to address the question of whether the attack had a differential impact across ethnic communities. In this nationwide prospective cohort study, we aimed to determine possible differences in psychopathology between Jews and Arabs in the post-October 7th attack. Specifically, we aimed to understand the role ethnicity may play in changes in probable PTSD, depression, and anxiety diagnoses from pre- to post-attack. METHODS The sample comprised 656 participants (332 female, 50.7%) aged 18-85 (M = 41.01, SD = 13.72). Of this cohort, 557 participants (84.9%) were Jews, and 99 (15.1%) were Arabs, reflecting their national proportionality. Validated self-report questionnaires were completed to assess PTSD, depression, and anxiety at two time points: August 20 to 30th, 2023 (T1; 6-7 weeks before the attack) and November 9-19, 2023 (T2; 5-6 weeks after the attack). RESULTS At T2, Arab Israeli participants reported significantly higher prevalences of probable PTSD, depression, and anxiety diagnoses than Jewish Israeli participants. A series of hierarchical logistic regressions revealed that, compared with Jews, Arab participants presented with higher prevalence of probable PTSD (OR = 2.53 95% CI = 1.46-4.37, p < 0.0001), depression (OR = 1.68 95% CI = 1.35-3.01, p < 0.0001) and anxiety (OR = 6.42 95% CI = 3.95-10.52, p < 0.0001), controlling for prevalences of probable diagnoses at T1 as well as for trauma-related variables. DISCUSSION Citizens belonging to the Arab ethnic minority in Israel were found to be at higher risk for psychopathology in the aftermath of the October 7, 2023, terrorist attack compared with their Jewish majority counterparts. Thus, it becomes critical to employ culturally sensitive assessments and interventions following the attack to prevent the development of chronic symptoms and disorders.
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Affiliation(s)
- Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Sami Hamdan
- School of Behavioral Sciences, the Academic College of Tel-Aviv Yaffo (MTA), Tel-Aviv, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, NY, USA
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
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John-Henderson NA, White EJ, Crowder TL. Resilience and health in American Indians and Alaska Natives: A scoping review of the literature. Dev Psychopathol 2023; 35:2241-2252. [PMID: 37345444 PMCID: PMC10739606 DOI: 10.1017/s0954579423000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.
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Affiliation(s)
- Neha A John-Henderson
- Department of Psychology, Montana State University, Bozeman, MT, USA
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Tony L Crowder
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
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Day SC, Caloudas A, Frosio K, Lindsay J, Shore JH. Culturally Centered Implementation of Video Telehealth for Rural Native Veterans. Telemed J E Health 2023; 29:1870-1877. [PMID: 37074341 DOI: 10.1089/tmj.2022.0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Introduction: Native American Veterans are the most rural and experience heightened risk for mental health (MH) challenges while facing significant health care inequities and access barriers. Rural Native Veterans (RNVs) have experienced historical loss and racial discrimination, contributing to mistrust of Veterans Health Administration (VHA) and other Federal systems. Telemedicine, including video telehealth (VTH), can improve access to MH care for RNVs by addressing barriers. Understanding the cultural context and existing community resources can improve engagement and implementation efforts with RNVs. Objective: This article describes a model of culturally centered MH care and a flexible implementation approach, Personalized Implementation of Virtual Treatments for Rural Native Veterans (PIVOT-RNV), used to disseminate the model. Methods: Participants included four VHA sites serving large RNV populations where PIVOT-RNV was applied to expand the availability of virtual solutions, including VTH, for RNVs. A mixed methods formative evaluation tracked VTH utilization and used provider and RNV feedback to inform iterative process improvements. Results: Where PIVOT-RNV was used, number of providers using VTH with RNVs, number of unique RNVs receiving MH care through VTH, and number of VTH encounters with RNVs grew annually. Provider and RNV feedback highlighted the importance of addressing the unique barriers and cultural context of RNVs. Conclusions: PIVOT-RNV demonstrates promise for improving implementation of virtual treatments and access to MH care for RNVs. The integration of implementation science within a cultural safety framework helps address specific barriers to adoption of virtual treatments for RNVs. Next steps include expanding PIVOT-RNV efforts at additional sites.
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Affiliation(s)
- Stephanie C Day
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra Caloudas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Kristen Frosio
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jan Lindsay
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Baker Institute for Public Policy, Rice University, Houston, Texas, USA
| | - Jay H Shore
- VHA Office of Rural Health Veterans Rural Health Resource Center, Salt Lake City, Utah, USA
- Department of Psychiatry, Centers for American Indian and Alaska Native Mental Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Gee G, Hulbert C, Kennedy H, Paradies Y. Cultural determinants and resilience and recovery factors associated with trauma among Aboriginal help-seeking clients from an Aboriginal community-controlled counselling service. BMC Psychiatry 2023; 23:155. [PMID: 36899333 PMCID: PMC9999632 DOI: 10.1186/s12888-023-04567-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/24/2023] [Indexed: 03/12/2023] Open
Abstract
In addition to resilience and resistance, collective and personal experiences of trauma are commonly cited within the context of Aboriginal and Torres Strait Islander and other Indigenous First People's experiences of colonisation. This study investigated whether a range of risk and protective factors, including cultural determinants of social and emotional wellbeing, were associated with posttraumatic stress outcomes among 81 Aboriginal help-seeking clients from an Aboriginal community-controlled counselling service in Melbourne, Australia. The study explored potential relationships between trauma exposure, child removal from natural family, experiences of racism, gender, and trauma symptom severity. The study also investigated whether personal, relationship, community and cultural strengths and determinants of wellbeing, as detailed in the Aboriginal Resilience and Recovery Questionnaire, moderated the relationship between trauma exposure and posttraumatic stress symptom severity. Participants commonly endorsed symptoms of distress consistent with Posttraumatic Stress Disorder and cultural idioms of distress as documented in the Aboriginal Australian Version of the Harvard Trauma Questionnaire. Two generations of child removal from one's natural family, experiences of racism, stressful life events experienced during the past 12 months, being male, and not having access to funds for basic living expenses were all associated with greater trauma symptom severity. Conversely, participants self-reported access to personal, relationship, community and cultural strengths was associated with lower trauma symptom severity. Regression analysis revealed that trauma exposure, stressful life events, access to basic living expenses, and personal, relationship, community, and cultural strengths were all important predictors of posttraumatic stress symptom severity. Participant access to strength and resources that included connections to community and culture, moderated the relationship between trauma exposure and trauma symptom severity.
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Affiliation(s)
- Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Intergenerational Health Group, Royal Children's Hospital, Level 5, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia. .,Victorian Aboriginal Health Service, (2008-2018), Fitzroy, VIC, Australia.
| | - Carol Hulbert
- School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Helen Kennedy
- Intergenerational Health Group, Murdoch Children's Research Institute, Intergenerational Health Group, Royal Children's Hospital, Level 5, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Victorian Aboriginal Health Service, (2008-2012), Fitzroy, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Yin Paradies
- School of Humanities and Social Science, Faculty of Arts and Education, Deakin University, Burwood, VIC, Australia
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White EJ, Demuth MJ, Nacke M, Kirlic N, Kuplicki R, Spechler PA, McDermott TJ, DeVille DC, Stewart JL, Lowe J, Paulus MP, Aupperle RL. Neural processes of inhibitory control in American Indian peoples are associated with reduced mental health problems. Soc Cogn Affect Neurosci 2023; 18:nsac045. [PMID: 35801628 PMCID: PMC9949499 DOI: 10.1093/scan/nsac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
American Indians (AI) experience disproportionately high prevalence of suicide and substance use disorders (SUD). However, accounting for risk burden (e.g. historical trauma and discrimination), the likelihood of mental health disorders or SUD is similar or decreased compared with the broader population. Such findings have spurred psychological research examining the protective factors, but no studies have investigated its potential neural mechanisms. Inhibitory control is one of the potential neurobehavioral construct with demonstrated protective effects, but has not been examined in neuroimaging studies with AI populations specifically. We examined the incidence of suicidal thoughts and behaviors (STB) and SUD among AI (n = 76) and propensity matched (sex, age, income, IQ proxy and trauma exposure) non-Hispanic White (NHW) participants (n = 76). Among the AI sample, functional magnetic resonance imaging (fMRI) data recorded during the stop-signal task (SST) was examined in relation to STB and SUDs. AIs relative to NHW subjects displayed lower incidence of STB. AIs with no reported STBs showed greater activity in executive control regions during the SST compared with AI who endorsed STB. AI without SUD demonstrated lower activity relative to those individual reporting SUD. Results are consistent with a growing body of literature demonstrating the high level of risk burden driving disparate prevalence of mental health concerns in AI. Furthermore, differential activation during inhibitory control processing in AI individuals without STB may represent a neural mechanism of protective effects against mental health problems in AI. Future research is needed to elucidate sociocultural factors contributing protection against mental health outcomes in AIs and further delineate neural mechanisms with respect to specific concerns (e.g. SUD vs STB).
