A Systematic Review of Mental Health Interventions That Address Historical Trauma Amongst Indigenous Peoples

Background/Purpose: Mental disorders is one of the leading causes for hospitalization within Indigenous Peoples (IP). IP appear to suffer from disproportionate high rates of suicidal behaviors, alcohol abuse/dependence and PTSD. Indigenous scholars have suggested that these mental health disparities stem from historical trauma (HT) (Brave Heart, Elkins, Tafoya, Bird & Salvador, 2012), and that HT should be at the center of designing preventive and therapeutic treatments for IP (McLeigh, 2010).  Despite the emphasis on HT, the use and efficacy of HT interventions have not been examined in systematic reviews of culturally appropriate interventions for IP. The purpose of this study was to systematically review the literature for mental health interventions that are 1) culturally appropriate and 2) that address HT among IP in the U.S.

Methods: The authors conducted a systematic review of the literature to identify both published and unpublished studies using six electronic databases, grey literature sources and consultations with experts in the area. Eligible studies were mental health intervention studies for IP that addressed HT. Two authors independently examined and assessed bias risks of 729 articles. 714 articles were excluded because they did not meet the criteria (inter-rater reliability rate of 98.1%). After in-depth readings of the 15 articles and data from 4 articles were extracted and included in the final analysis.

Findings: Four studies comprising 563 participants (mean age range 13.1 - 41.4 years) met inclusion criteria of being treated with mental health interventions that addressed HT. Results showed that addressing HT in mental health interventions significantly reduced the symptoms of historical loss and trauma (i.e. depression, anxiety) and improved coping skills. One study reported that 89.3% of participants found the intervention helpful in reducing HT symptoms. Another study found that the difference between baseline HT scale symptom scores and a 6-month follow up yielded significant results t(9) = 1.65, p <0.10 (d = .14). However, one study found that the intervention did not successfully maintain psychological benefits. The most successful interventions incorporated traditional healing methods from tribal practices (e.g. talking circles) into the mental health intervention.         

Conclusions and Implications: This study adds to the social work field because it is the only systematic review to investigate interventions that address HT in addition to treating mental health disorders amongst IP in the U.S. Our results indicated a positive association between these interventions and reducing HT outcomes. However, due to the limited number of studies, the heterogeneity of research findings and the methodological limitations suffered by the included studies, no definite conclusions about the interventions can be drawn.

 The design of culturally appropriate and effective treatments is a social justice issue for the field of social work. This systematic review is the first step in encouraging not only the development of interventions that address HT, but also the evaluation of these interventions so that we can better facilitate the healing process for IP.