Culturally Relevant Risk and Protective Factors Related to Depression Among U.S. Indigenous Peoples: Why Historical Oppression and Family Resilience Matter

Background and Purpose: The suicide rate for Indigenous peoples in the United States (American Indian and Alaska Natives) is 1.6 times that of the non-Indigenous peoples (Indian Health Service, 2016). Because depression is often an underlying contributor to suicidality, ameliorating depressive symptoms among Indigenous peoples is integral to addressing this health disparity. Moreover, Indigenous peoples experience a distinct context of historical oppression that is thought to give rise to disparities, such as depression. Informal and sustainable helping systems, in the forms of family resilience and other protective factors, are thought to have sustained Indigenous peoples despite experiencing oppression.  However, to our knowledge, no Indigenous-specific framework has been used to explain or understand the disproportionate rates of depression. The purpose of this paper is to use the culturally specific framework of Historical Oppression, Resilience, and Transcendence to identify risk (historical oppression, including disproportionate levels of proximal stressors) and protective (family resilience) to understand depressive symptoms. 

Methods: As part of a larger convergent mixed-methods design, the focus of this presentation is reporting on the follow-up survey that was created from qualitative ethnographic research with 436 Indigenous participants. A cross-tribal sample of 127 Indigenous peoples completed a follow-up survey. Demographic variables and several risk (adverse childhood events, daily hassles, historical oppression) and protective (individual resilience, family resilience, enculturation, and satisfaction with life) factors were used to predict depressive symptoms. We analyzed demographic variables, bivariate relationships, and predictor variables using linear regression. 

Results: With respect to the depressive symptoms, the average PHQ-9 score was 15.3, which corresponds with moderately severe depression. The respondent’s age, gender and tribal affiliation, as well as enculturation score, were not significantly associated with depressive symptoms in the bivariate analyses.  The multivariate linear regression model produced an R² = .567, F (7, 108) = 20.24, p = .000.  Historical oppression (β = .18, p = .011) and daily hassles (β = .34, p = .000) had significant positive regression weights, indicating respondents with higher scores on these measures had higher depressive symptoms.  A negative relationship was found between family resilience and depressive symptoms (β = -.23, p = .003), as well as income and depressive symptoms (β = -.22, p = .001), indicating that respondents with higher family resilience or higher income levels had lower depressive symptoms.

Conclusions and Implications: The model explained almost 60% of the variance related to depressive symptoms, indicating preliminary support for the Framework of Historical Oppression, Resilience, and Transcendence, indicating that historical and contemporary forms of oppression give rise to health disparities, such as depression; yet, family resilience can buffer against some health disparities. Results demonstrate that despite experiencing centuries of historical oppression, our results show that families are critical to the strength, resilience, and transcendence that are continually demonstrated among Indigenous communities. Family-focused, strengths based, and culturally relevant intervention and prevention approaches are recommended.

References

Indian Health Service. (2016). Disparities. Retrieved from American Psychological Association. (2010). APA fact sheet, mental health disparities: American Indian and Alaska Natives. Retrieved from http://www.psych.org/Share/OMNA/Mental-Health-Disparities-Fact-Sheet--American-Indians.aspx