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - Mara J Demuth
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Mariah Nacke
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | | | - Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA
| | - Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - John Lowe
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
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Abstract
Post-traumatic stress disorder (PTSD) is characterized by symptoms of re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity following exposure to a traumatic event. PTSD can be assessed by structured interviews and screening measures in psychiatric and nonpsychiatric settings. Evidence-based psychotherapies are the first-line treatment of PTSD, with cognitive behavioral therapies, such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing having the largest body and highest quality of evidence. Serotonin reuptake inhibitors are the first-line pharmacologic treatments for PTSD and are often used in conjunction with other therapeutic interventions.
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Affiliation(s)
- Addie N Merians
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA
| | - Tobias Spiller
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA
| | - Ilan Harpaz-Rotem
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA
| | - John H Krystal
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA.
| | - Robert H Pietrzak
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street #901, New Haven, CT 06511, USA
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Jones JL. Perspectives on the therapeutic potential of MDMA: A nation-wide exploratory survey among substance users. Front Psychiatry 2023; 14:1096298. [PMID: 37124269 PMCID: PMC10140372 DOI: 10.3389/fpsyt.2023.1096298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background Alcohol and other substance use disorders are commonly associated with post-traumatic stress disorder (PTSD), and the presence of these comorbidities is associated with worse treatment outcomes. Additionally, disparities in substance and PTSD prevalence have been associated with minority races and ethnicities, and minorities have been shown to be less likely to engage in treatment. Psychedelic-assisted treatments, including 3,4-methylenedioxymethamphetamine (MDMA), have shown preliminary trans-diagnostic effectiveness, however it is unknown how individuals with substance use disorders view the therapeutic potential of MDMA therapy. Previous studies have also shown that minority races and ethnicities are under-represented in the MDMA trials, leading to concerns about inequitable access to clinical treatment. Methods To explore demographic characteristics related to patient-level perspectives on the therapeutic potential of MDMA-assisted therapy, this study describes data from a nationwide, cross-sectional survey of 918 individuals self-reporting criteria consistent with alcohol or substance use disorders. Results Overall, a majority of individuals reported support for medical research of MDMA (68.1%), belief that MDMA-assisted therapy might be a useful treatment (70.1%), and willingness to try MDMA-assisted therapy if it were determined to be an appropriate treatment for them (58.8%). No race or ethnicity differences were found in support for further research or belief in effectiveness, however there were small disparities in terms of willingness to try MDMA-assisted therapy and concerns related to use of this treatment approach. Conclusion These results provide insights and future directions as the field of psychedelic-assisted therapy seeks to provide equitable access to clinical care and to diversify research participation.
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Ehlers CL, Yehuda R, Gilder DA, Bernert R, Karriker-Jaffe KJ. Trauma, historical trauma, PTSD and suicide in an American Indian community sample. J Psychiatr Res 2022; 156:214-220. [PMID: 36265258 PMCID: PMC9842016 DOI: 10.1016/j.jpsychires.2022.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
AIMS To study the associations between perceived historical trauma, current traumatic events, diagnoses of post-traumatic stress disorder (PTSD), and suicidal behaviors in an American Indian community sample. METHODS Participants were American Indians recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), as well as the Historical Loss Scale, Historical Loss Associated Symptoms Scale, and Stressful Life Events Scale. RESULTS In data from 447 American Indian adults (mean age = 33 years), twenty percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts, (including either a suicide attempt history or verified death by suicide (n = 4)). Diagnosis of PTSD and experience of assaultive trauma were each significantly associated with suicidal thoughts and acts, although assaultive trauma did not remain significant in models adjusting for gender and PTSD. High endorsement of symptoms associated with historical trauma was significantly associated with suicidal acts, and this remained significant when adjusting for gender and PTSD. CONCLUSIONS PTSD and historical trauma have an association with suicide and suicidal attempts in this American Indian community. Although further research is needed to evaluate the causal nature of these relations, these findings suggest treatment and prevention programs for American Indian suicide may benefit from addressing issues related to feelings of historical losses, PTSD, and their associated symptomatology.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - Rachel Yehuda
- James J. Peters Bronx Medical Center and Psychiatry Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences Stanford University, Stanford, CA, USA
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Albright DL, Fletcher KL, McDaniel J, Godfrey K, Thomas KH, Tovar M, Bertram JM. Mental and physical health in service member and veteran students who identify as American Indians and Alaskan natives. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:783-790. [PMID: 31944901 DOI: 10.1080/07448481.2019.1707206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/25/2019] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to explore (a) current utilization rates of university mental health services among American Indian/Alaskan Native/Native Hawaiian (AI/AN/NH) student veterans and (b) predictors of mental health service utilization among AI/AN student veterans. Participants: Data for this cross-sectional study were obtained from the American College Health Association (ACHA)'s 2011-2014 National College Health Assessment II (n = 103). Methods: University mental health service utilization rates were calculated as a percentage for AI/AN/NH student veterans. Multivariable logistic regression was used to determine predictors of mental health service utilization. Results: Results showed that 14% of AI/AN/NH student veterans have used university mental health services. Predictors of mental health service utilization in this population included financial stress, lack of deployment during service, suicidal ideation, and a diagnosis of depression, model χ 2 (13) = 162. 128, p < 0.001, Nagelkerke R2 = 0.130. Conclusion: This research identified gaps in service provision for AI/AN service member and veteran students on college campuses and provided possible models for intervention development.
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Affiliation(s)
- D L Albright
- University of Alabama, School of Social Work, Tuscaloosa, Alabama, USA
| | - K L Fletcher
- St. Catherine University - University of St. Thomas School of Social Work, St. Paul, Minnesota, USA
| | - J McDaniel
- Department of Public Health, Southern Illinois University, Carbondale, Illinois, USA
| | - K Godfrey
- University of Alabama, Tuscaloosa, Alabama, USA
| | - K H Thomas
- Charleston Southern University, Charleston, South Carolina, USA
| | - M Tovar
- Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
| | - J M Bertram
- MSW University of Alabama, Tuscaloosa, Alabama, USA
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Huyser KR, Locklear S, Sheehan C, Moore BL, Butler JS. Consistent Honor, Persistent Disadvantage: American Indian and Alaska Native Veteran Health in the National Survey of Veterans. J Aging Health 2021; 33:68S-81S. [PMID: 34167347 PMCID: PMC8236669 DOI: 10.1177/08982643211014034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To examine self-rated health and activities of daily living (ADLs) limitations among American Indian and Alaska Native (AI/AN) veterans relative to white veterans. Methods: We use the 2010 National Survey of Veterans and limit the sample to veterans who identify as AI/AN or non-Hispanic white. We calculated descriptive statistics, confidence intervals, and used logistic regression. Results: AI/AN veterans are younger, have lower levels of income, and have higher levels of exposure to combat and environmental hazards compared to white veterans. We found that AI/AN veterans are significantly more likely to report fair/poor health controlling for socioeconomic status and experience an ADL controlling for age, health behaviors, socioeconomic status, and military factors. Discussion: The results indicate that AI/AN veterans are a disadvantaged population in terms of their health and disability compared to white veterans. AI/AN veterans may require additional support from family members and/or Veteran Affairs to address ADLs.
