Academic journal article International Public Health Journal

Risk and Protective Factors Related to the Wellness of American Indian and Alaska Native Youth: A Systematic Review

Academic journal article International Public Health Journal

Risk and Protective Factors Related to the Wellness of American Indian and Alaska Native Youth: A Systematic Review

Article excerpt


A goal of the United States Affordable Health Care Act is to move the nation a step closer toward health equity, a priority of the Healthy People 2020 initiative (1, 2). If health equity, or reaching and maintaining the highest health for all people, is a desired outcome, then understanding the current inequalities is of utmost importance (2). American and Alaska Natives (AI/AN) inequities experience some of the most widely documented health disparities in the United States (3, 4). This is due, in part, to the disconnect between the paradigms employed in mainstream social work practice and research and the worldviews more salient among AI/AN populations (5, 6). For example, rather than separating mental health from physical health, many AI/AN populations value the strong connection between physical, mental, emotional and spiritual health (7, 8); emotional health is viewed from a perspective of wellness (7,8). We argue that the AI/AN nations deserve medical and mental health services that complement their cultural heritage that have sustained them for many centuries. We define wellness as the balance between the intertwined mind, body, soul, and spirit, (7). Researchers recommend this holistic and strengthsbased perspective about health (7, 8). Therefore, this systematic review focuses on wellness, which we view as resilience in the form of prosocial emotional and academic outcomes, as well as mental health disparities.

With a trust responsibility, based on treaty agreements with sovereign tribes requiring the United States federal government to provide for the healthcare of AI/AN populations in exchange for 400 million acres of land (9), a critical barrier to health equity among AI/AN populations exists. Great heterogeneity exists across AI/AN populations, and research consistently finds significant differences in prevalence of mental health disparities across these populations (3, 4, 10-12). Despite this variability, psychiatric distress in the form of mental health disorders tends to be disproportionately high across populations (3).

AI/ANs represent over five million people and 1.7% of the U.S. population (13). With rapidly changing demographics, AI/ANs increased by almost twice the rate of the general U.S. population between the years 2000 and 2010. In total, 78% of AI/ANs live off of reservation land (13). Yet, this percentage differs among people who identify as either multiethnic or solely AI/AN, with more AI/AN's living off of reservation land in the former than the latter (13). On average, these populations are more likely to live in poverty, experience violent victimization and traumatic loss, domestic violence, and educational inequities than non-AI/AN populations (4). AI/AN youth between the ages of 12 and 19 are more likely than non-AI/AN youth to experience serious violent crime and be affected by a sudden traumatic death (4). Rates of witnessing intimate partner violence and experiencing child maltreatment are also elevated (4). Given the disproportionately high rates that AI/AN youth experience inequity in income and education, as well as traumatic stressors, it is not surprising that many also experience mental health disparities (4).

Resilience among AI/AN youth

Although the research available on AI/AN youth is relatively small, studies document elevated rates for substance use disorders, conduct and oppositional defiant disorders, attention deficit-hyperactivity disorders, and posttraumatic stress disorders (PTSD) (3,4). Moreover, the suicide rate for AI/AN youth ranges from three to six times higher than non-AI/AN peers (4). Indeed suicide is the 2nd leading cause of death for AI/ANs ages 15-34 years (14).

With these concerning statistics, the fact that the majority of AI/AN youth are healthy and not experiencing mental health disparities can often be overlooked (12). Despite the undoubted resilience of AI/AN populations after centuries of historical trauma, loss, and oppression, current research tends to focus on risk factors (15). …

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