Multilevel context of depression in two American Indian tribes.

Abstract

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 two 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 one 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.

Prevalence of Mental Disorders from Adolescence Through Early Adulthood in American Indian and First Nations Communities

“…Our DSM-derived estimates of depression seem low given heightened exposure to risk factors and evidence that other indicators of psychological suffering like suicidality are disproportionately high in many Indigenous communities (Indian Health Service 2015). The validity of measures of internalizing symptoms across cultures has been previously critiqued (Nichter 2010), and our finding could be a signal that current operationalization of MDD misaligns with Indigenous expressions of distress (Kaufman et al 2013;O'Nell 1996).…”

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes

“…Depression is traditionally treated with a variety of modalities that include a combination of antidepressant medication, psychotherapy, and other somatic therapies (American Psychiatric Association, 2010). Kaufman and colleagues (2013), who analyzed data from a large representative psychiatric epidemiological study among AIs in two reservation communities, found that depression was related to family, cultural, or community dynamics—most likely all three – which has implications for treatment considerations for depression in AI individuals. Treatment interventions that address interpersonal relationships and family dynamics may be effective in treating depression that is related to family factors (Dirmaier et al, 2012; Brakemeir & Frase, 2012).…”

Disseminating the Results of a Depression Management Study in an Urban Alaska Native Health Care System

“…Behavioral health disorders in primary care are prevalent and potentially costly to patients and the health care system (Goldman, Wise, & Brody,1998; Greenberg, Fournier, Sisitsky, Pike, & Kessler, 2015; Kaufman, Beals, Croy, Jiang, & Novins, 2013; Kurian, Grannemann, & Trivedi, 2012; Miranda, Hohmann, Attkisson, & Larson, 1994; Ormel et al, 1994), yet these disorders are often under-recognized and, accordingly, untreated (Mulrow et al, 1995; Swartz & Rollman, 2003; Williams, Kerber, Mulrow, Medina, & Aguilar, 1995). Limited evidence indicates that depression is at least as common (if not more common) among AN/AI people than the general US population (Duran et al, 2004).…”