Mental health disparities, historical realities, and sociocultural barriers of american indians and alaska natives: A focus on suicide prevalence and prevention

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Indigenous Peoples: Perspectives, Cultural Roles and Health Care Disparities


American Indians and Alaska Natives (AI/AN) have experienced profound sociopolitical and economic hardship, characterized by a history of colonialism and racial oppression. These experiences have resulted in higher prevalence rates across a broad range of mental health difficulties, including depression, posttraumatic stress disorder (PTSD), anxiety, substance use disorders, and suicide, as compared to the general U.S. population (Beals et al., 2005; IHS, 2015). In this chapter, we provide a conceptual overview of the current state of the problem. We begin byproviding a framework for understanding these mental health disparities, including discussion regarding interpretations (material vs. psychosocial) designed to enhance our understanding of this phenomena, followed by a description of latent, pathway, cumulative and latent effects of disparities across the lifespan. We then review current research, including comparisons of lifetime prevalence rates for a variety of mental health consequences across AI/AN communities. In order to enhance our understanding of these disparities, we focus on suicidality, which represents one of the greatest discrepancies experienced among AI/AN individuals, and the leading cause of death due to mental health difficulties. Next, we critically examine risk and protective factors known to impact suicidality and other mental health disparities across AI/AN communities. This is followed by a discussion of the complex relationship between risk and protective factors, which provides a foundation for our recommendations. Finally, we conclude with an examination of indigenous epistemologies and cultural competence to prevention and early intervention that promote social justice within these communities.

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