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Affiliation(s)
- Kimberly R Huyser
- Department of Sociology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Sofia Locklear
- Department of Sociology, 170285University of New Mexico, Albuquerque, NM, USA
| | - Connor Sheehan
- School of Social and Family Dynamics, 7864Arizona State University, Tempe, AZ, USA
| | - Brenda L Moore
- Department of Sociology, 12292State University of New York at Buffalo, Buffalo, NY, USA
| | - John S Butler
- Department of Sociology and Management, 12330University of Texas at Austin, Austin, TX, USA
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Rural and Urban American Indian and Alaska Native Veteran Health Disparities: a Population-Based Study. J Racial Ethn Health Disparities 2020; 7:1071-1078. [DOI: 10.1007/s40615-020-00730-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/10/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
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Goss CW, Richardson WJ, Shore JH. Outcomes and Lessons Learned from the Tribal Veterans Representative Program: A Model for System Engagement. J Community Health 2019; 44:1076-1085. [PMID: 31227961 DOI: 10.1007/s10900-019-00683-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
American Indian and Alaska Native Veterans are more rural than Veterans of any other race or ethnicity and face significant barriers to accessing care. Since 2001, the Tribal Veterans Representative (TVR) Program, a partnership between the U.S. Department of Veterans Affairs (VA) and tribal nations, has trained liaisons from tribal communities to facilitate access to VA benefits and services. We delineate the TVR program model alongside supporting data. We reviewed TVR training materials and program evaluations to identify components of the program essential for increasing access to VA services and benefits. We then report a quantitative assessment of benefits attained in one tribal community. The TVR model is characterized by the exchange of two sets of knowledge and resources-'institutional' and 'community'-during a co-sponsored educational program aiming to train community liaisons about the institution. The institution leads the program's content; the community's traditions inform its process. Following the program, liaisons use support networks comprising trainers, trainees and local organizations to teach other community members to access health care and benefits. In the evaluation community, one liaison has facilitated access for hundreds of Veterans, with financial compensation exceeding $400,000 annually. The TVR program has begun to demonstrate its utility for other rural populations, though further formal evaluation is recommended. Compared with similar models to increase rural populations' access to health care and benefits, the long-term support networks from the TVR model may be most useful when the institution must build trust and engage with the target population.
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Affiliation(s)
- Cynthia W Goss
- U.S. Department of Veterans Affairs (VA) Office of Rural Health's (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, Utah, USA.
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, Colorado, 80045, USA.
| | - W J Richardson
- U.S. Department of Veterans Affairs (VA), Veterans Affairs Rocky Mountain Healthcare Network (VISN 19), Fort Harrison, Montana, USA
| | - Jay H Shore
- U.S. Department of Veterans Affairs (VA) Office of Rural Health's (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, Utah, USA
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, Colorado, 80045, USA
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Shore JH, Goss CW, Dailey NK, Bair BD. Methodology for Evaluating Models of Telemental Health Delivery Against Population and Healthcare System Needs: Application to Telemental Healthcare for Rural Native Veterans. Telemed J E Health 2019; 25:628-637. [PMID: 30129880 DOI: 10.1089/tmj.2018.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Rural American Indian and Alaska Native (AI/AN) Veterans face exceptional barriers to receiving quality mental healthcare. We aimed to identify models of in-person and telemental health service delivery with promise for adaptation and wide dissemination to rural AI/AN Veterans. Methods: Our method for matching specific populations with models of care includes (1) selecting frameworks that represent the healthcare organization's goals, (2) identifying relevant service delivery models for the target population(s), (3) assessing models against the selected frameworks, and (4) summarizing findings across models. We applied this approach to rural AI/AN Veteran populations. Results: Searches identified 13 current models of service delivery for rural AI/AN Veteran, rural AI/AN, and general rural Veteran populations. These models were assessed against four frameworks-the U.S. Department of Veterans Affairs' Office of Rural Health's Promising Practices, Veterans Health Administration's Guide to Mental Health Services, the Institute for Healthcare Improvement's Triple Aim Framework, and the American Indian Telemental Health Clinic framework. Discussion: The one model used for service delivery for rural AI/AN Veterans increases access and is patient-centered but lacks operational feasibility. Models for rural AI/ANs also increase access and are patient-centered but generally lack effectiveness evaluations. Models for rural Veterans demonstrate beneficial effects on mental health outcomes but do not emphasize cultural adaptations to diverse populations. Conclusions: Our approach to selecting models of service delivery considers the needs of operational partners as well as target populations and emphasizes large-scale implementation alongside effectiveness. Pending further testing, this approach holds promise for wider application.
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Affiliation(s)
- Jay H Shore
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Cynthia W Goss
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Nancy K Dailey
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Byron D Bair
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
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The influence of deployment stress and life stress on Post-Traumatic Stress Disorder (PTSD) diagnosis among military personnel. J Psychiatr Res 2018; 103:26-32. [PMID: 29772483 DOI: 10.1016/j.jpsychires.2018.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 11/21/2022]
Abstract
There is increasing recognition that traumatic stress encountered throughout life, including those prior to military service, can put individuals at increased risk for developing Posttraumatic Stress Disorder (PTSD). The purpose of this study was to examine the association of both traumatic stress encountered during deployment, and traumatic stress over one's lifetime on probable PTSD diagnosis. Probable PTSD diagnosis was compared between military personnel deployed in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF; N = 21,499) and those who have recently enlisted (N = 55,814), using data obtained from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Probable PTSD diagnosis was assessed using the PTSD Checklist. The effect of exposure to multiple types (i.e. diversity) of traumatic stress and the total quantity (i.e. cumulative) of traumatic stress on probable PTSD diagnosis was also compared. Military personnel who had been deployed experienced higher rates of PTSD symptoms than new soldiers. Diversity of lifetime traumatic stress predicted probable PTSD diagnosis in both groups, whereas cumulative lifetime traumatic stress only predicted probable PTSD for those who had been deployed. For deployed soldiers, having been exposed to various types of traumatic stress during deployment predicted probable PTSD diagnosis, but cumulative deployment-related traumatic stress did not. Similarly, the total quantity of traumatic stress (i.e. cumulative lifetime traumatic stress) did not predict probable PTSD diagnosis among new soldiers. Together, traumatic stress over one's lifetime is a predictor of probable PTSD for veterans, as much as traumatic stress encountered during war. Clinicians treating military personnel with PTSD should be aware of the impact of traumatic stress beyond what occurs during war.
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15
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Asdigian NL, Bear UR, Beals J, Manson SM, Kaufman CE. Mental health burden in a national sample of American Indian and Alaska Native adults: differences between multiple-race and single-race subgroups. Soc Psychiatry Psychiatr Epidemiol 2018; 53:521-530. [PMID: 29470596 DOI: 10.1007/s00127-018-1494-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Research on American Indian and Alaska Native (AIAN) mental health disparities is based largely on either tribal populations or national samples of adults that do not account for multiracial AIANs, even though over 40% of AIANs identify with multiple racial groups. The present investigation extends this research by assessing mental health status in a national sample of multiracial AIAN adults relative to adults who identify exclusively as either AIAN or White. METHODS 2012 BRFSS data were used to conduct multinomial logistic regression analyses comparing mental health outcomes among respondents who identified as either AIAN and one or more other races (AIAN-MR), AIAN-Single Race (AIAN-SR), or White-SR. RESULTS After demographic adjustment, the AIAN-MR group reported a higher lifetime prevalence of diagnosed depressive disorder, more days of poor mental health, and more frequent mental distress compared to both the AIAN-SR and White-SR groups. AIAN-MR individuals also had higher levels of Kessler 6 (K6) non-specific psychological distress compared to White-SR individuals but not AIAN-SR adults. Differences between AIAN-SR and White-SR adults were found in days of poor mental health, frequent mental distress, and total K6 scores. CONCLUSIONS These findings help gauge the magnitude of mental health disparities in the U.S. AIAN population and pinpoint AIAN subgroups for whom mental health is particularly problematic. As such, they raise concerns about restrictions that limit the identification of national survey respondents who report multiple race designations. Such restrictions will thwart efforts to understand the causal mechanisms and pathways leading to mental distress among AIAN individuals.
