1
|
Edwards KM, Waterman EA, Wheeler LA, Herrington R, Mullet N, Xu W, Hopfauf S, Charge LL, Trujillo P. Preventing Adverse Childhood Experiences in a Sample of Largely Indigenous Children. Pediatrics 2024; 154:e2023065412. [PMID: 39136077 DOI: 10.1542/peds.2023-065412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 09/02/2024] Open
Abstract
OBJECTIVES The purpose of this study was to develop, pilot, and evaluate a culturally grounded, family-based program to prevent adverse childhood experiences (ACEs) among low-income and Indigenous children aged 10 to 14. The Tiwahe Wicagwicayapi program (TWP) is a 7-session program that teaches skills to prevent ACEs and is rooted in Lakota culture, language, and history. METHODS A total of 124 families (124 caregivers [96% Indigenous; 90% reported yearly income <$40 000] with 194 children aged 10 to 14 [93% Indigenous]) were randomly assigned to treatment (N = 66 families and 173 individuals) or waitlist (N = 58 families and 145 individuals) control groups. Caregivers and children completed a baseline, immediate posttest, and 6-month follow-up survey. RESULTS Treatment effects were detected, indicating, compared with control participants, reductions in the incidence of child ACEs (incidence rate ratio [IRR] = 0.64), bullying victimization (odds ratio = 0.53), depression (d = -0.20), and externalizing behaviors (d = -0.23) and increased parent-child communication (g = 0.27) and child help-seeking behaviors (d = 0.28). For caregivers, the effects indicated that the program prevented intimate partner violence victimization (IRR = 0.36) and perpetration (IRR = 0.45), harsh parenting (g = -0.35), and depression (d = -0.24) and increased emotion regulation (d = 0.37), social support (d = 0.33), and cultural connection (d = 0.34). CONCLUSIONS The TWP holds great promise in preventing ACEs among low-income, Indigenous children, showing potential promise for widespread public health impact. Future rigorous research on the TWP is warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - Weiman Xu
- University of Nebraska, Lincoln, Lincoln, Nebraska
| | | | | | | |
Collapse
|
2
|
Archuleta S, Allison-Burbank JD, Ingalls A, Begay R, Begaye V, Howe L, Tsosie A, Keryte AP, Haroz EE. Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation During COVID-19. THE JOURNAL OF SCHOOL HEALTH 2024; 94:808-819. [PMID: 38936839 PMCID: PMC11323252 DOI: 10.1111/josh.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID-19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed-methods approach, integrating community-based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation-based schools. We conducted an analysis of caregiver self-report baseline data collected between August 2021 and May 2022. RESULTS A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non-Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in-person, hybrid, and online-only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self-efficacy. CONCLUSIONS This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts.
Collapse
Affiliation(s)
- Shannon Archuleta
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joshuaa D Allison-Burbank
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison Ingalls
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Renae Begay
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Vanessa Begaye
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lacey Howe
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alicia Tsosie
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Angelina Phoebe Keryte
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Emily E Haroz
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
3
|
Waterman EA, Edwards KM, Mullet N, Herrington R, Hopfauf S, Trujllo P, Even-Aberle N, Wheeler L. Rates of Recent Adverse Childhood Experiences Among Indigenous Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:295-305. [PMID: 38938960 PMCID: PMC11199426 DOI: 10.1007/s40653-023-00587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 06/29/2024]
Abstract
The current paper describes rates of recent (past six months) adverse childhood experiences (ACEs) and examines the association of ACEs with cultural connection and depressive symptoms among Indigenous children aged 10 to 14 (N = 177; mean age = 11.8; 48.3% boys; 44.3% girls; 7.4% another gender identity). Children completed baseline surveys as part of a larger evaluation of a culturally grounded, strengths-focused, family-based program to prevent ACEs. Surveys included an inclusive measure of ACEs developed for the current study, an adapted measure of connection to culture, and the Children's Depression Screener. Results for ACEs indicated that 18.6% of Indigenous children reported none, 37.2% reported one to three, and 44.2% reported four or more in the past six months. Importantly, children who reported no ACEs reported greater cultural connection than children who reported one to three ACEs. Depressive symptoms were higher among children who reported one to three and four or more ACEs compared to children who reported no ACEs.
Collapse
Affiliation(s)
| | - Katie M. Edwards
- University of Nebraska-Lincoln, 1400 R. St, Lincoln, NE 68588 USA
| | - Natira Mullet
- North Dakota State University, 1340 Administration Ave, Fargo, ND 58105 USA
| | | | - Skyler Hopfauf
- University of Nebraska-Lincoln, 1400 R. St, Lincoln, NE 68588 USA
| | | | | | - Lorey Wheeler
- University of Nebraska-Lincoln, 1400 R. St, Lincoln, NE 68588 USA
| |
Collapse
|
4
|
Reynolds A, Paige KJ, Colder CR, Mushquash CJ, Wendt DC, Burack JA, O'Connor RM. Negative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects. Res Child Adolesc Psychopathol 2024; 52:865-876. [PMID: 38407776 PMCID: PMC11108953 DOI: 10.1007/s10802-024-01173-1] [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] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Abstract
Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth (N = 117; 50% male; Mage=12.46-16.28; grades 6-10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.
Collapse
Affiliation(s)
- Ashley Reynolds
- Department of Psychology, Concordia University, Montreal, QC, Canada.
| | - Katie J Paige
- Department of Psychology, University of Buffalo, Buffalo, NY, USA
| | - Craig R Colder
- Department of Psychology, University of Buffalo, Buffalo, NY, USA
| | - Christopher J Mushquash
- Department of Psychology, Lakehead University, Ontario, Canada
- Thunder Bay Regional Health Sciences Centre, Ontario, Canada
- Thunder Bay Regional Health Research Institute, Ontario, Canada
- Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Thunder Bay, Ontorio, Canada
| | - Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Jacob A Burack
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada.
| |
Collapse
|
5
|
Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
Collapse
Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
6
|
Withdrawal: Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19. THE JOURNAL OF SCHOOL HEALTH 2024; 94:481. [PMID: 38225814 PMCID: PMC10987271 DOI: 10.1111/josh.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024]
Abstract
Withdrawal: 'Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19' by Shannon Archuleta MPH, Joshuaa D. Allison-Burbank PhD, Allison Ingalls MPH, Renae Begay MPH, Ryan Grass BS, Francene Larzelere PhD, Vanessa Begaye BS, Lacey Howe BS, Alicia Tsosie BS, Angelina Phoebe Keryte BA, Emily E. Haroz PhD, J Sch Health 2024, 10.1111/josh.13419. The above article, published online on 15 January 2024 in Wiley Online Library (https://onlinelibrary.wiley.com/doi/full/10.1111/josh.13419) has been withdrawn by agreement between the authors, the journal's Editor in Chief, Michael W. Long, the American School Health Association and Wiley Periodicals LLC. The withdrawal has been agreed because consent for publication from one of the tribes participating in the study was pending at the time of publication.
Collapse
|
7
|
Abufarsakh B, Okoli CTC, Darville AK, Williams LB, Garcia AR, Martin C. Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis. Addict Behav 2024; 152:107948. [PMID: 38277993 DOI: 10.1016/j.addbeh.2023.107948] [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] [Received: 08/30/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Tobacco use remains one of the most used substances among adults globally and substantially impacts individuals and society. Adverse childhood experiences (ACEs) contribute to tobacco use. However, the association between cumulative ACEs and tobacco use behaviors (TUB) has not been established in the literature. In this review, we aimed to estimate the prevalence of ACEs among adult tobacco users and evaluated the relationship between cumulative ACEs and TUB. METHODS We identified original articles published before October 2022 by searching PubMed, CINAHL, and Psych INFO databases. Inclusion criteria were: English language, adults and used instruments assessing for cumulative ACEs defined as four or more ACEs. RESULTS Forty-two studies, totaling 674,087 participants; predominantly cohort and cross-sectional in study design (n = 33). Exposure to 4 ≥ ACEs was significantly associated with increasing the odds of current tobacco use (n = 35), ever or former tobacco use (n = 13), tobacco use initiation, (n = 3) nicotine dependence (n = 1), and ever using electronic cigarettes (n = 1). In the meta-analysis, as compared to those without ACEs, those with 4 ≥ ACEs were twice as likely to have ever used tobacco (OR = 2.16, 95 %CI:1.73-2.70) and approximately four times more likely to have used tobacco currently (OR = 3.73, 95 %CI:2.69-5.18). CONCLUSION The cumulative ACEs exposure can increase the risk for TUB. However, the evidence is limited primarily to cigarette use. Ongoing research into the effects of cumulative ACEs on TUB is needed to integrate trauma-informed intervention in treating tobacco use and guide public health initiatives aimed to reduce the prevalence of ACEs and TUB among adults.
