Intergenerational Transmission of Ethnoracial Historical Trauma in the United States.

Throughout time, ethnoracial groups have endured a range of traumatic experiences as historically marginalized members of the United States. The consequences of these experiences have been referred to as historical trauma (HT): a collective trauma, inflicted on a group of people who share a specific identity, that has psychological, physical, and social impacts on succeeding generations. In this review, we examine the literature on HT in relation to US ethnoracial groups by defining HT, providing a background for its development, and describing critiques of the concept. We then review the literature on HT in relation to Indigenous Americans, African Americans, and Asian Americans. For each group, we address the nature of HT, the transmission of HT and its impacts, and healing strategies. We conclude with a summary of the benefits, limitations, and complexities of HT research as well as recommendations for future work in this area.

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust.

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

'Trauma sits in your body and makes you shut down:' sexual and reproductive health professionals' views of the impact of trauma on the sexual health of Native American older adolescent and young adult women.

A history of colonisation and corresponding traumas has resulted in disparate rates of violence and sexual health inequities among many Native American populations. As a result, Native American adolescents and young adults specifically, experience higher rates of STIs, HIV and unintended pregnancy relative to their non-Hispanic White counterparts. To address these inequities, sexual health education programmes should reflect Native American cultural values and traditional teachings to align with community assets and protective factors. The objective of this study was to describe sexual and reproductive health professionals' perspectives on how trauma collectively affects the sexual health of older adolescents and young adult Native American women between the ages of 15-25 years. We purposively sampled sexual and reproductive health professionals who worked with members of this priority population. Individual in-depth interviews were conducted, recorded, and transcribed. Transcripts were analysed using thematic analysis. The themes identified in the interviews include the impact of trauma and colonisation on sexual health, strategies for combatting trauma, promoting sexual health, and supporting the development of culturally congruent sexual health education curricula. Findings point to the need for culturally relevant, trauma-informed sexual health education interventions to help promote sexual and reproductive health equity for Native American adolescent and young adult women.

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Association between gene methylation and experiences of historical trauma in Alaska Native peoples.

BACKGROUND: Historical trauma experienced by Indigenous peoples of North America is correlated with health disparities and is hypothesized to be associated with DNA methylation. Massive group traumas such as genocide, loss of land and foodways, and forced conversion to Western lifeways may be embodied and affect individuals, families, communities, cultures, and health. This study approaches research with Alaska Native people using a community-engaged approach designed to create mutually-beneficial partnerships, including intentional relationship development, capacity building, and sample and data care. METHODS: A total of 117 Alaska Native individuals from two regions of Alaska joined the research study. Participants completed surveys on cultural identification, historical trauma (historical loss scale and historical loss associated symptoms scale), and general wellbeing. Participants provided a blood sample which was used to assess DNA methylation with the Illumina Infinium MethylationEPIC array. RESULTS: We report an association between historical loss associated symptoms and DNA methylation at five CpG sites, evidencing the embodiment of historical trauma. We further report an association between cultural identification and general wellbeing, complementing evidence from oral narratives and additional studies that multiple aspects of cultural connection may buffer the effects of and/or aid in the healing process from historical trauma. CONCLUSION: A community-engaged approach emphasizes balanced partnerships between communities and researchers. Here, this approach helps better understand embodiment of historical trauma in Alaska Native peoples. This analysis reveals links between the historical trauma response and DNA methylation. Indigenous communities have been stigmatized for public health issues instead caused by systemic inequalities, social disparities, and discrimination, and we argue that the social determinants of health model in Alaska Native peoples must include the vast impact of historical trauma and ongoing colonial violence.

Beyond resilience: A scoping review of Indigenous survivance in the health literature.

Health inequity scholars, particularly those engaged with questions of structural and systemic racism, are increasingly vocal about the limitations of "resilience." This is true for Indigenous health scholars, who have pushed back against resilience as a descriptor of modern Indigeneity and who are increasingly using the term survivance. Given the growing frequency of survivance in relation to health, we performed a scoping review to understand how survivance is being applied in health scholarship, with a particular interest in its relationship to resilience. Results from 32 papers indicate that health scholars are employing survivance in relation to narrative, temporality, community, decolonization, and sovereignty, with varying degrees of adherence to the term's original conception. Overwhelmingly, authors employed survivance in relation to historical trauma, leading us to propose the analogy: as resilience is to trauma, so survivance is to historical trauma. There may be value in further operationalizing survivance for health research and practice through the development of a unified definition and measurement tool, ensuring comparability across studies and supporting future strengths-based Indigenous health research and practice.

