Advantages of stress process approaches for measuring historical trauma

Engagement with reservation-based Head Start teachers to explore their stress and coping: A qualitative study

BACKGROUND

Native Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked.

METHODS

Qualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes.

RESULTS

Individually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being.

CONCLUSIONS

This paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.

Food insecurity as a mediator and moderator in the association between residential mobility and suicidal ideation among Indigenous adults in Canada

PURPOSE

Despite a growing body of literature on the link between residential mobility and suicidal ideation, research into potential mediating or moderating factors, especially among socioeconomically disadvantaged populations, is sparse. This study explores the mediating and moderating roles of food insecurity in the relationship between residential mobility and suicidal ideation in Indigenous Canadian adults.

METHODS

Data from the 2017 Aboriginal Peoples Survey, which represent a national sample of off-reserve First Nations peoples, Métis, and Inuit in Canada (N = 16,214), were analyzed using logistic regression models.

RESULTS

Food insecurity partially mediated the association between residential mobility in the past 5 years and increased suicidal ideation risk among Indigenous adults. Moreover, food insecurity intensified the adverse link between residential mobility during this same timeframe and suicidal ideation. Yet, while food insecurity did mediate the adverse relationship between residential mobility in the past year and suicidal ideation, it did not function as a moderator.

CONCLUSION

The results emphasize that food insecurity, as a systemic challenge, acts as both a partial mediator and, in some circumstances, an amplifier of the detrimental impacts of residential mobility on suicidal ideation.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Objective

The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.

Methods

We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.

Results

A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).

Conclusion

Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Using Ecological Momentary Assessments to Understand Black Youths' Experiences of Racism, Stress, and Safety

Anti-Black racism, both interpersonal and systemic, is pervasive. Individual- and neighborhood-level expressions of anti-Black racism have been explored in many studies; however, Black youths' experiences of racism across routine activity locations have not been examined as extensively. To address this gap, a Youth Research Advisory Board (YRAB) recruited 75 Black youths (M (SD) = 15.53 (1.77)), living in a segregated neighborhood (93% African American) with 42% of residents living below the poverty line, to participate in research on this topic. Participants in the study completed surveys three times a day for a month (ecological momentary assessment) about their positive and negative emotions and perceptions of racism and social support in routine activity locations (n = 2041). Youths reported more racism when attending school and walking on the street. A relationship between perceptions of racism and social support in routine activity locations and positive and negative momentary emotions was found. This paper will present implications for supporting adolescent development and interrupting anti-Black racism at the level of routine activity locations, along with opportunities for engaging youth-led community-based solutions.

Historical trauma and oppression: Associations with internalizing outcomes among American Indian adults with type 2 diabetes

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

An Integrated Historical Trauma and Posttraumatic Growth Framework: a Cross-Cultural Exploration

Trauma recovery for racial and ethnic groups experiencing ongoing systemic violence and discrimination requires a framework that simultaneously addresses harms and strengths. Historical trauma (HT) is a social determinant of health emanating from targeted mass group-level harm. Posttraumatic growth (PTG) focuses on positive shifts in individuals coping with trauma. This article highlights the unique contributions of these two distinct bodies of literature to inform trauma recovery. We explore areas of overlap, gaps, and tensions between the concepts to present an HT-PTG conceptual framework. The HT-PTG framework combines HT's focus on socio-structural-historical experiences in racial and ethnic groups targeted for oppression with PTG's descriptions of characteristics of growth. Specifically, five mass group-level domains of growth, centering healing, creativity, growth, and transformation are described. The ancestral legacies of the authors, including American Indian, Indigenous Mexican, African American, Puerto Rican, and Indigenous Taiwanese, inform the HT-PTG framework. This paper presents implications for trauma-recovery research and practice.

American Indian historical trauma: Anticolonial prescriptions for healing, resilience, and survivance