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Affiliation(s)
- Nancy L Asdigian
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Ursula Running Bear
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Janette Beals
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Spero M Manson
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Carol E Kaufman
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
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Genome-Wide Association Study of Post-Traumatic Stress Disorder in Two High-Risk Populations. Twin Res Hum Genet 2017; 20:197-207. [PMID: 28262088 DOI: 10.1017/thg.2017.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mexican Americans (MAs) and American Indians (AIs) constitute conspicuously understudied groups with respect to risk for post-traumatic stress disorder (PTSD), especially in light of findings showing racial/ethnic differences in trauma exposure and risk for PTSD. The purpose of this study was to examine genetic influences on PTSD in two minority cohorts. A genome-wide association study (GWAS) with sum PTSD symptoms for trauma-exposed subjects was run in each cohort. Six highly correlated variants in olfactory receptor family 11 subfamily L member 1 (OR11L1) were suggestively associated with PTSD in the MA cohort. These associations remained suggestively significant after permutation testing. A signal in a nearby olfactory receptor on chromosome 1, olfactory receptor family 2 subfamily L member 13 (OR2L13), tagged by rs151319968, was nominally associated with PTSD in the AI sample. Although no variants were significantly associated after correction for multiple testing in a meta-analysis of the two cohorts, pathway analysis of the top hits showed an enrichment cluster of terms related to sensory transduction, olfactory receptor activity, G-protein coupled receptors, and membrane. As previous studies have proposed a role for olfaction in PTSD, our results indicate this influence may be partially driven by genetic variation in the olfactory system.
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Xie Z, Xu J, Wu Z. Mental health problems among survivors in hard-hit areas of the 5.12 Wenchuan and 4.20 Lushan earthquakes. J Ment Health 2017; 26:43-49. [PMID: 28084103 DOI: 10.1080/09638237.2016.1276525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Earthquake exposure has often been associated with psychological distress. However, little is known about the cumulative effect of exposure to two earthquakes on psychological distress and in particular, the effect on the development of post-traumatic stress disorder (PTSD), anxiety and depression disorders. AIMS This study explored the effect of exposure on mental health outcomes after a first earthquake and again after a second earthquake. METHODS A population-based mental health survey using self-report questionnaires was conducted on 278 people in the hard-hit areas of Lushan and Baoxing Counties 13-16 months after the Wenchuan earthquake (Sample 1). 191 of these respondents were evaluated again 8-9 months after the Lushan earthquake (Sample 2), which struck almost 5 years after the Wenchuan earthquake. RESULTS In Sample 1, the prevalence rates for PTSD, anxiety and depression disorders were 44.53, 54.25 and 51.82%, respectively, and in Sample 2 the corresponding rates were 27.27, 38.63 and 36.93%. Females, the middle-aged, those of Tibetan nationality, and people who reported fear during the earthquake were at an increased risk of experiencing post-traumatic symptoms. CONCLUSIONS Although the incidence of PTSD, anxiety and depression disorders decreased from Sample 1 to Sample 2, the cumulative effect of exposure to two earthquakes on mental health problems was serious in the hard-hit areas. Therefore, it is important that psychological counseling be provided for earthquake victims, and especially those exposed to multiple earthquakes.
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Affiliation(s)
- Zongtang Xie
- a School of Business, Sichuan University , Chengdu , China
| | - Jiuping Xu
- a School of Business, Sichuan University , Chengdu , China
| | - Zhibin Wu
- a School of Business, Sichuan University , Chengdu , China
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Kisely S, Alichniewicz KK, Black EB, Siskind D, Spurling G, Toombs M. The prevalence of depression and anxiety disorders in indigenous people of the Americas: A systematic review and meta-analysis. J Psychiatr Res 2017; 84:137-152. [PMID: 27741502 DOI: 10.1016/j.jpsychires.2016.09.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 01/11/2023]
Abstract
Indigenous populations are considered at higher risk of psychiatric disorder but many studies do not include direct comparisons with similar non-Indigenous controls. We undertook a meta-analysis of studies that compared the prevalence of depression and anxiety disorders in Indigenous populations in the Americas with those of non-Indigenous groups with similar socio-demographic features (Registration number: CRD42015025854). A systematic search of PubMed, Medline, PsycInfo, PsycArticles, ScienceDirect, EMBASE, and article bibliographies was performed. We included comparisons of lifetime rates and prevalence of up to 12 months. We found 19 studies (n = 250, 959) from Latin America, Canada and the US. There were no differences between Indigenous and similar non-Indigenous groups in the 12-month prevalence of depressive, generalised anxiety and panic disorders. However, Indigenous people were at greater risk of PTSD. For lifetime prevalence, rates of generalised anxiety, panic and all the depressive disorders were significantly lower in Indigenous participants, whilst PTSD (on adjusted analyses) and social phobia were significantly higher. Results were similar for sub-analyses of Latin America, Canada and the US, and sensitivity analyses by study quality or setting (e.g. health, community etc.). Risk factors for psychiatric illness may therefore be a complex interaction of biological, educational, economic and socio-cultural factors that may vary between disorders. Accordingly, interventions should reflect that the association between disadvantage and psychiatric illness is rarely due to one factor. However, it is also possible that assessment tools don't accurately measure psychiatric symptoms in Indigenous populations and that further cross-cultural validation of diagnostic instruments may be needed too.
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Affiliation(s)
- Steve Kisely
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada; School of Medicine, The University of Queensland, Australia.
| | | | - Emma B Black
- Rural Clinical School, School of Medicine, The University of Queensland, Australia
| | - Dan Siskind
- School of Medicine, The University of Queensland and Metro South Addiction and Mental Health Service, Australia
| | - Geoffrey Spurling
- School of Medicine, The University of Queensland and Inala Indigenous Health Service, Australia
| | - Maree Toombs
- Rural Clinical School, School of Medicine, The University of Queensland, Australia
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Brave Heart MYH, Lewis-Fernández R, Beals J, Hasin DS, Sugaya L, Wang S, Grant BF, Blanco C. Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1033-46. [PMID: 27138948 PMCID: PMC4947559 DOI: 10.1007/s00127-016-1225-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/16/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To examine the prevalence of common psychiatric disorders and associated treatment-seeking, stratified by gender, among American Indians/Alaska Natives and non-Hispanic whites in the United States. Lifetime and 12-month rates are estimated, both unadjusted and adjusted for sociodemographic correlates. METHOD Analyses were conducted with the American Indians/Alaska Native (n = 701) and Non-Hispanic white (n = 24,507) samples in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions [(NESARC) n = 43,093]. RESULTS Overall, 70 % of the American Indian/Alaska Native men and 63 % of the women met criteria for at least one Diagnostic and Statistical Manual-IV lifetime disorder, compared to 62 and 53 % of Non-Hispanic white men and women, respectively. Adjusting for sociodemographic correlates attenuated the differences found. Nearly half of American Indians/Alaska Natives had a psychiatric disorder in the previous year; again, sociodemographic adjustments explained some of the differences found. Overall, the comparisons to non-Hispanic whites showed differences were more common among American Indian/Alaska Native women than men. Among those with a disorder, American Indian/Alaska Native women had greater odds of treatment-seeking for 12-month anxiety disorders. CONCLUSION As the first study to provide national estimates, by gender, of the prevalence and treatment of a broad range of psychiatric disorders among American Indians/Alaska Natives, a pattern of higher prevalence of psychiatric disorder was found relative to Non-Hispanic whites. Such differences were more common among women than men. Prevalence may be overestimated due to cultural limitations in measurement. Unmeasured risk factors, some specific to American Indians/Alaska Natives, may also partially explain these results.
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Affiliation(s)
- Maria Yellow Horse Brave Heart
- Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC09 5030, 1 UNM, Albuquerque, NM, USA.
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA.
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Janette Beals
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Luisa Sugaya
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
| | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Carlos Blanco
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- National Institute on Drug Abuse, Bethesda, MD, USA
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Tovar M, Patterson Silver Wolf DA, Stevenson J. Toward a culturally informed rehabilitation treatment model for American Indian/Alaska Native veterans. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2015; 14:163-175. [PMID: 26151410 DOI: 10.1080/1536710x.2015.1068255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
American Indians and Alaska Natives (AI/AN) have a long tradition of military service, allying with Western forces in North America since the 1700s. It is hardly surprising, therefore, that AI/AN veterans experience higher rates of overall disability and service-related disability than veterans of other races and ethnicities. It is not clear, however, that AI/AN veterans with disabilities are receiving effective, culturally informed rehabilitation services. This article examines the incidence of disability among contemporary AI/AN veterans, considers barriers to effective treatment, and points out model programs tailored to the particular needs of this population, with attention to the historical and cultural context of AI/AN military service.