Collapse
Affiliation(s)
| | | | - Audrey K Darville
- University of Kentucky College of Nursing, Lexington, KY 40536, USA.
| | | | - Antonio R Garcia
- University of Kentucky College of Social Work, Lexington, KY 40508, USA.
| | - Catherine Martin
- University of Kentucky Health Care Good Samaritan Hospital, Lexington, KY 40508, USA.
| |
Collapse
|
8
|
Herman KA, Hautala DS, Aulandez KMW, Walls ML. The resounding influence of benevolent childhood experiences. Transcult Psychiatry 2024:13634615231192006. [PMID: 38419503 DOI: 10.1177/13634615231192006] [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] [Indexed: 03/02/2024]
Abstract
Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.
Collapse
Affiliation(s)
- Kaley A Herman
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Dane S Hautala
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Kevalin M W Aulandez
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Melissa L Walls
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| |
Collapse
|
9
|
Muñoz AC, Rojano ÁEV, Caballero AR, Solé EP, Álvarez MG. Reprint of: Associations between mental health problems and Adverse Childhood Experiences ACEs in indigenous and non-indigenous Mexican adolescents. CHILD ABUSE & NEGLECT 2024; 148:106639. [PMID: 38242770 DOI: 10.1016/j.chiabu.2024.106639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have long-term consequences. The ACEs model has been extensively used in high-income countries. However, its effectiveness has yet to be demonstrated in low and middle-income countries and marginalized social groups. In indigenous populations, research has found inconsistent results in the prevalence and the relationship between ACEs and mental health outcomes. Therefore, the objectives of this study were 1) to determine the ACEs frequency among indigenous and non-indigenous Mexican adolescents; 2) to test the association between ACE scores and symptoms of Mental Health Problems (SMHP) in both groups; and 3) to review the ACEs model adequacy for the indigenous adolescents. PARTICIPANTS AND SETTINGS Data from an online survey in 20 of the 32 states of Mexico were analyzed. We selected an 87 adolescent sample from indigenous families and 174 non-indigenous matched for age, sex, and state of residence, with a mean age of 16 years; 60 % were women. METHODS ACE-IQ questionnaire and Youth Self Report instrument (eight SMHP) were used to collect data. ACEs' frequency was analyzed for each group, and Pearson correlations were used to identify the relationship between ACEs and SMHP. RESULTS There was no statistical significance between Indigenous and non-Indigenous adolescents in the ACEs report. ACE scores were associated with eight SMHP. Correlations between ACE score and SMHP were higher in non-indigenous adolescents. CONCLUSIONS ACEs were experienced similarly by both groups and were associated with mental health in all participants. Further research is needed to improve ACEs measurement in indigenous populations.
Collapse
Affiliation(s)
- Abigail Casas Muñoz
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Ángel Eduardo Velasco Rojano
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Aarón Rodríguez Caballero
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Eva Prado Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, Mexico
| | | |
Collapse
|
10
|
Schultz K, Taylor E, McKinney S, Hamby S. Exploring strengths, psychological functioning and youth victimization among American Indians and Alaska Natives in four southern states. CHILD ABUSE & NEGLECT 2024; 148:106197. [PMID: 37208233 DOI: 10.1016/j.chiabu.2023.106197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Identifying factors that support healthy psychological functioning after experiencing violence or other adversities in youth can lead to better prevention and intervention efforts. This is particularly important among communities with disproportionately high rates of adversity resulting from legacies of social and political injustices, such as American Indian and Alaska Native populations. METHODS Data were pooled from four studies in the southern U.S. to examine a subsample of American Indian/Alaska Native participants (N = 147; mean age 28.54 years, SD = 16.3). Using the resilience portfolio model, we investigate the impact of three categories of psychosocial strengths (regulatory, meaning making, and interpersonal) on psychological functioning (subjective well-being and trauma symptoms), controlling for youth victimization, lifetime adversities, age, and gender. RESULTS In examining subjective well-being, the full model accounted for 52 % of the variance, with strengths explaining more variance than adversities (45 % vs 6 %). For trauma symptoms, the full model accounted for 28 % of the variance, with strengths and adversities accounting nearly equally for the variance (14 % and 13 %). DISCUSSION Psychological endurance and sense of purpose showed the most promise for bolstering subjective well-being while poly-strengths (having a diversity of multiple strengths) was most predictive of fewer trauma symptoms. Building psychosocial strengths offers promising strategies for prevention and intervention in Native nations and communities.
Collapse
Affiliation(s)
- Katie Schultz
- University of Michigan School of Social Work, 1080 S University Ave, Ann Arbor, MI 48109, USA,.
| | - Elizabeth Taylor
- Life Paths Research Center, Oakland University, 654 Pioneer Drive, Pryale Hall, Rochester, MI 48309, USA.
| | - Sherise McKinney
- University of Michigan School of Social Work, 1080 S University Ave, Ann Arbor, MI 48109, USA.
| | - Sherry Hamby
- Life Paths Research Center, University of the South, PO Box 187, Sewanee, TN 37375, USA.
| |
Collapse
|
11
|
Muñoz AC, Rojano ÁEV, Caballero AR, Solé EP, Álvarez MG. Associations between mental health problems and Adverse Childhood Experiences ACEs in indigenous and non-indigenous Mexican adolescents. CHILD ABUSE & NEGLECT 2024; 147:106595. [PMID: 38061280 DOI: 10.1016/j.chiabu.2023.106595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have long-term consequences. The ACEs model has been extensively used in high-income countries. However, its effectiveness has yet to be demonstrated in low and middle-income countries and marginalized social groups. In indigenous populations, research has found inconsistent results in the prevalence and the relationship between ACEs and mental health outcomes. Therefore, the objectives of this study were 1) to determine the ACEs frequency among indigenous and non-indigenous Mexican adolescents; 2) to test the association between ACE scores and symptoms of Mental Health Problems (SMHP) in both groups; and 3) to review the ACEs model adequacy for the indigenous adolescents. PARTICIPANTS AND SETTINGS Data from an online survey in 20 of the 32 states of Mexico were analyzed. We selected an 87 adolescent sample from indigenous families and 174 non-indigenous matched for age, sex, and state of residence, with a mean age of 16 years; 60 % were women. METHODS ACE-IQ questionnaire and Youth Self Report instrument (eight SMHP) were used to collect data. ACEs' frequency was analyzed for each group, and Pearson correlations were used to identify the relationship between ACEs and SMHP. RESULTS There was no statistical significance between Indigenous and non-Indigenous adolescents in the ACEs report. ACE scores were associated with eight SMHP. Correlations between ACE score and SMHP were higher in non-indigenous adolescents. CONCLUSIONS ACEs were experienced similarly by both groups and were associated with mental health in all participants. Further research is needed to improve ACEs measurement in indigenous populations.
Collapse
Affiliation(s)
- Abigail Casas Muñoz
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Ángel Eduardo Velasco Rojano
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Aarón Rodríguez Caballero
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Eva Prado Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, Mexico
| | | |
Collapse
|
12
|
Schmidt L, Kanichy M, Njau G, Schmidt M, Stepanov A, Anderson R, Stiffarm A, Williams A. Adverse Childhood Experiences, Interpersonal Violence, and Racial Disparities in Early Prenatal Care in North Dakota (ND PRAMS 2017-2019). JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:237-262. [PMID: 37644756 DOI: 10.1177/08862605231195802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
In North Dakota (ND), American Indian women are more likely to be exposed to adverse childhood experiences (ACEs) and interpersonal violence, and receive late prenatal care (PNC) compared to other racial groups. In a sample of 1,849 (weighted n = 26,348) women from the 2017 to 2019 North Dakota Pregnancy Risk Assessment Monitoring System, we performed a series of logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for AI and Other Racial Identity women compared to White women regarding risk of late PNC (initiated after week 13) and dissatisfaction of PNC timing. Models were adjusted for interpersonal violence (from husband/partner, family member, someone outside of family, ex-husband/partner, or any) to determine if violence accounts for racial/ethnic disparities in PNC. AI women experienced two-fold higher risk of late PNC (OR: 2.25, 95% CI: 1.55, 3.26) and dissatisfaction of PNC timing (OR: 2.34, 95% CI: 1.61, 3.40) than White women. In the analyses for the association between joint ACEs (Higher: ≥4; Lower: <4)/Race and PNC outcomes, odds of late PNC were two-fold among AI women with Higher ACEs (OR: 2.35, 95% CI: 1.41, 3.94) and Lower ACEs (OR: 2.73, 95% CI: 1.69, 4.41), compared to White women with Lower ACEs. Results were similar for dissatisfaction of PNC timing. Accounting for violence did not significantly change odds ratios in any analyses. Thus, interpersonal violence surrounding pregnancy does not explain racial disparities in PNC in ND. To understand disparities in PNC among AI women, risk factors like historic trauma and systemic oppression should be examined.