The American Indian historical trauma (HT) concept is an important precursor to racial trauma (RT) theory that reflects the distinct interests of sovereign Indigenous nations but shares much of the same promise and challenge. Here, that promise and challenge is explored by tracing HT's theoretical development in terms of its anticolonial ambitions and organizing ideas. Three predominant modes of engaging HT were distilled form the literature (HT as a clinical condition, life stressor, and critical discourse), each informing a research program pursuing a different anticolonial ambition (healing trauma, promoting resilience, practicing survivance) organized by distinct ideas about colonization, wellness, and Indigeneity. Through critical reflection on these different ambitions and dialogue of their organizing ideas, conflict between research programs can be mitigated and a more productive anticolonialism realized in psychology and related health fields. Key recommendations emphasized clarifying clinical concepts (e.g., clinical syndrome vs. idiom of distress), disentangling clinical narratives of individual pathology (e.g., trauma) from social narratives of population adversity (e.g., survivance stories), attending to features of settler-colonialism not easily captured by heath indices (e.g., structural violence), and encouraging alignment of anticolonial efforts with constructive critiques establishing conceptual bridges to disciplines that can help to advance psychological understandings of colonization and Indigenous wellness (e.g., postcolonial studies). This conceptual framework was applied to the RT literature to elaborate similar recommendations for advancing RT theory and the interests of ethnic/racial minority populations through engagement with psychology and related health fields. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Cautionary Tale: Examining the Interplay of Culturally Specific Risk and Resilience Factors in Indigenous Communities

Efforts to build empirical evidence for the protective effects of Indigenous cultural factors on psychological health have yielded mixed findings. We examine the interplay of previously hypothesized culturally relevant risk (discrimination, historical loss) and protective (spiritual activities) factors among Indigenous people. The sample includes 569 Indigenous adolescents (M age = 17.23, SD = 0.88; 51.0% girls) and 563 Indigenous adult caregivers (M age = 44.66, SD = 9.18; 77.4% women). Our central finding was that indigenous spirituality was associated with poorer psychological outcomes across several domains (depressive symptoms, anger, anxiety, somatization and interpersonal difficulties), but observed effects were attenuated once perceived discrimination and historical losses were added to statistical models. Thus, consideration of relevant stressors drastically changed our conclusions, underscoring the uncertain dynamics through which specific Indigenous cultural factors impact mental health. Researchers should work in collaboration with Indigenous communities to improve measurement and empirical investigation of these complex constructs.

"I'm in this world for a reason": Resilience and recovery among American Indian and Alaska Native two-spirit women

American Indian and Alaska Native sexual minority (two-spirit) women are vulnerable to substance misuse and mental health challenges due to multiple minority oppressed status and exposure to stress and trauma. Yet, these women find pathways toward healing and wellness. We conducted a qualitative data analysis of interviews derived from a national health study and gained an understanding of 11 two-spirit women's resilience and recovery patterns. Emergent from the data, a braided resiliency framework was developed which elucidates multilayered abilities, processes, and resources involved in their resiliency. We recommend that resilience-promoting strategies be incorporated into substance misuse and mental health interventions.

"I'm stronger than I thought": Native women reconnecting to body, health, and place

This community-based research applied principles of wilderness experience programming and Indigenous knowledges in an exploratory intervention designed to address health disparities in a tribal community. Drawing on historical trauma frameworks, tribal members rewalked the Trail of Tears to consider its effect on contemporary tribal health. Qualitative data from tribal members suggest that engagement with place and experiential learning, particularly the physical and emotional challenge of the Trail, facilitated changes in health beliefs, attitudes, and behaviors. Deep engagement outside of traditional health service settings should be considered in interventions and may be particularly effective in promoting positive health behaviors in Native communities.

The Historical Loss Scale: Longitudinal measurement equivalence and prospective links to anxiety among North American indigenous adolescents

OBJECTIVES

Thoughts of historical loss (i.e., the loss of culture, land, and people as a result of colonization) are conceptualized as a contributor to the contemporary distress experienced by North American Indigenous populations. Although discussions of historical loss and related constructs (e.g., historical trauma) are widespread within the Indigenous literature, empirical efforts to understand the consequence of historical loss are limited, partially because of the lack of valid assessments. In this study we evaluated the longitudinal measurement properties of the Historical Loss Scale (HLS)-a standardized measure that was developed to systematically examine the frequency with which Indigenous individuals think about historical loss-among a sample of North American Indigenous adolescents. We also test the hypothesis that thoughts of historical loss can be psychologically distressing.

METHODS

Via face-to-face interviews, 636 Indigenous adolescents from a single cultural group completed the HLS and a measure of anxiety at 4 time-points, which were separated by 1- to 2-year intervals (Mage = 12.09 years, SD = .86, 50.0% girls at baseline).

RESULTS

Responses to the HLS were explained well by 3-factor (i.e., cultural loss, loss of people, and cultural mistreatment) and second-order factor structures. Both of these factor structures held full longitudinal metric (i.e., factor loadings) and scalar (i.e., intercepts) equivalence. In addition, using the second-order factor structure, more frequent thoughts of historical loss were associated with increased anxiety.

