Analysis of Socioeconomic Status on Behavioral Health in American Indian and Alaska Native (AI/AN) Populations: Examining Stress As a Moderator and Traditional Cultural Coping Practices to Mitigate Adverse Outcomes

Background: Research shows that AI/ANs have a lower life expectancy and quality of life compared to others, facing higher rates of chronic diseases and behavioral health issues. A national study indicated psychiatric disorders, particularly PTSD and substance use disorders, are more common among AI/ANs than non-Hispanic Whites (Soto et al., 2022). Socioeconomic determinants, like education and income, likely contribute to these increased issues.

Socioeconomic status (SES), which includes income, education, occupational prestige, and social class perceptions, impacts quality of life and predicts health outcomes. Material resources define objective SES, while subjective SES reflects perceived position, influenced by income, education, and sometimes occupation status (Coustaury et al., 2023). This study examines subjective SES with household income and education as predictor variables.

Socioeconomic challenges, among others, undermine cultural resilience in AI/ANs, worsening mental health disparities and heightening substance use and stress. Richardson et al. (2024) reported an increase in substance use during the COVID-19 pandemic; however, data on the impact of stress and how traditional coping practices mitigate disparities are limited. This study will examine SES, suicidal ideation, mental health issues (including depression and anxiety), and substance use (such as alcohol, tobacco, marijuana, and non-medical prescription drugs) in the AI/AN population during the pandemic.

Methods: A total of 8,877 adults identifying as AI/AN were surveyed via the National Native American COVID-19 Needs Assessment (NACA) in 2021. This survey was conducted utilizing a Qualtrics platform, and a snowball sampling method was employed in collaboration with AI/AN stakeholders. The assessment examined various factors, including demographics, sources of COVID-19 pandemic stress, coping strategies, suicidal ideation, and behavioral health.

Results: At least 42% reported pandemic-related stress across all income and education levels, but those earning less than $50,000 utilized traditional coping methods more than those earning $50,000. Ordinal logistic regression showed that AI/ANs with a household income of $50,000 or more and an associate or technical degree have an 8% lower likelihood of experiencing depression and a 12% lower likelihood of reporting pandemic-related stress compared to those with a H.S. diploma or GED (p< 0.05). However, they face a 23% greater likelihood of increased alcohol and non-medical prescription drug use due to pandemic-related stress (p< 0.05). Conversely, AI/ANs with an income of less than $50,000 and an H.S. diploma/GED or less have a 14% lower likelihood of suicidal ideation (p< 0.05). Still, this gap lessens by 15% (p< 0.05) with traditional cultural coping practices compared to those who do not practice them.

Conclusions: During the COVID-19 pandemic, AI/ANs with higher household incomes reported increased levels of depression, substance use, and suicidal ideation compared to those with lower incomes. In addition, AI/ANs with higher incomes and bachelor’s degrees or higher reported fewer traditional coping practices and experienced greater stress. This research highlights the need for culturally responsive interventions and further studies on behavioral health disparities in the AI/AN community, particularly for a more nuanced understanding of the effects of household income and education.