Mapping the Interventions for American Indian and Alaska Native Youth Mental Health

Background: Suicide is the second leading cause of death for Native youth aged 15-24. Similarly, Native youth have a suicide rate 1.5 times higher than the general population and are at higher risk for depression and substance use. Native youth are at higher risk for depression, substance abuse, and suicide due to high levels of economic and social disadvantage, acculturation stress, and the history of relocation, discrimination, and trauma. Mental and behavioral health issues, stressful life events, and substance use are associated with increases in suicide risk. A persistent need remains for culturally specific mental health interventions for American Indian youth.

Methods: In response to the push for evidence-based practices, evidence mapping has emerged as systematic, rigorous, and replicable analysis of evidence. Preliminary search criteria yielded a total of 613 articles. The vast majority of the articles were excluded from the study based upon search criteria. As a result, a total of 9 interventions were included in the study. While our findings may appear to be based on a small number of articles, these results are similar to previous work examining mental health interventions for AI/AN populations.

Results: A total of 9 interventions were mapped as evidence-based practices for American Indian mental health. The interventions fell into one or more of four main categories: school-based services, cultural adaptations, culture as treatment, and community involvement. While results are presented under four main headings, it is worth noting that considerable overlap existed among the interventions. Some studies included community involvement although they were administered in school-based settings. Most studies included cultural aspects and incorporations but were not solely focused on using culture as the entire intervention. Given the state of research within American Indian mental health, it is our recommendation to push for an increase in outcome studies evaluating evidence-based practices, practice-based evidence, and promising practices. It is also important to consider the restrictions of evidence-based practices and evaluate the actual evidence about the efficacy of interventions, rather than limiting practices solely to those measured in randomized control trials. Ultimately, it is of the utmost importance to honor tribal sovereignty and self-determination, especially in research practice, whether it be through the adaptation of other evidence-based practices or the creation of interventions utilizing culture as treatment. 

Conclusion and implications: Given the current state of mental health within Indian Country, it is vital for practitioners to not only be aware of prevalence statistics documenting the issues Native people face, but to actively seek to incorporate culturally-grounded population-specific interventions to address these disparities. Evidence mapping is important to bridge the gap between research and practice. Results of this study demonstrate the strength of culturally specific mental health interventions for American Indian youth. Future research should seek to evaluate promising practices for American Indian youth in order to increase available evidence-based practices. Future research should seek to combine Indigenous approaches with Western practices, focus on holistic wellness including co-occurring disorders, historical trauma, and poverty.