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Affiliation(s)
- Molly Tovar
- a Kathryn M. Buder Center for American Indian Studies , Washington University in St. Louis , St. Louis , Missouri , USA
| | | | - Julia Stevenson
- a Kathryn M. Buder Center for American Indian Studies , Washington University in St. Louis , St. Louis , Missouri , USA
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Tribal Veterans Representative (TVR) training program: the effect of community outreach workers on American Indian and Alaska Native Veterans access to and utilization of the Veterans Health Administration. J Community Health 2015; 39:990-6. [PMID: 24585103 DOI: 10.1007/s10900-014-9846-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
American Indians and Alaska Natives serve at the highest rate of any US race or ethnic group, yet are the most underserved population of Veterans and do not take advantage of the Department of Veterans Affairs (VA) benefits and services. Barriers to seeking care include stigma, especially for mental health issues; distance to care; and lack of awareness of benefits and services they are entitled to receive. In response to this underutilization of the VA, an innovative program--the Tribal Veterans Representative (TVR) program--was developed within the VA to work with American Indians and Alaska Natives in rural and remote areas. The TVR goes through extensive training every year; is a volunteer, a Veteran and tribal community member who seeks out unenrolled Native Veterans, provides them with information on VA health care services and benefits, and assists them with enrollment paperwork. Being from the community they serve, these outreach workers are able to develop relationships and build rapport and trust with fellow Veterans. In place for over a decade in Montana, this program has enrolled a countless number of Veterans, benefiting not only the individual, but their family and the community as well. Also resulting from this program, are the implementation of Telemental Health Clinics treating Veterans with PTSD, a transportation program helping Veterans get to and from distant VA facilities, a Veteran Resource Center, and a Veteran Tribal Clinic. This program has successfully trained over 800 TVRs, expanded to other parts of the country and into remote areas of Alaska.
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Cooper DC, Trivedi RB, Nelson KM, Reiber GE, Beaver KA, Eugenio EC, Fan VS. Post-traumatic Stress Disorder, Race/Ethnicity, and Coronary Artery Disease Among Older Patients with Depression. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0020-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature. Soc Psychiatry Psychiatr Epidemiol 2014; 49:417-33. [PMID: 24022752 PMCID: PMC3875613 DOI: 10.1007/s00127-013-0759-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 08/30/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE American Indians and Alaska Natives (AI/ANs) experience high rates of trauma and posttraumatic stress disorder (PTSD). We reviewed existing literature to address three interrelated questions: (1) What is the prevalence of PTSD and PTSD symptoms among AI/ANs? (2) What are the inciting events, risk factors, and co-morbidities in AI/ANs, and do they differ from those in the general U.S. population? (3) Are studies available to inform clinicians about the course and treatment of PTSD in this population? METHODS We searched the PubMed and Web of Science databases and a database on AI/AN health, capturing an initial sample of 77 original English-language articles published 1992–2010. After applying exclusion criteria, we retained 37 articles on prevalence of PTSD and related symptoms among AI/AN adults. We abstracted key information and organized it in tabular format. RESULTS AI/ANs experience a substantially greater burden of PTSD and related symptoms than U.S. Whites. Combat experience and interpersonal violence were consistently cited as leading causes of PTSD and related symptoms. PTSD was associated with bodily pain, lung disorders, general health problems, substance abuse, and pathological gambling. In general, inciting events, risk factors, and co-morbidities appear similar to those in the general U.S. population. CONCLUSIONS Substantial research indicates a strikingly high incidence of PTSD in AI/AN populations. However, inciting events, risk factors, and co-morbidities in AI/ANs, and how they may differ from those in the general population, are poorly understood. Very few studies are available on the clinical course and treatment of PTSD in this vulnerable population.
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Jin Y, Xu J, Liu H, Liu D. Posttraumatic stress disorder and posttraumatic growth among adult survivors of Wenchuan earthquake after 1 year: prevalence and correlates. Arch Psychiatr Nurs 2014; 28:67-73. [PMID: 24506990 DOI: 10.1016/j.apnu.2013.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022]
Abstract
This study investigates the prevalence and predictors for posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in adult survivors 1year after the 2008 Wenchuan earthquake. Questionnaires were used to collect the data. PTSD was assessed using the PTSD Check List-Civilian (PCL-C), and PTG was assessed using the Post Traumatic Growth Inventory (PTGI). A total of 2,300 individuals were involved in the survey with 2,080 completing the questionnaire, a response rate of 90.4%. The PTSD prevalence estimate in this study was found to be 40.1%, and the prevalence for PTG among the participants was measured at 51.1%. A bivariate correlation analysis indicated that there was a positive association between PTG and PTSD. In the conclusions, possible explanations for the findings and implications for future research are discussed.
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Affiliation(s)
- Yuchang Jin
- Uncertainty Decision-making Laboratory, Sichuan University, No. 24, South Section 1, Yihuan Road, Chengdu, Sichuan 610065, P. R. China; College of Teacher Education, Sichuan Normal University. No. 5, Jingan Road, Jinjiang District, Chengdu, Sichuan 610068, P. R. China.
| | - Jiuping Xu
- Uncertainty Decision-making Laboratory, Sichuan University, No. 24, South Section 1, Yihuan Road, Chengdu, Sichuan 610065, P. R. China.
| | - Hai Liu
- College of Teacher Education, Sichuan Normal University. No. 5, Jingan Road, Jinjiang District, Chengdu, Sichuan 610068, P. R. China.
| | - Dongyue Liu
- College of Teacher Education, Sichuan Normal University. No. 5, Jingan Road, Jinjiang District, Chengdu, Sichuan 610068, P. R. China.
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Westermeyer J, Canive J. Posttraumatic stress disorder and its comorbidities among American Indian veterans. Community Ment Health J 2013; 49:704-8. [PMID: 23149647 DOI: 10.1007/s10597-012-9565-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
Abstract
Goal consists of describing the demographic and comorbid characteristics associated with Posttraumatic Stress Disorder (PTSD) among American Indian veterans with any lifetime Axis 1 disorder. Sample included 252 American Indian veterans, obtained from a community sample of 557, using targeted sampling designed to provide a representative sample, structured to include equal numbers of rural and urban veterans and a twofold over sample of women. Data collection involved lifetime diagnoses based on the Diagnostic Interview Schedule/Quick Version/DSM-III-R, demographic characteristics, and combat exposure. Findings Bivariate comparisons showed positive relationships of PTSD with combat exposure, mood disorder and anxiety disorders (excluding PTSD), but a negative relationship with substance use disorder. Binary logistic regression analyses showed an independent association of PTSD with mood and anxiety disorders as well as combat exposure.
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Affiliation(s)
- Joseph Westermeyer
- Minneapolis VAMC, Department of Psychiatry and Anthropology, University of Minnesota, Minneapolis, MN, USA,
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26
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Gone JP. Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment. Transcult Psychiatry 2013; 50:683-706. [PMID: 23715822 DOI: 10.1177/1363461513487669] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Indigenous "First Nations" communities have consistently associated their disproportionate rates of psychiatric distress with historical experiences of European colonization. This emphasis on the socio-psychological legacy of colonization within tribal communities has occasioned increasingly widespread consideration of what has been termed historical trauma within First Nations contexts. In contrast to personal experiences of a traumatic nature, the concept of historical trauma calls attention to the complex, collective, cumulative, and intergenerational psychosocial impacts that resulted from the depredations of past colonial subjugation. One oft-cited exemplar of this subjugation--particularly in Canada--is the Indian residential school. Such schools were overtly designed to "kill the Indian and save the man." This was institutionally achieved by sequestering First Nations children from family and community while forbidding participation in Native cultural practices in order to assimilate them into the lower strata of mainstream society. The case of a residential school "survivor" from an indigenous community treatment program on a Manitoba First Nations reserve is presented to illustrate the significance of participation in traditional cultural practices for therapeutic recovery from historical trauma. An indigenous rationale for the postulated efficacy of "culture as treatment" is explored with attention to plausible therapeutic mechanisms that might account for such recovery. To the degree that a return to indigenous tradition might benefit distressed First Nations clients, redressing the socio-psychological ravages of colonization in this manner seems a promising approach worthy of further research investigation.
