Preventing Suicidal Behavior Among American Indian and Alaska Native Adolescents and Young Adults.

From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.

The public psychology for liberation training model: A call to transform the discipline.

Written against the backdrop of the 2020 twin pandemics of a global health crisis and greater national awareness of structural racism, this article issues a call for psychology to invest in training all psychologists to respond to the social ills of racial and other forms of oppression. We introduce a public psychology for liberation (PPL) training model. Essentially, the model reflects a science, a pedagogical commitment, and practice of, by, and with the people who have been most marginalized in society. The PPL consists of five foundational domains or cross-cutting areas of expertise (e.g., facilitate human relationships; generate reciprocal knowledge and translation) and 10 interrelated lifelong practices (e.g., cultural humility; care and compassion) that foster healing and equity. The model centers the perspectives of the Global Majority, focuses on radical healing and equity, and emphasizes a developmental, culturally grounded, strengths-based approach to training. Various training initiatives consistent with a public psychology for liberation approach are presented. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Conceptualizing School Belongingness in Native Youth: Factor Analysis of the Psychological Sense of School Membership Scale.

The Psychological Sense of School Membership (PSSM) scale is widely used to measure school belongingness among adolescents. However, previous studies identify inconsistencies in factor structures across different populations. The factor structure of the PSSM has yet to be examined with American Indian/Alaska Native (AI/AN) youth, a population of keen interest given reports of their educational and health disparities, and the potential of belongingness as a protective factor against risk behaviors. Thus, this study examined the factor structure of the PSSM in two samples of AI adolescents (N = 349). The two main aims of this study were to 1) determine if a comparable factor structure exists between the two AI groups and 2) examine the factor structure of the PSSM for use in AI/AN populations. Randomization analysis was used to test research aim one, and exploratory factor analysis was used to test research aim two. Analyses revealed that comparable factor structures existed based on responses from the two AI groups. Analyses also identified two factors: school identification/peer support and connection with teachers. Moreover, negatively worded statements were found to be unreliable and were removed from the final scale, reducing the PSSM to 13 items. Findings from this study will assist researchers and clinicians with assessing sense of school belongingness in AI/AN adolescents and with appropriately interpreting aspects of belongingness for this population.

Development and evaluation of an enhanced diabetes prevention program with psychosocial support for urban American Indians and Alaska natives: A randomized controlled trial.

Diabetes is highly prevalent, affecting over 25 million adults in the US, yet it can be effectively prevented through lifestyle interventions, including the well-tested Diabetes Prevention Program (DPP). American Indian/Alaska Native (AIAN) adults, the majority of whom live in urban settings, are more than twice as likely to develop diabetes as non-Hispanic whites. Additionally, prevalent mental health issues and psychosocial stressors may facilitate progression to diabetes and hinder successful implementation of lifestyle interventions for AIAN adults. This 2-phased study first engaged community stakeholders to develop culturally-tailored strategies to address mental health concerns and psychosocial stressors. Pilot testing (completed) refined those strategies that increase engagement in an enhanced DPP for urban AIAN adults. Second, the enhanced DPP will be compared to a standard DPP in a randomized controlled trial (ongoing) with a primary outcome of body mass index (BMI) and a secondary outcome of quality of life (QoL) over 12months. Obese self-identified AIAN adults residing in an urban setting with one or more components of the metabolic syndrome (excluding waist circumference) will be randomized to the enhanced or standard DPP (n=204). We hypothesize that addressing psychosocial barriers within a culturally-tailored DPP will result in clinical (BMI) and superior patient-centered (QoL) outcomes as compared to a standard DPP. Exploratory outcomes will include cardiometabolic risk factors (e.g., waist circumference, blood pressure, fasting glucose) and health behaviors (e.g., diet, physical activity). Results of this trial may be applicable to other urban AIAN or minority communities or even diabetes prevention in general.

Advancing suicide prevention research with rural American Indian and Alaska Native populations.

As part of the National Action Alliance for Suicide Prevention's American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance's prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond.

Hopelessness among White- and Indian-identified American Indian adolescents.

Despite a number of investigations into the protective effects of ethnic and cultural identity among a variety of diverse populations, there have been relatively few studies that examine the relationship between this identity and American Indian mental health. This brief report investigates the associations between ethnic/cultural identification and feelings of hopelessness among American Indian adolescents. Data were drawn from middle-school respondents on a reservation community at 2 time points 14 months apart. Although White cultural identification was significantly and negatively correlated with hopelessness at 14 months, Indian cultural identification was not associated with hopelessness at either time point. These results are discussed with attention to the developmental stage of our respondents and to the possibility of social dynamics relevant to this particular reservation community.