Collapse
Affiliation(s)
| | | | - Grace Njau
- North Dakota Department of Health & Human Services, Bismarck, ND, USA
| | - Matthew Schmidt
- North Dakota Department of Health & Human Services, Bismarck, ND, USA
| | | | | | - Amy Stiffarm
- University of North Dakota, Grand Forks, ND, USA
| | | |
Collapse
|
13
|
Yu P, Jiang Z, Zheng C, Zeng P, Huang L, Jin Y, Wang K. Variety ACEs and risk of developing anxiety, depression, or anxiety-depression co-morbidity: the 2006-2022 UK Biobank data. Front Psychiatry 2023; 14:1233981. [PMID: 38234367 PMCID: PMC10793109 DOI: 10.3389/fpsyt.2023.1233981] [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: 06/03/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives Adverse childhood experiences (ACEs) and anxiety-depression co-morbidity are attracting widespread attention. Previous studies have shown the relationship between individual psychiatric disorders and ACEs. This study will analyze the correlation between anxiety-depression co-morbidity and different levels of ACEs. Methods Seven categories of ACE and four classifications of psychiatric disorders were defined in a sample of 126,064 participants identified by the UK Biobank from 2006-2022, and correlations were investigated using logistic regression models. Then, to explore nonlinear relationships, restricted spline models were developed to examine differences in sex and age across cohorts (n = 126,064 for the full cohort and n = 121,934 for the European cohort). Finally, the impact of the category of ACEs on psychiatric disorders was examined. Results After controlling for confounders, ACEs scores showed dose-dependent relationships with depression, anxiety, anxiety-depression co-morbidity, and at least one (any of the first three outcomes) in all models. ACEs with different scores were significantly positively correlated with the four psychiatric disorders classifications, with the highest odds of anxiety-depression co-morbidity (odds ratio [OR] = 4.87, 95% confidence intervals [CI]: 4.37 ~ 5.43), p = 6.08 × 10-178. In the restricted cubic spline models, the risk was relatively flat for females at ACEs = 0-1 and males at ACEs = 0-2/3 (except in males, where ACEs were associated with a lower risk of anxiety, all other psychiatric disorders had an increased risk of morbidity after risk smoothing). In addition, the risk of having anxiety, depression, anxiety-depression co-morbidity, and at least one of these disorders varies with each category of ACEs. Conclusion The prevalence of anxiety-depression comorbidity was highest across ACE scores after controlling for confounding factors and had a significant effect on each category of ACEs.
Collapse
Affiliation(s)
- Peilin Yu
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhou Jiang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chu Zheng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Lab of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ping Zeng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Lab of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lihong Huang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingliang Jin
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Lab of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ke Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Lab of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
14
|
John-Henderson NA, Ginty AT. Profiles of historical loss and childhood trauma as predictors of mental and cardiometabolic health in American Indian adults. SSM - MENTAL HEALTH 2023; 4:100252. [PMID: 38188870 PMCID: PMC10769154 DOI: 10.1016/j.ssmmh.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Cardiometabolic disease and mental health conditions are two major contributors to persistent inequities in health and life expectancy for American Indian adults. The atrocities associated with European colonization are linked to intergenerational psychological and emotional wounding (i.e., historical trauma) and high incidence of childhood trauma. Prior work has examined the independent relationships of childhood trauma and thoughts about historical loss with cardiometabolic and mental health in American Indians. In the current work, we used a data-driven approach to identify profiles of childhood trauma and frequency of thoughts about historical loss, and then examined how these profiles related to cardiometabolic and mental health in a sample of American Indian adults from across the United States (N = 727). We found that a profile characterized by high levels of childhood trauma and high frequency of thoughts about historical losses was associated with the greatest risk for mental health conditions. The profile characterized by the highest levels of childhood trauma and by moderate frequency of thoughts about historical losses was associated with the largest risk of cardiometabolic conditions. The findings represent an important first step towards understanding how childhood trauma and thoughts about historical loss may simultaneously inform enduring inequities in American Indian health.
Collapse
Affiliation(s)
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Falkenstein DK, Jarvis JN. Systemic lupus erythematosus in American Indian/Alaska natives: Incorporating our new understanding of the biology of trauma. Semin Arthritis Rheum 2023; 63:152245. [PMID: 37595507 DOI: 10.1016/j.semarthrit.2023.152245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To review the literature regarding systemic lupus erythematosus (SLE) in American Indian/Alaska Native (AI/AN) people and relate prevalence and/or disease severity to our emerging understanding of the biology of trauma and toxic stress. METHODS We conducted a search and review of the literature using search terms "lupus and American Indians" "ACEs and disease outcome" "Biology of Adversity" "lupus and ACE scores," " lupus and childhood abuse." These search criteria were entered into Google Scholar and articles retrieved from PubMed, NBCI. This approach yielded a small numbers of papers used throughout this review. We excluded articles that were not published in a peer reviewed journals, as well as editorial commentaries. RESULTS In the AI/AN population, SLE shows high prevalence rates and severe disease manifestations, comparable to the African American population. AI/AN populations also have high rates of childhood trauma. Toxic stress and trauma such as those catalogued in the Adverse Childhood Experiences (ACE) study have broad-reaching immunologic and epigenetic effects that are likely to be relevant to our understanding of SLE in AI/AN people. CONCLUSIONS AI/AN people have high rates of SLE. These high rates are likely to be driven by many complex factors, not all of which are genetic. Future research is needed to establish (or refute) a causal connection between the biology of adversity and SLE in socially marginalized and historically traumatized populations.
Collapse
Affiliation(s)
- Danielle K Falkenstein
- Medical Student, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
| | - James N Jarvis
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA; Genetics, Genomics, & Bioinformatics Program, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA.
| |
Collapse
|
17
|
Spillane NS, Schick MR, Kirk-Provencher KT, Nalven T, Goldstein SC, Crawford MC, Weiss NH. Trauma and Substance Use among Indigenous Peoples of the United States and Canada: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3297-3312. [PMID: 36197078 DOI: 10.1177/15248380221126184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Substance use has been identified by Indigenous populations as contributing to health disparities facing their communities. Rates of trauma exposure and post-traumatic stress disorder are higher in Indigenous, compared to non-Indigenous, populations and have been linked to substance use. Historical trauma is thought to be one mechanism underlying substance use and related disorders. The purpose of the present study is to summarize the current state of the literature focusing on the association between trauma (historical and lived) and substance use among Indigenous populations in the United States and Canada. Databases were systematically searched using the preferred reporting items for systematic reviews and meta-analyses statement. The search strategy initially yielded 4,026 articles. After exclusion of ineligible articles, 63 articles remained for synthesis. Results of the present review provide evidence for a positive link between substance use and both historical trauma (i.e., 86.4% of studies) and lived trauma (i.e., 84.7% of studies). Indigenous participants reported that historical trauma and pain related to loss of cultural identity contributed to substance use in their communities. Indigenous participants also consistently described an association between lived trauma and substance use. Despite heterogeneity among Indigenous communities, findings suggest a significant association between trauma and substance use across many different tribes and settings (e.g., reservation/reserve, rural/urban). Indigenous participants identified healing from trauma and reconnecting with culture as necessary components for reducing substance use and maintaining sobriety. With this, the development and implementation of interventions should partner with Indigenous communities in a manner that promotes and enhances cultural values for healing.
Collapse
Affiliation(s)
| | - Melissa R Schick
- University of Rhode Island, Kingston, USA
- Yale School of Medicine, New Haven CT, USA
| | - Katelyn T Kirk-Provencher
- University of Rhode Island, Kingston, USA
- University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | | | | | | |
Collapse
|
18
|
Angelino AC, Burns J, Deen JF, Empey A. Late, Again: Moving Beyond ACEs in American Indian Communities. Pediatrics 2023; 152:e2023062207. [PMID: 37855053 DOI: 10.1542/peds.2023-062207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Alessandra C Angelino
- Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Burns
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Jason F Deen
- Department of Pediatrics, University of Washington, Seattle, Washington (Blackfeet)
| | - Allison Empey
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon, (Confederated Tribes of Grand Ronde)
| |
Collapse
|
19
|
Angelino AC, Burns J, LaForme C, Giroux R. Missing and murdered Indigenous women, girls, and Two Spirit people: a paediatric health crisis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:741-746. [PMID: 37451299 DOI: 10.1016/s2352-4642(23)00135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 07/18/2023]
Abstract
Indigenous children and adolescents across the USA and Canada experience increased emotional, physical, and sexual violence resulting from the longstanding effects of colonialism and historical trauma. There is a substantial lack of research exploring these issues and scarce efforts outside of Indigenous communities to support victims. However, the association between exposure to violence and abuse and adverse health outcomes among Indigenous children and adolescents is clear. In this Viewpoint, we explore this association, discuss historical context, highlight important work by governments and community organisations, and suggest actions for paediatricians and paediatric health-care providers.
