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Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions

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Abstract

Purpose

To examine the prevalence of common psychiatric disorders and associated treatment-seeking, stratified by gender, among American Indians/Alaska Natives and non-Hispanic whites in the United States. Lifetime and 12-month rates are estimated, both unadjusted and adjusted for sociodemographic correlates.

Method

Analyses were conducted with the American Indians/Alaska Native (n = 701) and Non-Hispanic white (n = 24,507) samples in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions [(NESARC) n = 43,093].

Results

Overall, 70 % of the American Indian/Alaska Native men and 63 % of the women met criteria for at least one Diagnostic and Statistical Manual-IV lifetime disorder, compared to 62 and 53 % of Non-Hispanic white men and women, respectively. Adjusting for sociodemographic correlates attenuated the differences found. Nearly half of American Indians/Alaska Natives had a psychiatric disorder in the previous year; again, sociodemographic adjustments explained some of the differences found. Overall, the comparisons to non-Hispanic whites showed differences were more common among American Indian/Alaska Native women than men. Among those with a disorder, American Indian/Alaska Native women had greater odds of treatment-seeking for 12-month anxiety disorders.

Conclusion

As the first study to provide national estimates, by gender, of the prevalence and treatment of a broad range of psychiatric disorders among American Indians/Alaska Natives, a pattern of higher prevalence of psychiatric disorder was found relative to Non-Hispanic whites. Such differences were more common among women than men. Prevalence may be overestimated due to cultural limitations in measurement. Unmeasured risk factors, some specific to American Indians/Alaska Natives, may also partially explain these results.

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Acknowledgments

The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded, in part, by the Intramural Program, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. This study is supported by National Institutes of Health grants MH076051 and MH082773 (Dr. Blanco), AA08159, AA018111 and AA00161 (Dr. Hasin), MD000507 (Dr. Beals), and P20 MD004811 (Dr. Brave Heart); the New York State Psychiatric Institute (Drs. Hasin and Lewis-Fernández), and the New York State Center of Excellence for Cultural Competence (Drs. Brave Heart and Lewis-Fernández).

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Authors and Affiliations

  1. Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC09 5030, 1 UNM, Albuquerque, NM, USA

    Maria Yellow Horse Brave Heart

  2. New York State Psychiatric Institute, New York, NY, 87131-0001, USA

    Maria Yellow Horse Brave Heart, Roberto Lewis-Fernández, Deborah S. Hasin, Luisa Sugaya, Shuai Wang & Carlos Blanco

  3. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA

    Roberto Lewis-Fernández & Deborah S. Hasin

  4. Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Janette Beals

  5. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Deborah S. Hasin

  6. School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

    Luisa Sugaya

  7. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA

    Bridget F. Grant

  8. National Institute on Drug Abuse, Bethesda, MD, USA

    Carlos Blanco

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  1. Maria Yellow Horse Brave Heart
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Correspondence to Maria Yellow Horse Brave Heart.

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Ethical standards statement

This current study is an analysis of data on American Indian/Alaska Native adults compared to non-Hispanic whites, from a nationally representative sample of the adult population of the US collected in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC derives from data collected by the US Census Bureau, which administered face-to-face interviews under the direction of the National Institute of Alcoholism and Alcohol Abuse (NIAAA), as described in detail elsewhere. The NESARC research protocol and informed consent procedures, received full ethical review and approval from the US Census Bureau and the Office of Management and Budget. Informed consent procedures were followed. All potential respondents were informed in writing about the nature of the survey, the statistical uses of the survey data, that participation was voluntary, and the adherence to Federal laws protecting confidentiality of identifiable survey information. This information was shared and consent obtained prior to any interviews. The authors had no access to raw data and data analysis only involved de-identified data. The original NESARC data was collected following ethical standards initially established in 1964 Declaration of Helsinki and all later amendments as relevant; no medical procedures were involved—only standardized verbal questions congruent with psychosocial psychiatric diagnostic assessments.

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Brave Heart, M.Y.H., Lewis-Fernández, R., Beals, J. et al. Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 51, 1033–1046 (2016). https://doi.org/10.1007/s00127-016-1225-4

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