Hope, help, and healing: Culturally embedded approaches to suicide prevention, intervention and postvention services with native Hawaiian youth.

Suicide rates have reached their highest documented levels in the United States with the greatest increases among indigenous youth, including Native Hawaiians. Culturally informed, effective prevention and treatment services are needed now more than ever for Native communities to heal and flourish. Multicomponent prevention and service strategies rooted in indigenous values and approaches show the most promise. Native Hawaiian communities are united around a common goal of suicide prevention, intervention and postvention, linking cultural meanings to improve understanding and guide local efforts. This paper highlights important cultural values to consider when developing and implementing suicide prevention, intervention and postvention. Strategies build upon the strengths of Native Hawaiian youth and their respective communities. Native Hawaiian sayings anchor each level and serve to organize a set of culturally informed and culturally embedded programs and approaches along the continuum of prevention, intervention and postvention. Application of indigenization to suicide prevention enhances connections to people and place, inspiring hope among Native Hawaiian youth, their families and their communities. (PsycINFO Database Record

The National Center on Indigenous Hawaiian Behavioral Health study of prevalence of psychiatric disorders in native Hawaiian adolescents.

OBJECTIVES: The prevalence rates of disorders among a community-based sample of Hawaiian youths were determined and compared to previously published epidemiological studies. METHOD: Using a two-phase design, 7,317 adolescents were surveyed (60% participation rate), from which 619 were selected in a modified random sample during the 1992-1993 to 1995-1996 school years: 590 selected randomly and 29 at risk (i.e., Center for Epidemiologic Studies-Depression score of >or=35 and suicidal risk) from grades 9-12. The Diagnostic Interview Schedule for Children-Version 2.3, was used to determine DSM-III-R diagnoses. Prevalence rates, weighted for ethnicity, Center for Epidemiologic Studies-Depression scores, and suicide attempts, were calculated for any diagnosis and various disorders. Meta-analyses compared the Hawai'i sample to four community-based studies (randomly selected youths from community populations) and two high-risk studies (homeless, low-income, or high unemployment communities). RESULTS: Hawaiian females had the highest rate for any diagnosis (37.7%; 95% confidence interval [CI] 28.4%-48.0%) and non-Hawaiian males had the lowest rate (19.6%; 95% CI 14.8%-25.5%). Hawaiian males (26.8%; 95% CI 18.2%-37.5%) and non-Hawaiian females (27.9%; 95% CI 22.2%-34.4%) had intermediate and comparable rates. Overall, Hawaiians had significantly higher rates (32.7%; 95% CI 26.1%-40.1%) than non-Hawaiians (23.7%; 95% CI 19.9%-28.0%) when controlling for gender, and girls had significantly higher rates (30.8%; 95% CI 25.8%-36.3%) than boys (21.1%; 95% CI 16.8%-26.1%) when controlling for ethnicity. These findings were primarily the result of the significant differences in rates regarding anxiety disorders. Meta-analyses showed the Hawaiian youth rate for any diagnosis was comparable to high-risk studies and nearly three times higher than the community studies. CONCLUSIONS: Hawaiian youths, especially females, are at high risk. Research on the sociocultural factors that underpin both the genesis of and protection from psychopathology is imperative for Hawaiian and non-Hawaiian mixed-ethnicity youths.

Resilience, family adversity and well-being among Hawaiian and non-Hawaiian adolescents.

BACKGROUND: Minorities and indigenous peoples are likely to have poor mental health and physical outcomes. This study examines resiliency indicators in Hawaiian adolescents. AIMS: Multiple resiliency indicators were examined across different domains including individual, family and community in relation to increased psychological well-being. METHODS: Existing data from the Native Hawaiian Mental Health Research Development Program (NHMHRDP) were used. These data included information from a community sample of five high schools on three islands from the state of Hawai'i. The sample included 1,832 students, where 64% were Native Hawaiian and 36% were non-Hawaiian. RESULTS: This study found that Native Hawaiian youth experienced more family adversity compared with non-Hawaiians, but Native Hawaiians were also more likely to have higher levels of family support. For internalizing symptomatology, the most robust resiliency factors were family support and physical fitness/ health for Native Hawaiian and non-Hawaiian adolescents. For externalizing symptomatology, achievement and family support were consistently strong resiliency factors. The indicator for physical fitness and health was more influential among Native Hawaiians than non-Hawaiians for externalizing symptoms, while academic achievement was more influential among non-Hawaiians than for Native Hawaiians for the protection against internalizing symptoms. CONCLUSIONS: Our findings support the need for intervention programs designed to promote resilience in adolescents, including highlighting the importance of the family. Further research is needed to design and evaluate programs that promote well-being, enhance resilience and improve mental health in culturally appropriate ways.

Demographic and social variables associated with psychiatric and school-related indicators for Asian/Pacific-Islander adolescents.

BACKGROUND: Factors associated with Asian/Pacific-Islander adolescent adjustment is a greatly neglected research area. AIMS: The purpose of the present study was to investigate the relation between demographic, social and adjustment measures based on a large-scale investigation of Asian/Pacific-Islander youths. METHOD: A total of 2577 adolescents were surveyed across 4 public schools in Hawai'i during the 1992--1993 school year. RESULTS: Three social variables (number of relatives frequently seen, family support and friends' support) exhibited statistically significant but low correlations. Family support had the highest negative association with the four psychiatric symptoms (depression, anxiety, aggression, substance use). Friends' support was inconsistently associated with the adjustment measures, and the number of relatives frequently seen resulted in negligible effects. In contrast, demographic variables, especially ethnicity, played a much greater role in the association with the four school-related measures (grade-point average, absences, suspensions, conduct infractions). DISCUSSION: For Asian/Pacific-Islander youths, the quality of the social supports, including family relations, may be particularly important in the adolescents' adjustment. When examining school-related outcomes, demographic variables, with particular emphases on ethnicity and culture, must be considered. When developing and implementing prevention and intervention services and programs, consideration of family and ethnic-cultural influences should be taken into account, with further research needed in several related domains: other SES influences, life stressors, migration-generational effects, ethnic identity, self-concept indicators and socio-political aspects.