Family Resilience and Violence in Families: Identifying Protective and Risk Factors Driving Mental Health Disparities Among U.S. Indigenous Peoples

Background and Purpose:  Mental health disparities among Indigenous peoples of the U.S. (American Indians, Alaska Natives, and Native Hawaiians) tend to be among the most salient relative to other populations; yet, culturally-specific protective factors, such as family resilience, are also of critical importance. Reported mental health disparities among Indigenous peoples include, depression and suicide, substance abuse, anxiety, and posttraumatic stress disorder (PTSD). The disproportionately high rates of violence in families (intimate partner violence (IPV)) and adverse childhood experiences (ACEs) likely contribute to these mental health disparities. Because family is the bedrock of Indigenous strength and resilience, family resilience may be an untapped resource for offsetting risks for poor mental health outcomes. The purpose of this study was to examine risk (IPV, ACEs) and protective factors (family resiliency, social support, community resources) related to mental health (depression, anxiety, PTSD, alcohol abuse) among Indigenous peoples of the U.S.

Methods: Using data collected from an online survey of 127 members of two Southeastern Indigenous tribes, we used a series of hierarchical regressions to examine the relation between ACEs, IPV, family resiliency, social supports, and the availability of community resources and depression, anxiety, PTSD, and alcohol abuse.

Results: Consistent with our hypotheses, we found victimization and family resilience each accounted for a unique portion of the variance in mental health outcomes. Results of the final models showed IPV was positively associated with depression (B = .39, p = .05, 95%CI .013, 1.03) and alcohol abuse (B = .35, p < .001, 95%CI .10, .31). ACEs were positively associated with anxiety (B = .27, p = .01, 95%CI 14, 1.05), PTSD (B = .23, p = .04, 95%CI .01, .30), and alcohol abuse (B = .28, p = .01, 95%CI .03, .25). Conversely, family resilience was negatively associated with depression (B = -.41, p <.001, 95%CI -1.17, -.51), anxiety (B = -.32, p < .001, 95%CI -.86, -.27), and PTSD (B = -.20, p = .02, 95%CI -20, -.01) but not alcohol abuse (B = .37, p = .37, 95%CI -.10, .04).  

Conclusions & Implications: These results support the notion that family violence is a risk factor for poor mental health and may drive such health disparities. Yet, family resilience was protective, indicating the need to bolster naturally-occurring, informal support networks to whom Indigenous peoples tend to turn. Given the relevance of family to resilience, mental health, and violence, family-based and culturally-grounded approaches to holistically addressing social and health disparities are warranted.