Collapse
Affiliation(s)
- Alessandra C Angelino
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Joseph Burns
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Cheyenne LaForme
- Department of Pediatrics, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Ryan Giroux
- Department of Pediatrics, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Edwards KM, Waterman EA, Mullet N, Herrington R, Cornelius S, Hopfauf S, Trujillo P, Wheeler LA, Deusch AR. Indigenous Cultural Identity Protects Against Intergenerational Transmission of ACEs Among Indigenous Caregivers and Their Children. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01795-z. [PMID: 37697145 DOI: 10.1007/s40615-023-01795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Arielle R Deusch
- Avera Research Institute, Sioux Falls, USA
- University of South Dakota, Vermillion, USA
| |
Collapse
|
21
|
Meldrum K, Andersson E, Webb T, Quigley R, Strivens E, Russell S. Screening depression and anxiety in Indigenous peoples: A global scoping review. Transcult Psychiatry 2023:13634615231187257. [PMID: 37490720 DOI: 10.1177/13634615231187257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Indigenous peoples' worldviews are intricately interconnected and interrelated with their communities and the environments in which they live. Their worldviews also manifest in a holistic view of health and well-being, which contrasts with those of the dominant western biomedical model. However, screening depression and/or anxiety in Indigenous peoples often occurs using standard western tools. Understandably, the cultural appropriateness of these tools has been questioned. The purpose of this scoping review was to map the literature that used any type of tool to screen depression or anxiety in Indigenous adults globally. A systematic scoping review method was used to search databases including, but not limited to, CINAHL, PubMed, Scopus and Google. Database-specific search terms associated with Indigenous peoples, depression and anxiety, and screening tools were used to identify literature. In addition, citation searches of related systematic reviews and relevant websites were conducted. The data set was limited to English language publications since database inception. Fifty-four publications met the review's inclusion criteria. Most studies were completed in community settings using standard western depression and anxiety screening tools. Thirty-three different tools were identified, with the Patient Health Questionnaire-9 being the most frequently used. The review's findings are concerning given repeated calls for culturally appropriate screening tools to be used with Indigenous peoples. Although there has been some work to cross-culturally adapt depression screening tools for specific Indigenous populations, clearly more clinicians and researchers need to be aware of, and use, culturally appropriate approaches to screening.
Collapse
Affiliation(s)
| | | | | | | | - Edward Strivens
- James Cook University
- Queensland Health, Cairns and Hinterland Hospital and Health Service
| | | |
Collapse
|
22
|
Beymer MR, Apostolou A, Smith CM, Paschane DM, Gomez SAQ, James TD, Bell AM, Santo T, Quartana PJ. Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis. Mil Med 2023; 188:e2292-e2299. [PMID: 36848142 DOI: 10.1093/milmed/usad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. RESULTS A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. CONCLUSIONS Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.
Collapse
Affiliation(s)
- Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Colin M Smith
- U.S. Indian Health Service, Rockville, MD 20852, USA
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | - Theresa Santo
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | |
Collapse
|
23
|
Cross LM, Warren-Findlow J, Bowling J, Reeve CL, Issel LM. A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression. CHILD ABUSE & NEGLECT 2023; 140:106158. [PMID: 36996592 DOI: 10.1016/j.chiabu.2023.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.
Collapse
Affiliation(s)
- Lisa M Cross
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, 333 S Columbia St, Chapel Hill, NC 27516, United States of America.
| | - Jan Warren-Findlow
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Charlie L Reeve
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - L Michele Issel
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| |
Collapse
|
24
|
Schick MR, Hostetler KL, Kirk-Provencher KT, Spillane NS. Depressive symptoms, alcohol use, and alcohol-related consequences: the moderating role of gender among American Indian adolescents. J Ethn Subst Abuse 2023:1-17. [PMID: 37222686 PMCID: PMC10667562 DOI: 10.1080/15332640.2023.2216162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Depression, alcohol use, and alcohol-related consequences are experienced disproportionately by American Indian (AI) adolescents. The co-occurrence of depression and alcohol use is clinically relevant, as it is associated with increased risk for suicide, among other negative consequences. Understanding how the association between depressive symptoms and alcohol use and related consequences is influenced by gender is important to understand for whom intervention efforts might be particularly relevant. Thus, the present study seeks to evaluate gender differences in these associations among AI adolescents. METHODS Participants were a representative sample of AI adolescents (N = 3,498, Mage=14.76, 47.8% female) residing on or near reservations who completed self-report questionnaires in school classrooms. Study activities were approved by IRB, school boards, and tribal authorities. RESULTS The interaction of depressive symptoms and gender was significant in predicting past-year alcohol use frequency (b=.02, p=.02) and, among youth reporting lifetime alcohol use, alcohol-related consequences (b=.03, p=.001). Analysis of simple slopes revealed that, for females, depressive symptoms were significantly associated with past-year alcohol use frequency (b=.02, p<.001) and alcohol-related consequences (b=.05, p<.001). For males, depressive symptoms were only significantly associated with alcohol-related consequences (b=.02, p=.04), and this effect was weaker than for females. CONCLUSIONS Results of the present study may inform the development of gender-sensitive recommendations for the assessment and treatment of alcohol use and alcohol-related consequences among AI adolescents. For instance, results suggest that treatments focusing on depressive symptoms may subsequently reduce alcohol use and related consequences for female AI adolescents.
Collapse
Affiliation(s)
- Melissa R. Schick
- Divisision of Prevention and Community Research, Yale School of Medicine Department of Psychiatry, New Haven CT 06511
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
| | | | - Katelyn T. Kirk-Provencher
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora CO 80045
| | - Nichea S. Spillane
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
| |
Collapse
|
25
|
Herron JL, Venner KL. A Systematic Review of Trauma and Substance Use in American Indian and Alaska Native Individuals: Incorporating Cultural Considerations. J Racial Ethn Health Disparities 2023; 10:603-632. [PMID: 35089579 PMCID: PMC9329482 DOI: 10.1007/s40615-022-01250-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disproportionate rates of psychiatric disorders, like substance use and posttraumatic stress disorders (SUD and PTSD), exist among American Indian and Alaska Native (AI/AN) individuals. This review examines substance use and trauma in existing AI/AN literature and utilizes an AI/AN-specific model to culturally inform the relationship between these factors and provide recommendations for future research. METHODS We searched three databases through April 2021 for peer-reviewed articles that examined substance use and trauma in AI/AN individuals. RESULTS The search identified 289 articles and of those, 42 were eligible for inclusion, including 36 quantitative and 6 qualitative studies. Rates of lifetime trauma exposure varied from 21 to 98% and were correlated with increased rates of SUDs. A dose response of traumatic events also increased the likelihood of an SUD among reservation-based AI populations. Factors from the Indigenist Stress Coping model included cultural buffers such as traditional healing and cultural identity, which aided in recovery from SUD and trauma, and social stressors like boarding school attendance, discrimination, and historical loss. CONCLUSIONS SUD and trauma are highly correlated among AI/AN individuals though rates of PTSD are lower than might be expected suggesting resilience. However, this pattern may not be consistent across all AI/AN groups and further research is needed to better explain the existing relationship of SUD and PTSD and relevant historical and cultural factors. Further research is needed to culturally tailor, implement, and validate PTSD and SUD assessments and treatments to ameliorate these health inequities.
Collapse
Affiliation(s)
- Jalene L Herron
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA.
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Kamilla L Venner
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA
| |
Collapse
|
26
|
Grasser LR, Jovanovic T. Neural Impacts of Stigma, Racism, and Discrimination. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1225-1234. [PMID: 35811064 DOI: 10.1016/j.bpsc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022]
Abstract
Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life and have long-term consequences. In this review, we sought to use neuroscience research to describe how stigma, racism, and discrimination can impact brain and mental health. Societal stigmas may be encoded by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecologic systems to build resilience and foster posttraumatic growth.
Collapse
Affiliation(s)
- Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan.
| |
Collapse
|
27
|
Serchen J, Mathew S, Hilden D, Southworth M, Atiq O. Supporting the Health and Well-Being of Indigenous Communities: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1594-1597. [PMID: 36215716 DOI: 10.7326/m22-1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination.
Collapse
Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Molly Southworth
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, Alaska (M.S.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | | | | |
Collapse
|
28
|
Siller L, Edwards KM, Herrington R, Bordeaux S, Charge LL, Charge DL. Reactions to Participating in Sexual and Dating Violence Research Among Native American Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP19188-NP19204. [PMID: 34355981 DOI: 10.1177/08862605211035884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of the current study was to explore the reactions of Native American adolescents to participating in survey research on sexual and dating violence. Participants were 149 Native American adolescents who completed a survey in school. Survey items included sexual assault, dating violence, sexual harassment, and demographic questions. At the end of the survey, participants were asked if they were upset by the survey. Results showed that almost a quarter of youth were upset by the survey (24.2%), victims were more likely than non-victims to be upset by the survey, perpetrators were more likely than non-perpetrators to be upset by the survey, and sexual minorities were more likely than non-sexual minorities to be upset by the survey. Sex and age did not emerge as significantly associated with being upset. Participants were asked to describe why they were upset, and a content analysis revealed four categories of responses (i.e., feeling awkward or weird, topic of the survey, reminders, and "other"). Overall, although the research was well tolerated by most of the participants, researchers should consider adding information about what might increase feelings of upset in parental consent and youth assent forms, such as being reminded of a past upsetting experience and/or feeling awkward or weird because of some of the questions.
