Spero M. Manson

The Psychiatric Effects of Massive Trauma on Cambodian Children: I. The Children

This report, which uses standardized interviews by psychiatrists, describes the psychiatric effects on 40 Cambodian high school students in the United States who suffered massive trauma from 1975 to 1979. They endured separation from family, forced labor and starvation, and witnessed many deaths because of the Pol Pot regime. After 2 years of living in refugee camps, they immigrated to the United States at about age 14. Four years after leaving Cambodia, 20 (50%) developed posttraumatic stress disorder; mild, but prolonged depressive symptoms were also common. Psychiatric effects were more common and more severe when the students did not reside with a family member.

Research in American Indian and Alaska Native communities: navigating the cultural universe of values and process.

The National Institutes of Healths guidelines for recruiting ethnic minorities and women into clinical research have raised numerous questions among investigators. Highlighted in this article are a number of important issues for those researchers seeking to include American Indians and Alaska Natives in their studies; that is, defining the population of American Indians and Alaska Natives for inclusion in a study, participation of the tribes in research and approval by the Institutional Review Board, issues of confidentiality and anonymity of individuals and tribes, identifying potential benefits to American Indian and Alaska Native communities, and the importance of evaluating the scientific merit of a proposed study. Awareness and a commitment to ongoing education regarding these issues will enhance the quality and benefits of research among American Indian and Alaska Native people.

The place of culture in DSM-IV.

This paper critically reviews the process and outcome of an effort to enhance the cultural validity of DSM-IV and outlines recommendations to improve future diagnostic systems. An ordered presentation of the antecedents and the main phases of this developmental effort is followed by a content analysis of what was proposed and what was actually incorporated, and a conceptual analysis of underlying biases and their implications. The cultural effort for DSM-IV, spearheaded by a scholarly independent NIMH workgroup, resulted in significant innovations including an introductory cultural statement, cultural considerations for the use of diagnostic categories and criteria, a glossary of culture-bound syndromes and idioms of distress, and an outline for a cultural formulation. However, proposals that challenged universalistic nosological assumptions and argued for the contextualization of illness, diagnosis, and care were minimally incorporated and marginally placed. Although a step forward has been taken to introduce cultural elements in DSM-IV much remains to be done. Further culturally informed research is needed to ensure that future diagnostic systems incorporate a genuinely comprehensive framework, responsive to the complexity of health problems in increasingly multicultural societies.

Ethnic Minority Older Adults Participating in Clinical Research: Developing Trust

Objectives:African American, Latino, and American Indian older adults are underrepresented in clinical research studies. A significant barrier to participation in research is mistrust of the scientific community and institutions. The aims of this article are to discuss the lack of representation of ethnic minorities in clinical research. Methods:This article presents a review of the literature regarding medical research mistrust. Also described are the trust-building activities of the Resource Centers on Minority Aging Research (RCMAR), federally funded centers focused on research and aging in communities of color. Discussion:The RCMAR centers are building trust with the communities they serve, resulting in the recruitment and retention of ethnic minority older adults in clinical research studies and health promotion projects. Implications are discussed for other researchers toward building trust with ethnic minority elders to increase their participation in research.

Cultural specificity and comparison in psychiatric epidemiology: Walking the tightrope in american indian research

Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences—most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)—to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts.

Social Epidemiology of Trauma Among 2 American Indian Reservation Populations

OBJECTIVES We examined the prevalence of trauma in 2 large American Indian communities in an attempt to describe demographic correlates and to compare findings with a representative sample of the US population. METHODS We determined differences in exposure to each of 16 types of trauma among 3084 tribal members aged 15 to 57 years through structured interviews. We compared prevalence rates of trauma, by gender, across the 2 tribes and with a sample of the US general population. We used logistic regression analyses to examine the relationships of demographic correlates to trauma exposure. RESULTS Lifetime exposure rates to at least 1 trauma (62.4%-67.2% among male participants, 66.2%-69.8% among female participants) fell at the upper limits of the range reported by other researchers. Unlike the US general population, female and male American Indians exhibited equivalent levels of overall trauma exposure. Members of both tribes more often witnessed traumatic events, experienced traumas to loved ones, and were victims of physical attacks than their counterparts in the overall US population. CONCLUSIONS American Indians live in adverse environments that place them at high risk for exposure to trauma and harmful health sequelae.

Spirituality and attempted suicide among American Indians

American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15-57yr) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (p(trend) for Christianity=0.22 and p(trend) for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (p(trend)=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality.

The Prevalence of Posttraumatic Stress Disorder Among American Indian Vietnam Veterans: Disparities and Context

This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.

Psychiatric Disorder Among American Indian Adolescents: Prevalence in Northern Plains Youth

UNLABELLED This article presents data on the prevalence of psychiatric disorders among American Indian adolescents, using DSM-III-R criteria. OBJECTIVE To generate current prevalence data using a structured diagnostic instrument, the Diagnostic Interview Schedule for Children, Version 2.1C (DISC-2.1C). METHODS Youths from a Northern Plains tribe who had participated in an earlier study comprised the sample. At reinterview, respondents were between 14 and 16 years of age, when Indian adolescents are thought to be at particularly high risk for manifesting emotional disorders. One hundred nine of the original sample of 251 were still in schools on the reservation. Trained indigenous lay interviewers administered the DISC-2.1C to respondents in a private setting within the school. RESULTS The findings indicate that rates of some psychiatric problems (e.g., disruptive behavior disorders, substance-related disorders, and their comorbidity) are high among these high school students. CONCLUSIONS These data, as well as national statistics, suggest that, compared with non-Indian populations, a greater percentage of Northern Plains adolescents manifest significant psychiatric symptoms which warrant treatment.

Measuring Bicultural Ethnic Identity among American Indian Adolescents A Factor Analytic Study

Based on the premise that ethnic identity provides a fruitful approach to exploring issues related to ethnicity, an empirically based strategy was used to develop a measure of ethnic identity among American Indian adolescents. Because American Indians live in two worlds, a bicultural approach was drawn on to measure the degree that respondents identified with Indian culture and with the mainstream or White culture. An exploratory factor analysis was used to examine the structure of ethnic identity among Indian adolescents and the resulting models were tested with confirmatory factor analysis. A scale for measuring bicultural ethnic identity was developed and the reliability and validity of the scale was assessed.