CONCLUSIONS

The identified 3-factor and second-order HLS structures held full longitudinal measurement equivalence. Moreover, as predicted, our results suggest that historical loss can be psychologically distressing for Indigenous adolescents.

"Where I have to learn the ways how to live:" youth resilience in a Yup'ik village in Alaska

What is it like to grow up Yup'ik and come of age today in a traditional hunting-gathering community setting located in a remote region of Alaska? Current research describes a contemporary experience often laden with trauma and crisis. Youth in Yup'ik communities today face threats to their very survival as they encounter, early on, things that their ancestors never faced--including alcohol-related deaths, violence in many forms, and high rates of suicide among their young peers. Yet all is not despair for the youth growing up in these remote indigenous communities. Many youth grow-up to become skilled hunters, strong leaders, and able parents. This paper reports findings from the Alaskan Yup'ik site of the Circumpolar Indigenous Pathways to Adulthood (CIPA) study. The goal of this study is to identify strengths and resilience in youth living in a Yup'ik community in southwest Alaska. Interviews were conducted with 25 youth age 11-18, currently residing in a southwest Alaska community. Qualitative analysis revealed important connections between local stressors, community-level protective resources, and youth-driven, solution-focused strategies for overcoming hardship and learning the "ways how to live." Findings from this study contribute critical information on indigenous youth protection and resilience, including community and cultural resilience processes beyond the individual level, and enhance our understanding of the types of resources that can lead to improved outcomes for Alaska Native youth.

Historical trauma and substance use among Native Hawaiian college students

OBJECTIVES

To test the relationships among historical trauma, perceived discrimination, and substance use (cigarette, alcohol, and marijuana use) among Native Hawaiians.

METHODS

Cross sectional self-report data were collected online from 128 Native Hawaiian community college students (M age = 27.5; SD = 9.5; 65% Women). Hypotheses were tested using structural equation modeling.

RESULTS

Historical trauma had 2 paths to substance use: an indirect path to higher substance use through higher perceived discrimination and a direct path to lower substance use.

CONCLUSIONS

Thoughts, knowledge, or experience associated with historical trauma may enhance substance use behavior via increased perceived discrimination and may also be protective against substance use, possibly via increased pride in one's cultural heritage. This research has implications for historical trauma, discrimination, and substance use research concerning Native Hawaiians.

Multilevel context of depression in two American Indian tribes

OBJECTIVE

Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions.

METHOD

We used data from a large representative psychiatric epidemiological study among American Indians in 2 reservation communities to estimate nested individual and multilevel models of past-year major depressive episode (MDE) accounting for family, cultural, and community conditions.

RESULTS

We found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in 1 tribe even after accounting for individual-level characteristics.

CONCLUSIONS

Accounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings.

Patterns and Correlates of Adult American Indian Substance Use

There is substantial literature on the patterns and correlates of substance use across minority youth populations, but comparatively little attention has been directed to substance use among adults. This is particularly the case for adult American Indians, generally due to sampling challenges. This article provides multivariate analyses of the correlates of substance use across five racial/ethnic groups and highlights analyses focused on American Indian adults. In addition to marijuana use and binge drinking, our analyses consider hard drug use, which remains understudied in the literature, and include a first consideration of “bender drinking,” a form of alcohol consumption that is most likely to lead to health, social, and legal problems. Our results indicate that although American Indians report higher levels of substance use and abuse than do those from other racial/ethnic groups, these differences are attenuated when sociodemographic and individual-level/risk protective factors are taken into account.

Advancing American Indian and Alaska Native substance abuse research: current science and future directions

American Indians and Alaska Natives (AI/AN) have disproportionately high rates of substance abuse yet there is little empirical research addressing this significant public health problem. This paper is an introduction to a special issue that includes cutting edge science in this research area. We identify several areas that require consideration in this field and indicate how the papers in the special issue address these gaps. These overarching areas of need, which should be considered in any substantive research, include attention to heterogeneity within the population, research that has tangible health benefits, continued work on research methods and strategies, increased focus on strength based and community oriented approaches, and the need for strong research partnerships. The special issue marks a major step forward for AI/AN substance abuse research. However, articles also highlight where more work is need to improve public health in AI/AN communities by addressing identified gap areas.