Pathways and processes to the embodiment of historical trauma secondary to settler colonialism.

AIM(S): This discursive article aims to examine how systemic factors of settler colonialism influence health outcomes among Indigenous peoples in the United States through pathways and processes that may lead to the embodiment of historical trauma. DESIGN: Discursive paper. METHODS: We completed a comprehensive search of empirical and grey literature between September 2022 and January 2023 in PubMed, CINAHL and Google Scholar. Using these articles as a foundation, we explored factors related to the pathways and processes leading to the embodiment of historical trauma rooted in settler colonialism. RESULTS: A conceptual framework of the pathways and processes of the embodiment of historical trauma secondary to settler colonialism was developed, and is presented. CONCLUSION: The societal and historical context for Indigenous peoples includes harmful settler colonial structures and ideologies, resulting in stressors and historical trauma that impact health outcomes and disparities through the phenomenon of the process of embodiment. IMPLICATIONS FOR NURSING: To provide holistic nursing care, nurses must be aware of settler colonialism as a determinant of health. They must be attuned to the pathways and processes through which settler colonial exposures may impact health among Indigenous peoples. Nurses must challenge existing structural inequities to advance health equity and social justice.

Clinically relevant historical trauma sequelae: A systematic review.

OBJECTIVES: The purpose of this systematic review (SR) was to present the current state of research on historical trauma, and the topics closely related to its semantic space that include intergenerational trauma, collective trauma, and extended cultural bodily and mental responses, in order to identify gaps in the literature that need to be addressed. METHODS: A search of empirical studies from 1990 to 2022 was performed via Scopus, Web of Science, MEDLINE, EBSCOhost-PsychInfo, and Embase, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. RESULTS: The initial search yielded 1012 studies, 52 of which were included in the current review. The results show that the historical trauma concept has a high potential for new research in the field of Global Mental Health. Gaps in the literature were identified, including a lack of standard features of historical trauma, and assessments of historical trauma in additional contexts than its original fields of application with Indigenous Americans. CONCLUSION: Although the introduction of the concept of historical trauma was intended to fill the gap of trauma-related difficulties not covered by the criteria of post-traumatic stress disorder (PTSD), this concept needs further scientific refinement.

TOWARD A HEALTHY SOCIETY: WHEN TRAUMA AFFECTS GROUP IDENTITY.

OBJECTIVE: The aim: The purpose of the article is to identify the essence and causes of collective trauma and reveal its consequences for group identity. PATIENTS AND METHODS: Materials and methods: The authors used an interdisciplinary approach along with the principles of objectivity, tolerance, and impartiality. The analysis of the texts was conducted according to the basic principles of hermeneutics, namely the inexhaustibility of the authentic text and immanent critique. In addition, the method of conceptual and categorical analysis was applied, as well as induction, deduction, generalization, etc. The data collection was carried out using PubMed, Scopus, Google Scholar databases. Research papers were identified according to search terms: "trauma", "traumatic experience", "collective trauma", "traumatization", "stress", "historical trauma", "defeat", "the Holocaust", etc. CONCLUSION: Conclusions: Collective trauma is a mental wound caused by the direct or indirect traumatic experience - a stressful situation that becomes a source of emo¬tional tension due to an unexpected threat to the life of a group of people. Collective trauma occurs, on the one hand, due to the awareness of helplessness in the face of danger and, on the other hand, due to the excessiveness of traumatic experience, which turns it into the eternal present and destroys identity. Historical traumas arise in the process of conscious exploitation of traumatic experience by political or other leaders in order to achieve emotional unity and group consolidation. Without appropriate processing, they can cause antisocial behavior of the traumatized persons that manifests in seeking revenge. Social partnership can help us to avoid the negative consequences of collective trauma and achieve social consensus.

Conceptualizing Mental Health Through Bhutanese Refugee Lens: Findings from a Mixed Methods Study.

Despite the rapidly growing need to understand mental health challenges faced by refugee subpopulations, there is a dearth of literature exploring mental health conceptualization through the unique refugee lens. Guided by historical trauma theory, we gathered data using a two-phase explanatory sequential mixed-methods study (quantitative: n = 40; qualitative: n = 6) in a Midwestern U.S. region to understand mental health conceptualization from the Bhutanese refugee perspective by examining the cultural meaning and perception of mental health, describing experiences of mental health problems, and examining cultural protective factors and coping strategies. We argue that recognition of refugees' conceptualization of mental health and identification of cultural protective factors is paramount to healing. Findings emphasize the need to understand historical and cultural perspectives in cross-cultural contexts for the development and implementation of culturally responsive services. Our study also contributes to emerging knowledge on methodological rigor in research among understudied, hard-to-reach, small populations.