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Kun P, Tong X, Liu Y, Pei X, Luo H. What are the determinants of post-traumatic stress disorder: age, gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake. Public Health 2013; 127:644-52. [DOI: 10.1016/j.puhe.2013.04.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 12/18/2012] [Accepted: 04/16/2013] [Indexed: 11/26/2022]
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Gehrman P, Seelig AD, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, Ulmer CS, Smith TC. Predeployment Sleep Duration and Insomnia Symptoms as Risk Factors for New-Onset Mental Health Disorders Following Military Deployment. Sleep 2013; 36:1009-1018. [PMID: 23814337 DOI: 10.5665/sleep.2798] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY OBJECTIVES To evaluate predeployment sleep duration and insomnia symptoms in relation to the development of mental health symptoms. DESIGN Longitudinal cohort study. SETTING The Millennium Cohort Study survey is administered via a secure website or US mail. PARTICIPANTS Data were from 15,204 participants who completed their first deployment between the submissions of 2 consecutive Millennium Cohort questionnaires (2001-2008). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Using self-reported data from the Millennium Cohort Study we evaluated the association of predeployment sleep duration and insomnia symptoms on the development of new-onset mental disorders among deployers. Multivariable logistic regression was used to estimate the odds of developing posttraumatic stress disorder (PTSD), depression, and anxiety, while adjusting for relevant covariates including combat-related trauma. The study outcomes were assessed using validated instruments, including the PTSD checklist-civilian version, and the PRIME-MD Patient Health Questionnaire. We identified 522 people with new-onset PTSD, 151 with anxiety, and 303 with depression following deployment. In adjusted models, combat-related trauma and predeployment insomnia symptoms were significantly associated with higher odds of developing posttraumatic stress disorder, depression, and anxiety postdeployment. CONCLUSIONS Sleep characteristics, especially insomnia symptoms, are related to the development of mental disorders following military deployments. Assessment of insomnia symptoms predeployment may help to better identify those at highest risk for subsequent adverse mental health outcomes. CITATION Gehrman P; Seelig AD; Jacobson IG; Boyko EJ; Hooper TI; Gackstetter GD; Ulmer CS; Smith TC; for the Millennium Cohort Study Team. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. SLEEP 2013;36(7):1009-1018.
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Affiliation(s)
- Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Ehlers CL, Gizer IR, Gilder DA, Yehuda R. Lifetime history of traumatic events in an American Indian community sample: heritability and relation to substance dependence, affective disorder, conduct disorder and PTSD. J Psychiatr Res 2013; 47:155-61. [PMID: 23102628 PMCID: PMC3530021 DOI: 10.1016/j.jpsychires.2012.10.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/22/2012] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Abstract
American Indians appear to experience a higher rate of traumatic events than what has been reported in general population surveys. American Indians also suffer higher alcohol related death rates than any other ethnic group in the U.S. population. Therefore efforts to delineate factors which may uniquely contribute to increased likelihood of trauma, post traumatic stress disorder (PTSD), and substance use disorders (SUD) over the lifetime in American Indians are important because of the high burden of morbidity and mortality that they pose to American Indian communities. Participants were American Indians recruited from reservations that were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), family history assessment and the stressful-life-events scale. Of the 309 participants, equivalent numbers of men and women (94%) reported experiencing traumas; however, a larger proportion of women received a PTSD diagnosis (38%) than men (29%). Having experienced multiple trauma and sexual abuse were most highly associated with PTSD. Having experienced assaultive trauma and having PTSD symptoms were both found to be moderately heritable (30-50%). Logistic regression revealed that having an anxiety and/or affective disorder and having a substance dependent diagnosis, but not having antisocial personality disorder/conduct disorder, were significantly correlated with having a diagnosis of PTSD. These studies suggest that trauma is highly prevalent in this American Indian community, it is heritable, is associated with PTSD, affective/anxiety disorders and substance dependence. Additionally, trauma, PTSD and substance dependence appear to all co-emerge in early adulthood in this high-risk population.
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Affiliation(s)
- Cindy L. Ehlers
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037, USA,Corresponding author: Dr. Cindy.L. Ehlers, TSRI, 10550 North Torrey Pines Road SP30-1501, La Jolla, CA 92037 USA, Telephone: (858) 784-7058; Fax: (858) 784-7409;
| | - Ian R. Gizer
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - David A. Gilder
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Rachael Yehuda
- James J. Peters Veterans Affairs Medical Center and Traumatic Stress Studies Division, Psychiatry Department, Mount Sinai School of Medicine, Bronx, NY 10029-6574, USA
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Kasckow J, Brown C, Morse J, Begley A, Bensasi S, Reynolds CF. Post-traumatic stress disorder symptoms in emotionally distressed individuals referred for a depression prevention intervention: relationship to problem-solving skills. Int J Geriatr Psychiatry 2012; 27:1106-11. [PMID: 23044651 PMCID: PMC3468913 DOI: 10.1002/gps.2826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/24/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study examined the rates of syndromal and subthreshold post-traumatic stress disorder (PTSD) and PTSD symptom scores in participants with symptoms of emotional distress, subsyndromal depression, and a history of traumatic exposure. Participants had been referred to a study of an indicated depression prevention intervention using problem-solving therapy in primary care. We hypothesized that higher severity of PTSD symptom scores would predict poorer problem-solving skills. In addition, some reports have suggested that there are higher rates of PTSD in minority populations relative to Caucasians; thus we hypothesized that race would also predict problem-solving skills in these individuals. METHODS We examined the rates of traumatic exposure, syndromal, and subthreshold PTSD. In those exposed to trauma, we performed a multiple linear regression to examine the effects of PTSD symptoms, depression symptoms, race, age, and gender on social problem-solving skills. RESULTS Of the 244 participants, 64 (26.2%) reported a traumatic event; 6/234 (2.6%) had syndromal PTSD, and 14/234 (6.0%) had subthreshold PTSD. By way of regression analysis, higher PTSD symptom scores predicted poorer problem-solving skills. In addition, racial status (Caucasian vs. African American) predicted problem-solving skills; Caucasians exhibited lower levels of problem-solving skills. CONCLUSIONS Individuals presenting with subsyndromal depressive symptoms may also have a history of traumatic exposure, subthreshold and syndromal PTSD. Thus, screening these individuals for PTSD symptoms is important and may inform clinical management decisions because problem-solving skills are lower in those with more severe PTSD symptoms (even after adjusting for race, age, gender, and depressive symptoms).
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Affiliation(s)
- J Kasckow
- VA Pittsburgh MIRECC and Behavioral Health, Pittsburgh, PA, USA.
| | - C Brown
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - J Morse
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - A Begley
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - S Bensasi
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - CF Reynolds
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
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Sawchuk CN, Roy-Byrne P, Noonan C, Bogart A, Goldberg J, Manson SM, Buchwald D. Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians. Nicotine Tob Res 2012; 14:1048-56. [PMID: 22345318 DOI: 10.1093/ntr/ntr331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes. METHODS Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members. RESULTS Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes. CONCLUSIONS This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.
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Affiliation(s)
- Craig N Sawchuk
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Shore J, Kaufmann LJ, Brooks E, Bair B, Dailey N, Richardson WJB, Floyd J, Lowe J, Nagamoto H, Phares R, Manson S. Review of American Indian veteran telemental health. Telemed J E Health 2012; 18:87-94. [PMID: 22283396 DOI: 10.1089/tmj.2011.0057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.
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Affiliation(s)
- Jay Shore
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health, Department of Veterans Affairs, Salt Lake City, Utah, USA.
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Brooks E, Manson SM, Bair B, Dailey N, Shore JH. The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders. Telemed J E Health 2012; 18:60-6. [PMID: 22082106 PMCID: PMC3306586 DOI: 10.1089/tmj.2011.0076] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 05/13/2011] [Accepted: 06/01/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. MATERIALS AND METHODS We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. RESULTS Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. CONCLUSION The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.
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Affiliation(s)
- Elizabeth Brooks
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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Gone JP, Trimble JE. American Indian and Alaska Native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol 2011; 8:131-60. [PMID: 22149479 DOI: 10.1146/annurev-clinpsy-032511-143127] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.