Collapse
Affiliation(s)
- Laura Siller
- University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Ramona Herrington
- University of Nebraska-Lincoln, Lincoln, NE, USA
- Oglala Sioux Tribe, Pine Ridge, SD, USA
| | | | | | | |
Collapse
|
29
|
Edwards KM, Herrington R, Edwards M, Banyard V, Mullet N, Hopfauf S, Simon B, Waterman EA. Using intergenerational photovoice to understand family strengths among Native American children and their caregivers. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3625-3639. [PMID: 35403719 PMCID: PMC9545977 DOI: 10.1002/jcop.22860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 05/24/2023]
Abstract
The purpose of the current study was to examine Native American children and caregivers' perspectives of family and cultural strengths using photovoice and to identify lessons learned from the first-ever implementation of intergenerational photovoice with Native Americans. Participants were Native American, low-income caregivers (n = 6) and their children (n = 12) between the ages of 10 and 15 who participated in six photovoice sessions. The themes that emerged from photos and group discussion included myriad challenges faced by Native American families including exposure to community violence, substance abuse, and criminal offending and incarceration. Themes also emerged that highlighted the strengths of Native families that were used to overcome identified challenges, including religion/spirituality, engagement in traditional cultural practices (e.g., prayer, song, dance), healthy activities (e.g., running, meditation). These data provided foundational information that is currently being used, along with other data, to develop a culturally grounded, strengths-focused, family-based program (Tiwahe Wicagwicayapi [Strengthening/Growing Families in Lakota]) to prevent adverse childhood experiences. We also discuss the challenges of intergenerational photovoice and lessons learned to inform future intergenerational photovoice projects.
Collapse
Affiliation(s)
- Katie M. Edwards
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Ramona Herrington
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Marcey Edwards
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | | | - Natira Mullet
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Skyler Hopfauf
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Briana Simon
- Nebraska Center for ResearchUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | | |
Collapse
|
30
|
Smith CM, Kennedy JL, Evans ME, Person MK, Haverkate R, Apostolou A. Mental Illness in Adults With HIV and HCV Infection: Indian Health Service, 2001-2020. Am J Prev Med 2022; 63:e77-e86. [PMID: 35589441 PMCID: PMC9887638 DOI: 10.1016/j.amepre.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mental health disorders (MHDs) and substance use disorders (SUDs) in people living with HIV, hepatitis C virus (HCV) infection, and HIV/HCV coinfection are common and result in significant morbidity. However, there are no national prevalence estimates of these comorbidities in American Indian and Alaska Native (AI/AN) adults with HIV, HCV infection, or HIV/HCV coinfection. This study estimates the prevalence of MHD and SUD diagnoses in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection within the Indian Health Service (IHS). METHODS In 2021, a cross-sectional study using data from the National Patient Information Reporting System was completed to identify MHD or SUD diagnoses in AI/AN adults with HIV, HCV infection, or HIV/HCV coinfection within the IHS during fiscal years 2001‒2020. Logistic regression was used to compare the odds of MHD or SUD diagnoses, adjusting for age and sex. RESULTS Of AI/AN adults diagnosed with HIV, hepatitis C virus infection, or HIV/HCV coinfection, the period prevalence of MHD or SUD diagnoses ranged from 57.2% to 81.1%. Adjusting for age and sex, individuals with HCV infection had higher odds of receiving a MHD diagnosis (AOR=1.57; 95% CI=1.47, 1.68) or SUD diagnosis (AOR=3.40; 95% CI=3.18, 3.65) than those with HIV, and individuals with HIV/HCV coinfection had higher odds of receiving a MHD diagnosis (AOR=1.60; 95% CI=1.35, 1.89) or SUD diagnosis (AOR=2.81; 95% CI=2.32, 3.41) than those with HIV. CONCLUSIONS MHD and SUD diagnoses were common in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection, highlighting the need for culturally appropriate screening and treatment programs sensitive to the diverse strengths of AI/AN populations and structural challenges they endure.
Collapse
Affiliation(s)
- Colin M Smith
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Indian Health Service, Rockville, Maryland.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Evans
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
31
|
Falkenstein DK, Jarvis JN. Health inequities in the rheumatic diseases of childhood. Curr Opin Rheumatol 2022; 34:262-266. [PMID: 35797523 DOI: 10.1097/bor.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To describe differences in disease manifestations and outcomes in pediatric rheumatic diseases as they occur in non-European-descended populations in North America. RECENT FINDINGS Differences in disease prevalence, clinical phenotypes, disease course, and outcomes have been described across the spectrum of pediatric-onset rheumatic diseases. Although these differences are commonly explained by differences in genetic risk or access to tertiary healthcare facilities, our emerging understanding of the immunobiology of historical/ongoing trauma suggest a more complex explanation for these observed differences. SUMMARY Health inequities as observed in pediatric rheumatic diseases are likely to emerge from a complex interplay between social and biological factors. The important contribution of historical and repetitive trauma deserves further exploration.
Collapse
Affiliation(s)
| | - James N Jarvis
- Department of Pediatrics
- Genetics, Genomics, & Bioinformatics Program, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
32
|
Edwards KM, Siller L, Wheeler LA, Charge LL, Charge DPL, Bordeaux S, Herrington R, Hopfauf SL, Simon B. Effectiveness of a Sexual Assault Self-defense Program for American Indian Girls. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13245-NP13267. [PMID: 33813945 DOI: 10.1177/0886260521997942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study evaluated the effectiveness of a 6-session (12-hour) empowerment self-defense classroom delivered curriculum (i.e., IMpower) among American Indian girls. Girls (N = 74) in one middle school and two high schools on an Indian Reservation in the Great Plains region of the United States received the intervention and completed a pre-test and a post-test six months following the final program session. The surveys administered assessed hypothesized intermediary (i.e., efficacy to resist a sexual assault, self-defense knowledge), primary (i.e., sexual violence victimization), and secondary (i.e., physical dating violence, sexual harassment) outcomes. Native American girls (N = 181) in five middle schools and three high schools in a nearby city where there was no sexual assault prevention occurring completed surveys assessing sexual violence, physical dating violence, and sexual harassment victimization approximately six months apart, thus serving as a comparison to girls in the treatment condition on primary and secondary outcomes. Girls exposed to the IMpower program reported significant increases over time in efficacy to resist a sexual assault and knowledge of effective resistance strategies. Furthermore, propensity score analyses suggested that girls who received the IMpower program reported significantly fewer types of sexual assault and sexual harassment at follow-up compared to girls in the control condition. However, no effect was found for physical dating violence. These data suggest that empowerment self-defense is a promising approach in preventing sexual assault and sexual harassment among American Indian girls.
Collapse
Affiliation(s)
| | | | | | | | | | - Simone Bordeaux
- Rosebud Sioux Tribe Health Administration, Rosebud, SD, United States
| | - Ramona Herrington
- University of Nebraska, Lincoln, NE, USA
- Oglala Sioux Tribe, Pine Ridge, SD, United States
| | | | | |
Collapse
|
33
|
Cole AB, Armstrong CM, Giano ZD, Hubach RD. An update on ACEs domain frequencies across race/ethnicity and sex in a nationally representative sample. CHILD ABUSE & NEGLECT 2022; 129:105686. [PMID: 35662683 DOI: 10.1016/j.chiabu.2022.105686] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) research has yielded important information regarding ACEs prevalence and impacts; however, few studies have included American Indian/Alaska Native (AI/AN) populations. OBJECTIVE We aimed to update and expand the ACEs literature by using recent data (2009-2018; over 50% from 2015 to 2017); using a large, nationally representative sample (total N = 166,606) and AI/AN sub-sample (N = 3369); and including additional covariates (i.e., sex, age, income, education) to provide a comprehensive understanding of ACEs across diverse populations. PARTICIPANTS AND SETTING Data were from the CDC's BRFSS, a standardized scale used in most ACEs literature, to improve generalizability of study findings, which may contribute to investigating future ACEs trends. METHODS Descriptive statistics and negative binomial regression analyses were conducted to examine the frequency of ACEs and the eight ACEs domains across racial/ethnic and sex groups. RESULTS AI/ANs had the highest ACEs compared to all racial/ethnic groups. Females had higher mean ACEs compared to males of the same racial/ethnic group; significant differences were identified between non-Hispanic White (NHW) females and NHW males, and between Hispanic females and Hispanic males. Across all 10 stratified subgroups, AI/AN females had the highest average ACEs followed by AI/AN males. Emotional abuse was the most reported ACEs domain across all individuals, and family incarceration was the lowest. AI/AN females and males had the highest ACEs frequencies in family substance use, witnessing intimate partner violence, and sexual and emotional abuse. CONCLUSIONS Findings have important implications for public health intervention and prevention efforts that may mitigate the impact of ACEs across racial/ethnic groups, particularly for AI/AN populations.
