Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study.

OBJECTIVE: Our objective was to investigate change in prevalence rates for mental and substance abuse disorders between early adolescence and young adulthood in a cohort of indigenous adolescents who participated in an 8-year panel study. METHOD: The data are from a lagged, sequential study of 671 indigenous adolescents (Wave 1) from a single culture in the Northern Midwest USA and Canada. At Wave 1 (mean age 11.3 years, Wave 4 (mean age 14.3 years), Wave 6 (mean age 16.2 years), and at Wave 8 (mean age 18.3 years) the tribally enrolled adolescents completed a computer-assisted personal interview that included DISC-R assessment for 11 diagnoses. Our yearly retention rates by diagnostic wave were: Wave 2, 94.7 %; Wave 4, 87.7 %; Wave 6, 88.0 %; Wave 8, 78.5 %. RESULTS: The findings show a dramatic increase in lifetime prevalence rates for substance use disorders. By young adulthood, over half had met criteria of substance abuse or dependence disorder. Also at young adulthood, 58.2 % had met lifetime criteria of a single substance use or mental disorder and 37.2 % for two or more substance use or mental disorders. The results are compared to other indigenous diagnostic studies and to the general population. CONCLUSIONS: A mental health crisis exists within the indigenous populations that participated in this study. Innovations within current mental health service systems are needed to address the unmet demand of adolescents and families.

Correlates of homeless episodes among indigenous people.

This study reports the correlates of homeless episodes among 873 Indigenous adults who are part of an ongoing longitudinal study on four reservations in the Northern Midwest and four Canadian First Nation reserves. Descriptive analyses depict differences between those who have and have not experienced an episode of homelessness in their lifetimes. Multivariate analyses assess factors associated with a history of homeless episodes at the time of their first interview and differentiate correlates of "near homelessness" (i.e., doubling up) and "homeless episodes" (periods of actual homelessness). Results show that individuals with a history of homeless episodes had significantly more individual and family health, mental health, and substance abuse problems. Periods of homelessness also were associated with financial problems. Among the female caretakers who experienced episodes of homelessness over the course of the study, the majority had been homeless at least once prior to the start of the study and approximately one-fifth met criteria for lifetime alcohol dependence, drug abuse, or major depression. Family adversity during childhood was also common for women experiencing homelessness during the study.

Propensity for Violence among Homeless and Runaway Adolescents: An Event History Analysis*

Little is known about the prevalence of violent behaviors among homeless and runaway adolescents or the specific behavioral factors that influence violent behaviors across time. In this longitudinal study of 300 homeless and runaway adolescents aged 16-19 years at baseline, we use event history analysis to assess the factors associated with acts of violence over three years, controlling for individual propensities and time-varying behaviors. The results indicate that females, non-minorities, and non-heterosexuals were less likely to engage in violence across time. Those who met criteria for substance abuse disorders (i.e. alcohol abuse, alcohol dependence, drug abuse) were more likely to engage in violence. A history of caretaker abuse was associated with violent behaviors, as were street survival strategies such as selling drugs, participating in gang activity, and associating with deviant peers. Simply having spent time directly on the streets at any specific time point also increased the likelihood for violence.

Gestational risks and psychiatric disorders among indigenous adolescents.

This study reports on the effects maternal prenatal binge drinking, cigarette smoking, drug use, and pregnancy and birth complications on meeting criteria for psychiatric disorders at ages 10-12 and 13-15 years among 546 Indigenous adolescents from a single culture in the northern Midwest and Canada. Adolescent DSM-IV psychiatric disorders were assessed with the Diagnostic Interview Schedule for Children-Revised (DISC-R). Results indicate that maternal behaviors when pregnant have significant effects on adolescent psychiatric disorders even when controlling for age and gender of adolescent, family per capita income, living in a single mother household, and adolescent reports of mother's positive parenting.

A longitudinal examination of the measurement properties and predictive utility of the Center for Epidemiologic Studies Depression Scale among North American Indigenous adolescents.