Patterns of hopelessness among American Indian adolescents: relationships by levels of acculturation and residence.

Poor mental health among American Indian adolescents has been a matter of significant concern for the past two decades. This study extends the literature on acculturation within this population by investigating the relationship between hopelessness, levels of acculturation, and residence among American Indian adolescents. Utilizing data drawn from 438 adolescents across 67 American Indian tribes, our analyses show that American Indian adolescents who have bicultural competence (i.e., those who are adept in both Indian and White cultures) have significantly less hopelessness than do those with adeptness in only one culture or in neither culture. Our findings also show a significant difference by residence, with American Indians who live on reservations indicating less hopelessness than those living in urban or rural/nonreservation areas. Analysis of interaction effects suggests that the beneficial effect of adeptness in White culture is particularly true for American Indians living in urban areas.

The Zuni Life Skills Development Program: a school/community-based suicide prevention intervention.

The Zuni Life Skills Development Program, an effective community-initiated and high-school-based suicide prevention intervention, is featured. Development and evaluation of this intervention are followed by note of the specific challenges associated with stabilizing the program. A more tribally diverse, culturally-informed model entitled the American Indian Life Skills Development Curriculum is then presented to illustrate a hybrid approach to the cultural tailoring of interventions. This curriculum is broad enough to address concerns across diverse American Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs and practices. Finally, we reflect upon issues in community-based research that emerged during this collaboration.

Suicidal ideation among American Indian youths.

This study examined correlates of suicidal ideation among 212 American Indian youth who lived on or near three reservations in the upper Midwestern United States. The youths were, on average, 12 years old, and 9.5% reported current thoughts about killing themselves. Females were over 2 times more likely than males to think about suicide. Multivariate logistic regression results indicated that gender, enculturation, negative life events, perceived discrimination, self-esteem, and drug use were related to the likelihood of thinking about suicide. Drug use was the strongest correlate of suicidal ideation, and both enculturation and perceived discrimination emerged as important culturally specific variables. It was suggested that suicide prevention programs should draw on the strengths of American Indian culture.

The racial identity and cultural orientation of Lumbee American Indian high school students.

The uncertain and complex lineage of the Lumbee American Indian tribe has made the issue of identity of prime concern. The cultural identification, racial identification, bicultural competence, and perceived school environment for 103 Lumbee Indian high school students were examined in this study. Higher self-ratings on American Indian cultural competence and American Indian cultural identification than on White cultural competence and White cultural identification were found, and t-test comparisons revealed no gender differences on responses to the instruments. Analysis of variance was conducted to assess whether differences in perceived school environment could be attributed to cultural orientation. Rather than appearing assimilated, this generation of Lumbees tends to exhibit J. E. Helms's (1995b) Internalization identity status and an American Indian cultural orientation.

Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest.

American Indian adults are thought to experience significant depressive symptoms at rates several times higher than adults in the general population, yet we know very little about factors associated with depressive symptoms among this under studied group. Many researchers have argued that depressive symptoms are associated with conflicts between American Indian traditional cultural values, practices, and beliefs and those of the majority culture. This report, based on a sample 287 American Indian adults from the upper Midwest, takes into account two measures of cultural effects: perceived discrimination, as one indicator of culture conflict, and traditional practices, as a measure of cultural identification. The results indicate that discrimination is strongly associated with depressive symptoms among American Indian adults and that engaging in traditional practices is negatively related to depressive symptoms. Moreover, interaction effects between perceived discrimination and traditional practices indicate that engaging in traditional practices buffers the negative effects of discrimination among those who regularly participate in them.

Psychological impact of biculturalism: evidence and theory.

A vital step in the development of an equal partnership for minorities in the academic, social, and economic life of the United States involves moving away from assumptions of the linear model of cultural acquisition. In this article we review the literature on the psychological impact of being bicultural. Assimilation, acculturation, alternation, multicultural, and fusion models that have been used to describe the psychological processes, social experiences, and individual challenges and obstacles of being bicultural are reviewed and summarized for their contributions and implications for investigations of the psychological impact of biculturalism. Emphasis is given to the alternation model, which posits that an individual is able to gain competence within 2 cultures without losing his or her cultural identity or having to choose one culture over the other. Finally, a hypothetical model outlining the dimensions of bicultural competence is presented.