Opioid use in indigenous populations: indigenous perspectives and directions in culturally responsive care.

In this work, we outline the necessary components for culturally responsive treatment to opioid use disorders in Indigenous communities. First, we examine the context of historical trauma faced by Indigenous groups in the U.S. and how this context may affect successful implementation of treatment. We then outline the strategies of Penobscot Nation and Little Earth in developing holistic treatment regimens for Indigenous peoples, and list policy interventions suited to improve outcomes for Indigenous groups related to opioid use disorders. We conclude with suggestions for future directions in anticolonial strategies for addressing opioid use in Indigenous communities. The combination of culturally responsive treatment, tribal sovereignty in the treatment of opioid use disorders, and effective resource allocation is necessary to affect positive change in Indigenous substance use trajectories.

An indigenous framework of the cycle of fetal alcohol spectrum disorder risk and prevention across the generations: historical trauma, harm and healing.

Objective: To build on Evans-Campbell's [2008. "Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities." Journal of Interpersonal Violence 23 (3): 316-338. doi:10.1177/0886260507312290.] multilevel framework of historical trauma and health by focusing on the cycle of fetal alcohol spectrum disorders (FASD) in the socio-cultural, historical, and interpersonal context of trauma shared by American Indian and Alaska Native (AI/AN) peoples.Methods: We analyzed qualitative data from focus groups with seventy four urban AI/ANs who were 15 years of age and older. Community-based participatory research methods were used for data collection and analysis. Our study explored knowledge and attitudes about FASD, perspectives on FASD risk factors, and culturally relevant approaches to FASD prevention and healthcare.Results: According to our study's participants, efforts to address FASD among urban AI/ANs should align with and emerge from community values, promote healing, consider the broader context that influences behaviors, and reflect the community's understanding that FASD risk behaviors are inextricably linked with historical and contemporary trauma.Conclusion: Effective, multiple-level FASD prevention approaches for AI/ANs may include prioritizing Indigenous culture, supporting intergenerational cohesion, focusing on non-stigmatic healing of traumas, and authentically engaging community knowledge. This work draws on community and cultural strengths in an effort to reduce the occurrence of substance-exposed pregnancies, and encourages transformational changes in systems that serve AI/AN peoples to promote a healthy and thriving community and future generations.

Health consequences of child removal among Indigenous and non-Indigenous sex workers: Examining trajectories, mechanisms and resiliencies.

The child protection system can be a highly consequential institution for mothers who are sex workers, yet scant attention has been paid to the health consequences of its policies on this population. Drawing on 31 in-depth, semi-structured interviews with 19 Indigenous and 12 non-Indigenous sex workers in Vancouver, Canada, and using the stress process model and the concept of slow violence, this study proposes a typology of four trajectories through which child removal by this system shaped sex workers' health. Results suggest that child removal has health consequences beyond the conventionally thought of mechanism of mental distress and related health sequelae, to additionally alter women's social conditions, which also carried risks for health. Notably, while trajectories of Indigenous and non-Indigenous sex workers were similar, Indigenous participants, whose families are disproportionately impacted by long-standing colonial policies of child removal, were more severely jeopardized. Findings highlight how child removal can enact violence in the form of reverberating harms to sex workers' health, further reinforcing their marginalized statuses. This study calls for greater attention to how the child protection system (CPS) may influence the health of marginalized mothers, including how health inequities may be both causes and consequences of interventions by this system.

Narrative frames as choice over structure of American Indian sexual and reproductive health consequences of historical trauma.

Emerging evidence suggests that the historical trauma associated with settler colonialism affects the sexual and reproductive health (SRH) of American Indian (AI) communities today. This article examines how one AI community narratively frames the influence of historical trauma within the context of community-based participatory research (CBPR) and the implications of this framing for health behaviours, internalized oppression, SRH outcomes, and future CBPR interventions. We found that AIs framed the SRH consequences of historical trauma with renderings that favoured personal choice over structural explanations. Our findings suggest future interventions could: (1) include educational components on historical trauma and the continued role settler colonialism plays in structural violence against AI bodies and communities; and (2) recognize the role that the individualized logic of westernized/white culture may play in the erasure of traditional collectivist AI culture, internalized oppression, and SRH.