We examined the longitudinal measurement properties and predictive utility of the Center for Epidemiologic Studies Depression Scale (CES-D) from early to late adolescence among a sample of North American Indigenous youths. Participants were 632 North American Indigenous adolescents (n = 632; 50.3% girls; M age at baseline = 11.11 years) participating in an 8-year, 8-wave longitudinal study. Via in-person interviews, participants completed the CES-D at Waves 1, 3, 5, and 7, and the major depressive disorder (MDD) module of the Diagnostic Interview Schedule for Children at Waves 1, 4, 6, and 8. Confirmatory factor analyses indicated that responses to the CES-D were similarly explained by 2-, 3-, and 4-factor models, as well as a 1-factor model with correlations between the error variances for the positively worded items. Longitudinal measurement equivalence analyses indicated full structural (i.e., factor structure), metric (i.e., factor loadings), and scalar (i.e., observed item intercepts) equivalence for each factor structure. Substantive analyses showed that the CES-D was significantly associated with MDD both concurrently and prospectively, although these effects were smaller than might be expected. Finally, the CES-D negative affect and somatic complaints subscales were the strongest and most consistent predictors of MDD. Among our sample of North American Indigenous youths, the measurement properties of the CES-D were stable from early to late adolescence. Moreover, somatic difficulties and depressed affect were the strongest predictors of MDD.

Factors Associated with Growth in Daily Smoking among Indigenous Adolescents.

North American Indigenous adolescents smoke earlier, smoke more, and are more likely to become regular smokers as adults than youth from any other ethnic group yet we know very little about their early smoking trajectories. We use multilevel growth modeling across five waves of data from Indigenous adolescents (aged 10 to 13 years at Wave 1) to investigate factors associated with becoming a daily smoker. Several factors, including number of peers who smoked at Wave 1 and meeting diagnostic criteria for major depressive episode and conduct disorder were associated with early daily smoking. Only age and increases in the number of smoking peers were associated with increased odds of becoming a daily smoker.

Pregnancy and mental health of young homeless women.

Pregnancy rates among young women who are homeless are significantly higher than rates among housed young women in the United States (J. M. Greene & C. L. Ringwalt, 1998). Yet, little research has addressed mental health or risk and resilience among young mothers who are homeless. Based on a sample from the Midwest Longitudinal Study of Homeless Adolescents, this study explores pregnancy and motherhood in unaccompanied homeless young women over a period of 3 years. The data are supplemented by in-depth interviews with a subset of young women. Results show that almost half (46.4%) of sexually active young women who are homeless (n=222, M age = 17.2) had been pregnant at baseline. Among those who stated they had children between Waves 2 and 13 (n=90), only half reported caring for their children consistently over time, and one fifth reported never seeing their children. Of the participants with children in their care at the last interview (Wave 13), almost one third met criteria for lifetime major depressive episode, lifetime posttraumatic stress disorder, and lifetime drug abuse, and half met criteria for lifetime antisocial personality disorder. Twelve-month diagnoses are also reported. The impacts of homelessness on maternal and child outcomes are discussed.

Tribal vs. Public Schools: Perceived Discrimination and School Adjustment among Indigenous Children from Early to Mid-Adolescence.

The purpose of this study is to assess the differential effects of perceived discrimination by type of school on positive school adjustment among Indigenous children during late elementary and early middle school years. The analysis utilizes a sample of 654 Indigenous children from four reservations in the Northern Midwest and four Canadian First Nation reserves. Multiple group linear growth modeling within a structural equation framework is employed to investigate the moderating effects of school type on the relationship between discrimination and positive school adjustment. Results show that students in all school types score relatively high on positive school adjustment at time one (ages 10-12). However, in contrast to students in tribal schools for whom positive school adjustment remains stable, those attending public schools and those moving between school types show a decline in school adjustment over time. Furthermore, the negative effects of discrimination on positive school adjustment are greater for those attending public schools and those moving between schools. Possible reasons for this finding and potential explanations for why tribal schools may provide protection from the negative effects of discrimination are discussed.

Depressive symptoms, gender, and growth in cigarette smoking among indigenous adolescents.

This study reports findings from two-level growth curve modeling of cigarette smoking and depressive symptoms based on the first three waves of data from a longitudinal study of Indigenous adolescents and their parents/caretakers in the northern Midwest and Canada. The 743 adolescents were aged 10-13 years at Wave 1 and 12-15 years at Wave 3. Over the three years of the study the overall retention rate was 93%. By Wave 3, 39% of the adolescent girls and 25% of the boys had smoked cigarettes in the past 12 months. The growth curve results indicated that smoking increased for both adolescent boys and girls across time. Depressive symptoms were associated with an increase in cigarette smoking for girls but not boys.