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Affiliation(s)
- Joseph P Gone
- Department of Psychology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Stander VA, Thomsen CJ, Merrill LL, Rabenhorst MM, Crouch JL, Milner JS. Gender and Military Contextual Risk Factors for Intimate Partner Aggression. MILITARY PSYCHOLOGY 2011. [DOI: 10.1080/08995605.2011.616808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | | | - Lex L. Merrill
- a Naval Health Research Center , San Diego , California , USA
| | - Mandy M. Rabenhorst
- b Center for the Study of Family Violence and Sexual Assault , Northern Illinois University , DeKalb , Illinois , USA
| | - Julie L. Crouch
- b Center for the Study of Family Violence and Sexual Assault , Northern Illinois University , DeKalb , Illinois , USA
| | - Joel S. Milner
- b Center for the Study of Family Violence and Sexual Assault , Northern Illinois University , DeKalb , Illinois , USA
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Hinton DE, Lewis-Fernández R. The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depress Anxiety 2011; 28:783-801. [PMID: 21910185 DOI: 10.1002/da.20753] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 08/21/2010] [Accepted: 08/26/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is considerable debate about the cross-cultural applicability of the posttraumatic stress disorder (PTSD) category as currently specified. Concerns include the possible status of PTSD as a Western culture-bound disorder and the validity of individual items and criteria thresholds. This review examines various types of cross-cultural validity of the PTSD criteria as defined in DSM-IV-TR, and presents options and preliminary recommendations to be considered for DSM-5. METHODS Searches were conducted of the mental health literature, particularly since 1994, regarding cultural-, race-, or ethnicity-related factors that might limit the universal applicability of the diagnostic criteria of PTSD in DSM-IV-TR and the possible criteria for DSM-5. RESULTS Substantial evidence of the cross-cultural validity of PTSD was found. However, evidence of cross-cultural variability in certain areas suggests the need for further research: the relative salience of avoidance/numbing symptoms, the role of the interpretation of trauma-caused symptoms in shaping symptomatology, and the prevalence of somatic symptoms. This review also indicates the need to modify certain criteria, such as the items on distressing dreams and on foreshortened future, to increase their cross-cultural applicability. Text additions are suggested to increase the applicability of the manual across cultural contexts: specifying that cultural syndromes-such as those indicated in the DSM-IV-TR Glossary-may be a prominent part of the trauma response in certain cultures, and that those syndromes may influence PTSD symptom salience and comorbidity. CONCLUSIONS The DSM-IV-TR PTSD category demonstrates various types of validity. Criteria modification and textual clarifications are suggested to further improve its cross-cultural applicability.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Xu J, Song X. Posttraumatic stress disorder among survivors of the Wenchuan earthquake 1 year after: prevalence and risk factors. Compr Psychiatry 2011; 52:431-7. [PMID: 21683180 DOI: 10.1016/j.comppsych.2010.08.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 08/03/2010] [Accepted: 08/13/2010] [Indexed: 11/16/2022] Open
Abstract
Exposure to earthquakes has been associated with psychological distress in particular, the development of posttraumatic stress disorder (PTSD). The aims of this study are to estimate the prevalence of PTSD, explore the associated risk factors among survivors 1 year after the Wenchuan earthquake in China, and compare the findings in our study to other disasters. Cross-sectional sample survey was conducted to collect data in severely affected counties. We use the PTSD Check List-Civilian Version, which consists of 17 items corresponding to each symptom in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD criteria B, C, and D. The prevalence estimates of probable PTSD in our sample ranged from 21.5% (based on Check List-Civilian Version score of 50 or higher) to 40.1% (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The prevalence of PTSD was high, compared with rates of PTSD in previous studies. Low social support, feeling fear during the earthquake, female, young people, Han nationality, low monthly income, and low educational level were risk factors significantly related to the development of PTSD. Postdisaster mental health recovery interventions including early identification, ongoing monitoring, and sustained psychosocial support are required for the high-risk population with PTSD. Existing rural and urban health care services should be convenient for people, and special measures need to be designed, such as home visits and mobile clinics.
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Affiliation(s)
- Jiuping Xu
- Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu, PR China.
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Xu J, Song X. A cross-sectional study among survivors of the 2008 Sichuan earthquake: prevalence and risk factors of posttraumatic stress disorder. Gen Hosp Psychiatry 2011; 33:386-92. [PMID: 21762836 DOI: 10.1016/j.genhosppsych.2011.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the prevalence of probable posttraumatic stress disorder (PTSD), explore the related risk factors among Sichuan earthquake survivors in different counties and compare the findings in our study to others. METHOD A cross-sectional sample survey was conducted to collect data in heavily (n=367) and moderately damaged counties (n=337). We used the PTSD Check List-Civilian Version (PCL-C), which consists of 17 items corresponding to each symptom of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS The prevalence of probable PTSD in heavily damaged counties (48.2%) was higher than that in moderately damaged counties (14.5%). Many associated risk factors were identified in the cross-sectional study. CONCLUSION Female, Han nationality, low monthly income, fear during earthquake and low social support in the past year were significant risk factors in heavily damaged counties, while the probable PTSD in moderately damaged counties was related to female, youth, fear during earthquake and low social support.
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Affiliation(s)
- Jiuping Xu
- Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu 610064, PR China.
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Spillane NS, Smith GT. Individual differences in problem drinking among tribal members from one first nation community. Alcohol Clin Exp Res 2011; 34:1985-92. [PMID: 20659067 DOI: 10.1111/j.1530-0277.2010.01288.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health disparities related to drinking in native communities are of concern. Although individuals living in native communities have high rates of problem drinking, there is also variability in their drinking levels. The authors conducted a test of a model of First Nation drinking risk that incorporates personality and psychosocial learning to examine its cross-cultural applicability. That model identifies a risk process thought to explain aspects of individual differences in both native problem drinking and non-native problem drinking. One implication of the theory is that positive alcohol expectancies mediate the influence of negative urgency (the tendency to act rashly when distressed) on problem drinking similarly for both cultures. METHODS We administered questionnaires to a total of 211 First Nation people and 236 Caucasians. RESULTS A structural modeling analysis of 211 First Nation people and 236 Caucasian people found that (i) personality, alcohol expectancy, and problem drinking measures were invariant across the 2 cultures and (ii) results consistent with the hypothesis that positive alcohol expectancies mediated the influence of negative urgency on problem drinking were also invariant across culture. CONCLUSIONS The findings support the theory that personality traits and psychosocial learning are important determinants of problem drinking in First Nation people and Caucasians.
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Affiliation(s)
- Nichea S Spillane
- Department of Community Health, Center for Alcohol and Addiction Studies, Brown University, Box G-S-121-4, Providence, RI, USA.
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Villa VM, Harada ND, Huynh-Hohnbaum ALT. Health and Ambulatory Care Use Among Native American Veterans. Home Health Care Serv Q 2010; 29:195-215. [DOI: 10.1080/01621424.2010.535414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stephens KA, Sue S, Roy-Byrne P, Unützer J, Wang J, Rivara FP, Jurkovich GJ, Zatzick DF. Ethnoracial variations in acute PTSD symptoms among hospitalized survivors of traumatic injury. J Trauma Stress 2010; 23:384-92. [PMID: 20564368 PMCID: PMC3947745 DOI: 10.1002/jts.20534] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ethnoracial minority status contributes to an increased risk for posttraumatic stress disorder (PTSD) after trauma exposure, beyond other risk factors. A population-based sampling frame was used to examine the associations between ethnoracial groups and early PTSD symptoms while adjusting for relevant clinical and demographic characteristics. Acutely injured trauma center inpatients (N = 623) were screened with the PTSD Checklist. American Indian and African American patients reported the highest levels of posttraumatic stress and preinjury cumulative trauma burden. African American heritage was independently associated with an increased risk of higher acute PTSD symptom levels. Disparities in trauma history, PTSD symptoms, and event related factors emphasize the need for acute care services to incorporate culturally competent approaches for treating these diverse populations.
