Melissa L. Walls

Diagnostic prevalence rates from early to mid-adolescence among indigenous adolescents: first results from a longitudinal study.

OBJECTIVE Investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. METHOD The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest United States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children-Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. RESULTS The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%-10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13- to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey-Replication (46.4%) for individuals 18 years and older. CONCLUSIONS A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them.

Mental Health and Substance Abuse Services Preferences among American Indian People of the Northern Midwest

ABSTRACTThis study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.

Substance Abuse Prevention in American Indian and Alaska Native Communities

In this article we review three categories of American Indian/Alaska Native (AIAN) substance abuse prevention programs: (1) published empirical trials; (2) promising programs published and unpublished that are in the process of development and that have the potential for empirical trials; and (3) examples of innovative grassroots programs that originate at the local level and may have promise for further development. AIAN communities are taking more and more independent control of substance abuse prevention. We point out that European American prevention scientists are largely unaware of the numerous grassroots prevention work going on in AIAN communities and urge a paradigm shift from adapting European American prevention science “best practices” to creating cultural “best practices” by working from inside AIAN communities.

Strain, Emotion, and Suicide Among American Indian Youth

In this article, we test the utility of Agnews general strain theory to explain suicidal behaviors among American Indian youth. Data from 721 American Indian adolescents from the Midwest and Canada were collected in partnership with participating reservations/reserves and a research team. We investigate the effects of strains/stressors on suicide, including tests of mediating effects of negative emotions on relationships between stressors and suicidality. We found that several strains/stressors were related to suicidality, including coercive parenting, caretaker rejection, negative school attitudes, and perceived discrimination. We also found that depressive symptoms and anger mediated the effects of several key predictors of suicidality. We discuss the theoretical and policy implications of our work for the general strain theory and for American Indian suicide in general.

Experiences of Mentors Training Underrepresented Undergraduates in the Research Laboratory

The goal of this research was to better understand the experiences and perspectives of mentors in a program designed to increase the number of American Indian students garnering PhDs. Challenges and benefits associated with mentoring undergraduates were identified through semistructured interviews.

The Intergenerational Effects of Relocation Policies on Indigenous Families

This research uses life course perspective concepts of linked lives and historical time and place to examine the multigenerational effects of relocation experiences on Indigenous families. Data were collected from a longitudinal study currently underway on four American Indian reservations in the Northern Midwest and four Canadian First Nation reserves where residents share a common Indigenous cultural heritage. This article includes information from 507 10- to 12-year-old Indigenous youth and their biological mothers who participated in the study. Results of path analysis revealed significant direct and indirect effects whereby grandparent-generation participation in government relocation programs negatively affects not only grandparent-generation well-being but also ripples out to affect subsequent generations.

Distress among Indigenous North Americans Generalized and Culturally Relevant Stressors

Stress process and life-course models of mental distress emphasize sociocultural and historical processes that influence stress exposure and the impact of stress on mental health outcomes. Drawing from these theoretical orientations as well as concepts from the historical trauma literature, the authors examine the effects of culturally relevant and more generalized sources of stress on distress among North American Indigenous adults and test for the potential cumulative and interactive effects of stress on distress across the life course via self-reported early childhood and adult and contemporary stressors. Results of ordinary least squares regression analyses reveal positive, significant associations between general stressors and distress as well as culturally meaningful stressors and distress. In addition, the authors found evidence of the accumulating and interactive impact of stress on psychological distress.

Unconscious Biases: Racial Microaggressions in American Indian Health Care

Purpose: This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM). Methods: This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM. Results: Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. Conclusions: Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

Marijuana and Alcohol Use during Early Adolescence: Gender Differences among American Indian/First Nations Youth:

This study examines the growth of alcohol and marijuana use during early adolescence among a sample of 746 Indigenous youth (aged 10–12 years at wave 1; 50.3% female) of the upper Midwest and Canada, with a special focus on potential gender differences in these patterns. Research documenting the disproportionately high rates of Indigenous substance use, coupled by our lack of understanding of gender patterns among this group—especially in very early adolescence—highlight the need for this culturally specific work. Results of latent growth curve analyses from three waves of annual data collection indicate that the females in our sample engage in alcohol and marijuana use at rates similar to or greater than their male peers. This finding counters conventional ideas of gender and substance use that place young males at elevated rates of use compared to females, and also adds to our understanding of gendered substance use patterns among Indigenous youth.

Suicidal ideation among Métis adult men and women – associated risk and protective factors: findings from a nationally representative survey

OBJECTIVE To determine the prevalence of suicidal ideation among Métis men and women (20-59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006). STUDY DESIGN Secondary analysis of previously collected data from a nationally representative cross-sectional survey. RESULTS Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor. CONCLUSION The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.Objective. To determine the prevalence of suicidal ideation among Métis men and women (20–59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006). Study design. Secondary analysis of previously collected data from a nationally representative cross-sectional survey. Results. Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor. Conclusion. The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.OBJECTIVE To determine the prevalence of suicidal ideation among Métis men and women (20-59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006). STUDY DESIGN Secondary analysis of previously collected data from a nationally representative cross-sectional survey. RESULTS Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor. CONCLUSION The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.