Collapse
Affiliation(s)
- Ashley B Cole
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA.
| | - Cassidy M Armstrong
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA.
| | - Zachary D Giano
- Center for Innovative Design & Analysis, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 13001 East 17(th) Place, 4th Floor West, Mail Stop B119, Aurora, CO 80045, USA.
| | - Randolph D Hubach
- Department of Public Health, Purdue University, Matthews Hall, 219A, 812 W. State St., West Lafayette, IN 47907, USA.
| |
Collapse
|
34
|
Radford A, Toombs E, Zugic K, Boles K, Lund J, Mushquash CJ. Examining Adverse Childhood Experiences (ACEs) within Indigenous Populations: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:401-421. [PMID: 35600513 PMCID: PMC9120316 DOI: 10.1007/s40653-021-00393-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 06/03/2023]
Abstract
Health concerns in Indigenous people are often greater in comparison to those in non-Indigenous populations, including increased rates of chronic diseases and mental health concerns. Adverse childhood experiences (ACEs) may be an explanatory variable for such heightened rates of mental and physical health difficulties for Indigenous populations as these communities have experienced a lack of adequate health care due to remoteness, historical traumas, cultural insensitivity, racism, and perpetuating systemic discrimination. To date, relatively few studies have examined ACEs within an Indigenous population and their relevance to both physical and mental health outcomes. The present study explored existing ACE literature relevant to Indigenous populations and mental or physical health outcomes by retrieving and organizing available ACE literature. A systematic review was conducted using 14 electronic databases of peer-reviewed literature and 18 grey literature databases. Twenty-one publications investigating general health outcomes and prevalence of ACEs met eligibility criteria. ACEs were reported to be higher in Indigenous populations when compared to non-Indigenous population. Higher ACE scores for Indigenous participants were associated with increased rates of suicidality and psychological distress. Protective factors to reduce the impact of ACEs were cultural identity and connectedness, education, social support, and psychological resilience. Future research may further explore the relationship between ACE scores and protective factors, varying prevalence within specific sub-populations, and consistent reporting of outcomes across studies. Ongoing research has the potential to clarify existing dose-response relationships between early traumatic experiences and current health disparities experienced within some Indigenous communities.
Collapse
Affiliation(s)
- Abbey Radford
- Department of Psychology, Lakehead University, Thunder Bay, ON Canada
| | - Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, ON Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Thunder Bay, ON Canada
| | - Katie Zugic
- Dilico Anishinabek Family Care, Fort William First Nation, Thunder Bay, ON Canada
| | - Kara Boles
- Department of Psychology, Lakehead University, Thunder Bay, ON Canada
| | - Jessie Lund
- Department of Psychology, Lakehead University, Thunder Bay, ON Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Thunder Bay, ON Canada
- Northern Ontario School of Medicine (NOSM), Lakehead University, Thunder Bay, ON Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON Canada
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON Canada
| |
Collapse
|
35
|
Spillane NS, Nalven T, Goldstein SC, Schick MR, Kirk-Provencher KT, Jamil A, Weiss NH. Assaultive trauma, alcohol use, and alcohol-related consequences among American Indian adolescents. Alcohol Clin Exp Res 2022; 46:815-824. [PMID: 35342962 PMCID: PMC9117488 DOI: 10.1111/acer.14819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND American Indian (AI) adolescents report disproportionate higher rates of alcohol use and alcohol-related consequences than adolescents from other racial/ethnic groups. Trauma exposure is also reported at high rates among AI individuals and likely confers risk for alcohol use. The purpose of the present study was to examine the effects of assaultive trauma experiences (e.g., physical assault, sexual assault) on alcohol use and alcohol-related consequences in AI adolescents. METHODS We conducted a secondary analysis of self-reported data on trauma exposure, alcohol consumption, and lifetime alcohol-related consequences provided by AI 7th to 12th graders residing on or near a reservation (n = 3498, Mage = 14.8; 49.5% female). Institutional Review Boards, tribal authorities, and school boards approved the study protocols prior to beginning data collection. RESULTS Nearly half (49.3%, n = 1498) of AI adolescents reported having experienced at least one assaultive trauma in their lifetime. Those who had experienced assaultive trauma were more likely to report lifetime alcohol use (χ2 = 111.84, p < 0.001) and experienced greater alcohol-related consequences (t(1746) = 12.21, p < 0.001) than those with no assaultive trauma exposure. Multilevel regression analyses indicated that a greater number of assaultive traumatic events was significantly associated with greater odds of lifetime alcohol use (p < 0.001, OR = 1.81, 95% CI [1.65, 2.00]) and having experienced a greater number of alcohol-related consequences (b = 0.36, SE = 0.04, t = 16.95, p < 0.001, 95% CI [0.31, 0.46]). CONCLUSIONS Findings of the present study highlight the relevance of exposure to assaultive trauma to AI adolescents' use of alcohol and experiences of alcohol-related consequences. These findings support the need for trauma-informed interventions in addressing alcohol use among AI adolescents.
Collapse
Affiliation(s)
- Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Tessa Nalven
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Melissa R Schick
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Aayma Jamil
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| |
Collapse
|
36
|
Soto C, West AE, Ramos GG, Unger JB. Substance and Behavioral Addictions among American Indian and Alaska Native Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2974. [PMID: 35270667 PMCID: PMC8910676 DOI: 10.3390/ijerph19052974] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This paper examines substance and behavioral addictions among American Indian and Alaska Natives (AIAN) to identify the structural and psychosocial risk and cultural protective factors that are associated with substance use and behavioral addictions. METHODS Five databases were used to search for peer reviewed articles through December 2021 that examined substance and behavioral addictions among AIANs. RESULTS The literature search identified 69 articles. Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions. CONCLUSIONS There is a dearth of research on behavioral addictions among AIANs. Unique risk factors in AIAN communities such as historical trauma and socioeconomic challenges have interfered with traditional cultural resilience factors and have increased the risk of behavioral addictions. Future research on resilience factors and effective prevention and treatment interventions could help AIANs avoid behavioral addictions.
Collapse
Affiliation(s)
- Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
| | - Amy E. West
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA;
| | - Guadalupe G. Ramos
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
| |
Collapse
|
37
|
Suglia SF, Appleton AA, Bleil ME, Campo RA, Dube SR, Fagundes CP, Heard-Garris NJ, Johnson SB, Slopen N, Stoney CM, Watamura SE. Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research. Prev Med 2021; 153:106736. [PMID: 34293381 PMCID: PMC8595689 DOI: 10.1016/j.ypmed.2021.106736] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.
Collapse
Affiliation(s)
- Shakira F Suglia
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY, United States of America
| | - Maria E Bleil
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States of America
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Shanta R Dube
- Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States of America
| | - Nia J Heard-Garris
- Division of Advanced General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Sara B Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Catherine M Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Sarah E Watamura
- Department of Psychology, University of Denver, Denver, CO, United States of America
| |
Collapse
|
38
|
Elma JHL, Hautalab D, Abrahamson-Richardsa T, Wallsb ML. Patterns of adverse childhood experiences and mental health outcomes among American Indians with type 2 diabetes. CHILD ABUSE & NEGLECT 2021; 122:105326. [PMID: 34627041 PMCID: PMC8784163 DOI: 10.1016/j.chiabu.2021.105326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Extensive research demonstrates that Adverse Childhood Experiences (ACEs) are highly interconnected and have numerous health consequences well into adulthood. Yet, there is a dearth of focused research that examines ACEs and health inequities for American Indians (AIs). OBJECTIVE To assesses the prevalence of ten types of childhood adversities, explore constellations of exposures, and examine whether there are differential risks of mental health outcomes according to sub-group classification. PARTICIPANTS AND SETTING Adult AIs with type 2 diabetes from five reservation-based tribal communities in the Great Lakes region of the U.S. METHODS Prevalence was estimated using a modified version of the World Health Organization's ACE-International Questionnaire. To examine heterogeneity in ACEs exposures, latent class analysis was used. Risk of mental health outcomes was calculated by class. RESULTS The four most common ACEs reported were residing with someone who abused substances, witnessing household violence, incarceration of a household member, and sexual abuse. Three latent classes were identified: low risk (56.7%), family maladjustment with high probabilities of household violence, incarceration, and substance abuse (27.1%), and complex trauma (16.3%) with moderate to high probabilities of exposure to all ACEs. The most consistent differences in mental health outcomes were between the low risk and complex trauma classes. CONCLUSIONS Identification of a high number of participants in the low-risk class helps structure a more wholistic image of AI families, as negative stereotypes of AIs are abundant. For the minority of individuals in the complex trauma class, risk for chronic mental health challenges and co-morbidities appears to be high.