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Affiliation(s)
- Kari A Stephens
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
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Kun P, Han S, Chen X, Yao L. Prevalence and risk factors for posttraumatic stress disorder: a cross-sectional study among survivors of the Wenchuan 2008 earthquake in China. Depress Anxiety 2010; 26:1134-40. [PMID: 19842170 DOI: 10.1002/da.20612] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The impact of the May 2008 Wenchuan earthquake, measuring a massive 8.0 on the surface wave magnitude scale, on public health in China has been significant and multifaceted. In light of extant data on prevalence and risk factors for posttraumatic stress disorder (PTSD) after other natural diasters, we collected data from the Wenchuan earthquake survivors to estimate the prevalence of PTSD and to characterize a range of PTSD risk factors. METHODS A cross-sectional multicluster sample survey of 446 respondents (201 from the Qiang ethnic-minority group, 245 the majority Han Chinese group) was conducted in August 2008 in Beichuan county, Sichuan province, a region that was severely affected by the earthquake. In total, 240 households were represented, with a mean of 2.2 respondents per household. Data were collected from structured interviews and the Harvard Trauma Questionnaire (HTQ) and DSM-IV criteria were used to diagnose PTSD. RESULTS The prevalence of PTSD was 45.5% (203/446). Low household income, being from an ethnic minority, living in a shelter or temporary house, death in family, and household damage were factors significantly related to increased odds of PTSD. CONCLUSIONS PTSD is common after a major disaster. Postdisaster mental health recovery programs that include early identification, ongoing monitoring, preventive and intervention programs, and sustained psychosocial support are needed for the highest-risk population, namely, the bereaved, people without incomes and those with serious household damage. These populations may also benefit from governmental and nongovernmental programs that provide social and economic support, as suggested by earlier studies.
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Affiliation(s)
- Peng Kun
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
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Whitesell NR, Beals J, Mitchell CM, Manson SM, Turner RJ. Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation. J Stud Alcohol Drugs 2010; 70:971-81. [PMID: 19895776 DOI: 10.15288/jsad.2009.70.971] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure. METHOD The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project provided data from 2,927 American Indians on the occurrence and age at onset of adversities, substance use, and substance-use-disorder symptoms. RESULTS The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder. CONCLUSIONS Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter.
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Affiliation(s)
- Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
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Laudenslager ML, Noonan C, Jacobsen C, Goldberg J, Buchwald D, Bremner JD, Vaccarino V, Manson SM. Salivary cortisol among American Indians with and without posttraumatic stress disorder (PTSD): gender and alcohol influences. Brain Behav Immun 2009; 23:658-62. [PMID: 19146946 PMCID: PMC2711684 DOI: 10.1016/j.bbi.2008.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 12/15/2008] [Accepted: 12/16/2008] [Indexed: 12/31/2022] Open
Abstract
Disruptions in hypothalamic-pituitary-adrenal regulation and immunity have been associated with posttraumatic stress disorder (PTSD). We examined the association of PTSD with diurnal rhythms in salivary cortisol in a convenience sample from a population-based study of male and female American Indians. Subjects with and without PTSD were identified from American Indians living on/near a Northern Plains reservation as part of a larger study. Over two days diurnal saliva samples were collected by staff at the University of Colorado Denver Clinical Research Center at waking, 30min after waking, before lunch, and before dinner. Generalized estimating equations linear regression models investigated the influence of PTSD on cortisol over time. The association of a lifetime diagnosis of PTSD with salivary cortisol level was assessed in subjects with complete data (PTSD: n=27; no PTSD n=32) for age, gender, and alcohol consumption in the past month. Subject mean age was 44 years, and 71% were women. When stratified by gender, women with a lifetime diagnosis of PTSD had significantly higher mean cortisol levels throughout the day than women without PTSD (p=0.01); but there was no significant association between PTSD and cortisol levels in men (p=0.36). The cortisol awakening response - the difference in cortisol levels from waking to 30min after waking - was not associated with PTSD in men or women. A lifetime diagnosis of PTSD may influence diurnal cortisol among American Indian women. These effects were independent of influences of current alcohol use/abuse. The unexpected elevation in cortisol in American Indian women with a lifetime diagnosis of PTSD may reflect acute anxiety associated with experiencing a number of novel tests in a strange location (e.g., cardiac imaging, medical, dental exams, etc.), or concurrent depression.
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Affiliation(s)
- Mark L. Laudenslager
- University of Colorado Denver School of Medicine, Department of Psychiatry, Denver, CO
| | - Carolyn Noonan
- University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, WA
| | - Clemma Jacobsen
- University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, WA
| | - Jack Goldberg
- University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, WA
| | - Dedra Buchwald
- University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, WA
| | - J. Douglas Bremner
- Emory University School of Medicine, Department of Psychiatry, Atlanta, GA
| | - Viola Vaccarino
- Emory University School of Medicine, Department of Medicine, Atlanta, GA
| | - Spero M. Manson
- University of Colorado Denver School of Medicine, Department of Psychiatry, Denver, CO
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Beals J, Belcourt-Dittloff A, Freedenthal S, Kaufman C, Mitchell C, Whitesell N, Albright K, Beauvais F, Belcourt G, Duran B, Fleming C, Floersch N, Foley K, Jervis L, Kipp BJ, Mail P, Manson S, May P, Mohatt G, Morse B, Novins D, O'Connell J, Parker T, Quintero G, Spicer P, Stiffman A, Stone J, Trimble J, Venner K, Walters K. Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: comment on Spillane and Smith (2007). Psychol Bull 2009; 135:339-43; discussion 344-6. [PMID: 19254084 DOI: 10.1037/a0014819] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In their recent article, N. Spillane and G. Smith suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.
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Affiliation(s)
- Janette Beals
- American Indian and Alaska Native Programs, University of Colorado, Denver, Aurora, CO 80045 USA.
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Kramer BJ, Jouldjian S, Washington DL, Harker JO, Saliba D, Yano EM. Health Care for American Indian and Alaska Native Women. Womens Health Issues 2009; 19:135-43. [DOI: 10.1016/j.whi.2008.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/13/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022]
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Lee CS, Chang JC, Liu CY, Chang CJ, Chen THH, Chen CH, Cheng ATA. Acculturation, psychiatric comorbidity and posttraumatic stress disorder in a Taiwanese aboriginal population. Soc Psychiatry Psychiatr Epidemiol 2009; 44:55-62. [PMID: 18622537 DOI: 10.1007/s00127-008-0405-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/13/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigates acculturation and other antecedent psychiatric and socio-environmental risk factors for posttraumatic stress disorder (PTSD) in one aboriginal group (the Bunun) exposed to an earthquake disaster in Taiwan. METHOD Respondents (n = 196) were assessed 5 months after the disaster, using a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry and the Taiwan Aboriginal Acculturation Scale. RESULT Four risk factors exerted independent effect on the risk of PTSD, including magnitude of the earthquake, subsequent traumas, antecedent major depressive disorder and acculturation status. CONCLUSION Public mental health programs need to consider the liability to PTSD in populations with different ethnicity and socio-cultural environments.
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Affiliation(s)
- Chau-Shoun Lee
- Department of Psychiatry, Lo-Tung Poh-Ai Hospital, Yilan, Taiwan
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Grubaugh AL, Slagle DM, Long M, Frueh BC, Magruder KM. Racial Disparities In Trauma Exposure, Psychiatric Symptoms, and Service Use Among Female Patients In Veterans Affairs Primary Care Clinics. Womens Health Issues 2008; 18:433-41. [PMID: 19041595 DOI: 10.1016/j.whi.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Anouk L Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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O'Malley SS, Robin RW, Levenson AL, GreyWolf I, Chance LE, Hodgkinson CA, Romano D, Robinson J, Meandzija B, Stillner V, Wu R, Goldman D. Naltrexone alone and with sertraline for the treatment of alcohol dependence in Alaska natives and non-natives residing in rural settings: a randomized controlled trial. Alcohol Clin Exp Res 2008; 32:1271-83. [PMID: 18482155 PMCID: PMC2746027 DOI: 10.1111/j.1530-0277.2008.00682.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the mu-opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians. METHODS Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence. RESULTS Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking-related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response. CONCLUSIONS Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.
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Affiliation(s)
- Stephanie S O'Malley
- Yale University School of Medicine, Connecticut Mental Health Center, S202, 34 Park Street, New Haven, CT 06519, USA.
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