Insights into fear: A phenomenological study of Black mothers.

AIM: The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN: A phenomenological approach was used. METHODS: Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS: Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION: Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT: Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.

An Integrated Historical Trauma and Posttraumatic Growth Framework: a Cross-Cultural Exploration.

Trauma recovery for racial and ethnic groups experiencing ongoing systemic violence and discrimination requires a framework that simultaneously addresses harms and strengths. Historical trauma (HT) is a social determinant of health emanating from targeted mass group-level harm. Posttraumatic growth (PTG) focuses on positive shifts in individuals coping with trauma. This article highlights the unique contributions of these two distinct bodies of literature to inform trauma recovery. We explore areas of overlap, gaps, and tensions between the concepts to present an HT-PTG conceptual framework. The HT-PTG framework combines HT's focus on socio-structural-historical experiences in racial and ethnic groups targeted for oppression with PTG's descriptions of characteristics of growth. Specifically, five mass group-level domains of growth, centering healing, creativity, growth, and transformation are described. The ancestral legacies of the authors, including American Indian, Indigenous Mexican, African American, Puerto Rican, and Indigenous Taiwanese, inform the HT-PTG framework. This paper presents implications for trauma-recovery research and practice.

"Being on the Walk Put It Somewhere in My Body": The Meaning of Place in Health for Indigenous Women.

Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally-specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.

Momentum and Longevity for Tribally Driven Health Equity Science: Evidence from the Gathering for Health Project.

American Indian health disparities have reached crisis levels, and there is a need to develop culturally congruent interventions through meaningful tribal involvement and ethical community-oriented approaches. Hence, it is imperative that researchers and university administrators better understand how research translation occurs for tribally driven health-equity research projects. Utilizing thematic analysis methods, the authors examined documents from a 12-year community-based participatory research partnership to elucidate factors that ignite momentum and support partnership longevity. The overarching finding was that trust and respect provide a foundation for momentum and longevity and are closely intertwined with other themes identified in analyses. Seven themes were extrapolated and classified into two domains: (1) investments, which are catalyzing factors that advance research, and (2) intermediate processes, which link investments to success. Investment themes include Indigenous scholar involvement, time and effort, establishing rapport, and clear and appropriate communication. Intermediate process themes include generative colearning, active participation, and recognition and celebration. Community-based participatory research principles were reflected in these findings. This study also upholds prior published work on Indigenous research methodologies, promotes the lived experiences of Indigenous people, and contributes to Indigenous theory building and science.

Comparing enhanced versus standard Diabetes Prevention Program among indigenous adults in an urban setting: a randomized controlled trial.

BACKGROUND: Indigenous people in the United States are at high risk for diabetes. Psychosocial stressors like historical trauma may impede success in diabetes prevention programs. METHODS: A comparative effectiveness trial compared a culturally tailored diabetes prevention program (standard group) with an enhanced one that addressed psychosocial stressors (enhanced group) in 2015 to 2017. Participants were 207 Indigenous adults with a body mass index (BMI) of ≥30 and one additional criterion of metabolic syndrome, and were randomized to the standard or enhanced group. Both groups received a culturally tailored behavioral diabetes prevention program. Strategies to address psychosocial stressors were provided to the enhanced group only. Change in BMI over 12 months was the primary outcome. Secondary outcomes included change in quality of life, and clinical, behavioral, and psychosocial measures at 6 and 12 months. RESULTS: The two groups did not significantly differ in BMI change at 12 months. The two groups also did not differ in any secondary outcomes at 6 or 12 months, with the exception of unhealthy food consumption; the standard group reported a larger mean decrease (95% CI) in consumption of unhealthy food compared with the enhanced group (- 4.6 [- 6.8, - 2.5] vs. -0.7 [- 2.9, 1.4], p = 0.01). At 6 months, significant improvements in weight and the physical component of the quality of life measure were observed for both groups compared with their baseline level. Compared with baseline, at 12 months, the standard group showed significant improvement in BMI (mean [95% CI], - 0.5 [- 1.0, - 0.1]) and the enhanced group showed significant improvement in the physical component of the quality of life (2.9 [0.7, 5.2]). CONCLUSIONS: Adding strategies to address psychosocial barriers to a culturally tailored diabetes prevention program was not successful for improving weight loss among urban Indigenous adults. TRIAL REGISTRATION: (if applicable): NCT02266576. Registered October 17, 2014 on clinicaltrials.gov. The trial was prospectively registered.

A Systematic Review of Trauma Interventions in Native Communities.

American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.