Collapse
Affiliation(s)
- Jessica H L Elma
- University of Washington, United States of America; Johns Hopkins University, United States of America.
| | - Dane Hautalab
- University of Washington, United States of America; Johns Hopkins University, United States of America
| | | | - Melissa L Wallsb
- University of Washington, United States of America; Johns Hopkins University, United States of America
| |
Collapse
|
39
|
Burns J, Angelino AC, Lewis K, Gotcsik ME, Bell RA, Bell J, Empey A. Land Rights and Health Outcomes in American Indian/Alaska Native Children. Pediatrics 2021; 148:e2020041350. [PMID: 34706902 DOI: 10.1542/peds.2020-041350] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) land rights, sovereignty conflicts, and health outcomes have been significantly influenced by settler colonialism. This principle has driven the numerous relocations and forced assimilation of AI/AN children as well as the claiming of AI/AN lands across the United States. As tribes across the country begin to reclaim these lands and others continue to struggle for sovereignty, it is imperative to recognize that land rights are a determinant of health in AI/AN children. Aside from the demonstrated biological risks of environmental health injustices including exposure to air pollution, heavy metals, and lack of running water, AI/AN children must also face the challenges of historical trauma, the Missing and Murdered Indigenous Peoples crisis, and health care inequity based on land allocation. Although there is an undeniable relationship between land rights and the health of AI/AN children, there is a need for extensive research into the impacts of land rights and recognition of sovereignty on the health of AI/AN children. In this article we aim to summarize existing evidence describing the impact of these factors on the health of AI/AN children and provide strateg ies that can help pediatricians care and advocate for this population.
Collapse
Affiliation(s)
- Joseph Burns
- Cohen Children's Medical Center of New York, Queens, New York
- Contributed equally as co-first authors
| | - Alessandra C Angelino
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Contributed equally as co-first authors
| | - Kyna Lewis
- Oregon Health Sciences University, School of Medicine, Portland, Oregon
| | | | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Joseph Bell
- Children's Health Carolina, Pembroke, North Carolina
| | - Allison Empey
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
40
|
Abstract
American Indian and Alaska Native (AI/AN) populations have substantial health inequities, and most of their disease entities begin in childhood. In addition, AI/AN children and adolescents have excessive disease rates compared with the general pediatric population. Because of this, providers of pediatric care are in a unique position not only to attenuate disease incidence during childhood but also to improve the health status of this special population as a whole. This policy statement examines the inequitable disease burden observed in AI/AN youth, with a focus on toxic stress, mental health, and issues related to suicide and substance use disorder, risk of and exposure to injury and violence in childhood, obesity and obesity-related cardiovascular risk factors and disease, foster care, and the intersection of lesbian, gay, bisexual, transgender, queer, and Two-Spirit and AI/AN youth. Opportunities for advocacy in policy making also are presented.
Collapse
Affiliation(s)
- Shaquita Bell
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Jason F Deen
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Molly Fuentes
- Rehabilitation Medicine, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington; and
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
41
|
Wesner CA, Zhang W, Melstad S, Ruen E, Deffenbaugh C, Gu W, Clayton JL. Assessing County-Level Vulnerability for Opioid Overdose and Rapid Spread of Human Immunodeficiency Virus and Hepatitis C Infection in South Dakota. J Infect Dis 2021; 222:S312-S321. [PMID: 32877549 DOI: 10.1093/infdis/jiaa231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Key indicators of vulnerability for the syndemic of opioid overdose, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) due to injection drug use (IDU) in rural reservation and frontier counties are unknown. We examined county-level vulnerability for this syndemic in South Dakota. METHODS Informed by prior methodology from the Centers for Disease Control and Prevention, we used acute and chronic HCV infections among persons aged ≤40 years as a proxy measure of IDU. Twenty-nine county-level indicators potentially associated with HCV infection rates were identified. Using these indicators, we examined relationships through bivariate and multivariate analysis and calculated a composite index score to identify the most vulnerable counties (top 20%) to this syndemic. RESULTS Of the most vulnerable counties, 69% are reservation counties and 62% are rural. The county-level HCV infection rate is 4 times higher in minority counties than nonminority counties, and almost all significant indicators of opioid-related vulnerability in our analysis are structural and potentially modifiable through public health interventions and policies. CONCLUSIONS Our assessment gives context to the magnitude of this syndemic in rural reservation and frontier counties and should inform the strategic allocation of prevention and intervention services.
Collapse
Affiliation(s)
- Chelsea A Wesner
- Master of Public Health Program, University of South Dakota, Vermillion, South Dakota, USA
| | - Weiwei Zhang
- Department of Sociology & Rural Studies, South Dakota State University, Brookings, South Dakota, USA
| | | | - Elizabeth Ruen
- Master of Public Health Program, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Wei Gu
- Department of Sociology & Rural Studies, South Dakota State University, Brookings, South Dakota, USA
| | | |
Collapse
|
42
|
Lewis ME, Volpert-Esmond HI, Deen JF, Modde E, Warne D. Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1821. [PMID: 33668461 PMCID: PMC7918141 DOI: 10.3390/ijerph18041821] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Indigenous people experience the greatest cardiometabolic disease disparity in the Unites States, yet high cardiometabolic disease risk factors do not fully explain the extent of the cardiometabolic disease disparity for Indigenous people. Stress, trauma, and racism occur at high rates within Indigenous communities and have not been well explored as significant contributors to cardiometabolic disease disparities despite emerging literature, and therefore will be described here. METHODS This descriptive study explores the relationship between cardiometabolic disease risks and Indigenous-specific stressors (e.g., early childhood stress and trauma, adulthood stress and trauma, and historical and intergenerational trauma) using current literature. Indigenous-specific protective factors against cardiometabolic disease are also reviewed. RESULTS Increasing research indicates that there is a relationship between Indigenous-specific stressful and traumatic life experiences and increased cardiometabolic disease risk. Mental health and psychophysiology play an important role in this relationship. Effective interventions to reduce cardiometabolic disease risk in Indigenous communities focus on ameliorating the negative effects of these stressors through the use of culturally specific health behaviors and activities. CONCLUSIONS There is increasing evidence that cultural connection and enculturation are protective factors for cardiometabolic disease, and may be galvanized through Indigenous-led training, research, and policy change.
Collapse
Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | | | - Jason F. Deen
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA;
| | - Elizabeth Modde
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Donald Warne
- Family & Community Medicine Department, University of North Dakota, Grand Forks, ND 58202, USA;
| |
Collapse
|
43
|
Giano Z, Camplain RL, Camplain C, Pro G, Haberstroh S, Baldwin JA, Wheeler DL, Hubach RD. Adverse Childhood Events in American Indian/Alaska Native Populations. Am J Prev Med 2021; 60:213-221. [PMID: 33223364 PMCID: PMC8098634 DOI: 10.1016/j.amepre.2020.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Adverse childhood experiences are linked to deleterious outcomes in adulthood. Certain populations have been shown to be more vulnerable to adversity in childhood than others. Despite these findings, research in this area lacks an empirical investigation that examines adverse childhood experiences among American Indian and Alaska Native populations using large, nationally representative data. As such, the authors have compiled what they believe is the largest empirical investigation of adverse childhood experiences among American Indian and Alaska Native individuals to date. METHODS Data were collected from the Behavioral Risk Factor Surveillance System from 34 states (2009-2017), whereby all individuals self-report as American Indian and Alaska Native (N=3,894). Adverse childhood experience scores were calculated and further stratified by sex, age, household income, education, employment status, sexual orientation, Census region, and state. In addition, frequencies and prevalence of each adverse childhood experience domain (stratified by the same categories) were calculated. Analysis was conducted in 2019. RESULTS The average adverse childhood experience score among American Indians and Alaska Natives was 2.32, higher than those of individuals identifying as White (1.53), Black (1.66), and Hispanic (1.63). Female participants had a higher average adverse childhood experience score than male participants (2.52 vs 2.12). Generally, younger individuals and those with lower incomes reported higher adverse childhood experience scores, whereas those with higher educational attainment reported lower scores. CONCLUSIONS Compared with the few studies among American Indian and Alaska Native populations that have used either smaller samples or nontraditional adverse childhood experience data (i.e., asking parents about their children's experiences), these results present overall higher adverse childhood experience averages than previously published studies. Nevertheless, aligning with other research on adverse childhood experiences, female individuals, younger adults, and sexual minorities reported higher adverse childhood experiences scores than other categories in their respective demographics.
Collapse
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.
| | - Ricky L Camplain
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona
| | - Carolyn Camplain
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona
| | - George Pro
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Shane Haberstroh
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona
| | - Denna L Wheeler
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Randolph D Hubach
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| |
Collapse
|
44
|
Richards TN, Schwartz JA, Wright E. Examining adverse childhood experiences among Native American persons in a nationally representative sample: Differences among racial/ethnic groups and race/ethnicity-sex dyads. CHILD ABUSE & NEGLECT 2021; 111:104812. [PMID: 33220946 DOI: 10.1016/j.chiabu.2020.104812] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Existing research using nationally representative samples has provided valuable information regarding the prevalence and context of childhood adversity, but Native American persons have largely been absent from these studies. OBJECTIVE We examined adverse childhood experiences (ACEs) among persons identifying as White, Black, Asian, Hispanic, and Native American in the NESARC, a longitudinal study (Wave 1: 2001-2002; Wave 2: 2004-2005) using a nationally representative sample from the United States. METHODS Means tests and negative binomial regression were used to examine the prevalence and variety of ACEs across racial/ethnic groups and race/ethnicity-sex dyads. RESULTS Native American persons reported the greatest average number and variety of ACEs than persons from any other racial/ethnic group, and reported the highest rates of physical abuse, sexual abuse, parental substance abuse, and witnessing violence than members of any other racial/ethnic category. Native American females reported the greatest rates of emotional abuse, while Native American males reported the greatest rates of physical neglect; the highest rates of parental substance use among the race/ethnicity-sex dyads were reported by both Native American females and males. Significantly higher rates of sexual violence were reported by Native American females compared to other groups; almost 1 in 4 Native American females reported sexual violence. CONCLUSIONS Future research should make a concerted effort to broaden examinations of ACEs to include Native American respondents and to include measures of historical trauma and racial discrimination. Broader support for system change as well as increased development and use of culturally responsive prevention and intervention programming is likely necessary to reduce ACEs among Native American persons.
Collapse
Affiliation(s)
- Tara N Richards
- School of Criminology and Criminal Justice, University of Nebraska Omaha, USA.
| | - Joseph A Schwartz
- College of Criminology and Criminal Justice, Florida State University, USA
| | - Emily Wright
- School of Criminology and Criminal Justice, University of Nebraska Omaha, USA
| |
Collapse
|
45
|
Lee MS, Kim HS, Bhang SY. Exposure to Adverse Childhood Experiences (ACEs) and Stress among the Community-based Urban Pediatric Population in Korea. J Korean Med Sci 2020; 35:e421. [PMID: 33372423 PMCID: PMC7769697 DOI: 10.3346/jkms.2020.35.e421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to investigate the impact of exposure to adverse childhood experiences (ACEs) and stress among the community-based urban pediatric population in Korea. METHODS In 2017, the analysis was conducted on 3,937 children and adolescents in an urban area in Korea based on the impact of actual traumatic experience, addiction, and mental health. The respondents were excluded if they were missing data on the survey, resulting in a final sample size of 3,556. The collected data were analyzed by applying cross-sectional and correlation analyses. RESULTS Among the respondents in the study group (mean age = 13.77), 43.1% were boys (n = 1,532) and 56.9% were girls (n = 2,024). Overall, 23.5% (n = 835) reported at least one ACE and 1.8% (n = 63) reported experiencing four or more ACEs. Emotional abuse (13.2%) was the most commonly reported ACE, followed by abandonment (7.7%) and physical abuse (7.5%). Self-reported measures of stress were associated with the ACE scores. CONCLUSION This is the first study of self-reported ACEs from a community-based pediatric population in Korea. We found that the number of the students revealed more than one ACEs was similar to the data in the US community study with self-reporting among the community samples and exposure to adverse experiences is highly correlated with various stress responses.
Collapse
Affiliation(s)
- Mi Sun Lee
- Department of Meditation Psychology, Nungin University, Hwaseong, Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Soo Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Nowon Eulji University Hospital, Seoul, Korea
- Nowon Community Addiction Management Center, Seoul, Korea.
| |
Collapse
|
46
|
Walls M, Sittner KJ, Whitbeck LB, Herman K, Gonzalez M, Elm JHL, Hautala D, Dertinger M, Hoyt DR. Prevalence of Mental Disorders from Adolescence through Early Adulthood in American Indian and First Nations Communities. Int J Ment Health Addict 2020; 19:2116-2130. [PMID: 35002580 PMCID: PMC8734560 DOI: 10.1007/s11469-020-00304-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Melissa Walls
- Johns Hopkins University, Department of International Health; Center for American Indian Health; 1915 South Street, Duluth, MN 55812
| | | | - Les B. Whitbeck
- University of Nebraska, Lincoln, Department of Sociology, Lincoln, NE
| | - Kaley Herman
- Johns Hopkins University, Department of International Health; Center for American Indian Health; 1915 South Street, Duluth, MN 55812
| | - Miigis Gonzalez
- Johns Hopkins University, Department of International Health; Center for American Indian Health; 1915 South Street, Duluth, MN 55812
| | - Jessica H. L. Elm
- Johns Hopkins University, Department of International Health; Center for American Indian Health; 1915 South Street, Duluth, MN 55812
| | - Dane Hautala
- University of Minnesota, Department of Psychiatry, Minneapolis, MN
| | - Melinda Dertinger
- University of Minnesota Medical School, Duluth campus, Department of Family Medicine & Biobehavioral Health
| | - Dan R. Hoyt
- University of Nebraska, Lincoln, Department of Sociology, Lincoln, NE
| |
Collapse
|
47
|
John-Henderson NA. Childhood trauma as a predictor of changes in sleep quality in American Indian adults during the COVID-19 pandemic. Sleep Health 2020; 6:718-722. [PMID: 33092992 PMCID: PMC7572354 DOI: 10.1016/j.sleh.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Early life adversity associates with poor sleep in adulthood and is believed to sensitize individuals to later stressors. Infectious disease outbreaks increase psychological stress, and life events impact sleep quality. American Indians have been disproportionately affected by the COVID-19 pandemic. OBJECTIVE Investigate whether childhood trauma predicts changes in sleep quality following onset of the pandemic and test whether pandemic stress contributes to changes in sleep. METHODS In a sample of 210 American Indian adults (Age M (SD) = 55.09 (13.10), 59.5% female) demographics, childhood trauma and sleep quality were measured at Time 1. One month following the onset of the pandemic, psychological stress specific to the pandemic and sleep quality were measured. RESULTS Using linear regression controlling for age, sex, income, and sleep quality at Time 1, childhood adversity predicted both psychological stress specific to the pandemic and changes in sleep quality from Time 1 to Time 2 (β = 0.33, t(205) = 4.88, P < .001, ΔR2 = 0.10) and (β = 0.24, t(204) = 3.48, P < .001, ΔR2 = 0.05), respectively. Mediation analyses indicated a significant indirect effect between childhood adversity and changes in sleep quality through COVID-19 stress (indirect effect [standard error, SE] = (0.03[0.01], 95% confidence interval = [0.003, 0.03]). CONCLUSIONS In American Indians childhood trauma predicts greater declines in sleep quality associated with the onset of the COVID-19 pandemic, in part because greater psychological stress related to COVID-19. Future work should identify factors which alleviate stress related to life events for individuals who experienced childhood trauma in order to improve health behaviors and health.
Collapse
|
48
|
Hall T, Rooks R, Kaufman C. Intersections of Adverse Childhood Experiences, Race and Ethnicity and Asthma Outcomes: Findings from the Behavioral Risk Factor Surveillance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218236. [PMID: 33171864 PMCID: PMC7664623 DOI: 10.3390/ijerph17218236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.
Collapse
Affiliation(s)
- Tristen Hall
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Health and Behavioral Sciences, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO 80204, USA;
- Correspondence: ; Tel.: +1-303-724-8009
| | - Ronica Rooks
- Department of Health and Behavioral Sciences, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO 80204, USA;
| | - Carol Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| |
Collapse
|
49
|
Burns J, Gneck J, Bell S. Missing and murdered Indigenous women and girls: A case for abuse screening in at-risk paediatric populations. J Paediatr Child Health 2020; 56:1641. [PMID: 33099826 DOI: 10.1111/jpc.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph Burns
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York, United States.,Committee on Native American Child Health, American Academy of Pediatrics, Itasca, Illinois, United States
| | - Jeremey Gneck
- Department of Pediatrics, Diamond Children's Medical Center, University of Arizona, Tucson, Arizona, United States
| | - Shaquita Bell
- Committee on Native American Child Health, American Academy of Pediatrics, Itasca, Illinois, United States.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States
| |
Collapse
|
50
|
McKinley CE, Boel-Studt S, Renner LM, Figley CR. Risk and protective factors for symptoms of depression and anxiety among American Indians: Understanding the roles of resilience and trauma. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 13:16-25. [PMID: 32940525 DOI: 10.1037/tra0000950] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Depression and anxiety are comorbid conditions that are disproportionately high among American Indians (AIs) or Alaska Natives. The purpose of this study was to identify potential risk (e.g., low income, intimate partner violence [IPV], adverse childhood experiences [ACEs]) and protective factors (e.g., family resilience, social and community support) related to symptoms of depression and anxiety among AI adults. METHOD As part of larger exploratory sequential mixed-methods research, the study focused on survey data with 127 AI adults from two Southeastern tribes (n = 117 when missing data were removed). We used the following three-stage hierarchical regression to understand factors related to depressive and anxiety symptoms: (a) demographics, including income; (b) ACEs and IPV; and (c) family resilience, along with family and community support. RESULTS Many participants experienced elevated levels of clinically significant symptoms of depression and anxiety (15% and 20%, respectively). Results indicated lower income was associated with higher depressive and anxiety symptoms. IPV and ACE variables were positively associated with depressive and anxiety symptoms. Family resilience was negatively associated with symptoms of anxiety and depression. Social and community support were associated with symptoms of anxiety. CONCLUSIONS The findings provide strong preliminary support for the role of family protective and promotive factors in offsetting symptoms of anxiety and depression. This is contrary to most models of interventions for anxiety and depression focusing on individual psychotherapy rather than promoting family resilience or involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|