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Native Americans’ experience of chronic distress in the USA

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Abstract

Over ten million Native Americans live in the USA today, but their experiences are often obscured in empirical research. While the rise in despair, or chronic distress, among White Americans is much discussed, what is not discussed is what has happened for the first Americans. We demonstrate that levels of consistently poor mental health were higher among Native peoples than among White or Black Americans in every year between 1993 and 2020, and these levels have been rising. We find this pattern among those over the age of 30 but less so for the young. Chronic distress seems to be lowest among Native peoples living in the seven states with the largest proportion of Native Americans as a fraction of their population: Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma and South Dakota. In our judgment, these facts are important and not widely known. This stands in stark contrast to the enormous scholarly and media interest in declining physiological well-being among White Americans.

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Data availability

The BRFSS data are publicly available from the Center for Disease Control. The Gallup data files are available through libraries.

Notes

  1. See, for example, Case and Deaton (2015, 2017), Meara and Skinner (2015), Roux (2017), Shanahan et al. (2019) and Stein et al. (2017).

  2. Miniño and Hedegaard (2021) report that the age-adjusted overdose death rates in 2019 were 21.6 for all races; 30.5 for Non-Hispanic American Indian or Alaska Natives; 26.2 for Non-Hispanic whites; 24.8 for Non-Hispanic Blacks; 3.3 for Non-Hispanic Asians; 9.5 for Non-Hispanic Native Hawaiian or Other Pacific Islanders and 12.7 for Hispanics. In the last two years of data available, CDC data suggest suicide rates have been increasing for Native peoples.

  3. The current paper might also be seen as a contribution in the spirit of recent work by Muennig et al. (2018), although that study was not able to include information on Native Americans, Graham and Pinto (2019) and Pescosolido et al. (2020).

  4. However, gaming is associated with increased crime rates (Grinols and Mustard 2006).

  5. See, for example, the Honoring Nations reports and case studies from the Harvard Project on American Indian Economic Development: https://hpaied.org/publications-and-research. Last accessed November 4, 2021.

  6. The pattern is consistent with recent work by Graham and Pinto (2019), who demonstrate that minority populations have better mental health in regions with larger, more firmly established cultural communities.

  7. There are 18,318 observations from the first part of 2020 in the 2019 survey.

  8. Details of the weighting schemes in the BRFSS are provided in The BRFSS Data User Guide August 15, 2013: https://www.cdc.gov/brfss/data_documentation/pdf/UserguideJune2013.pdf. Last accessed November 4th, 2021.

  9. See https://data.census.gov/cedsci/table?q=race%20demographics&tid=ACSDP1Y2019.DP05. Last Accessed October 30, 2021.

  10. The US Census Bureau has also traditionally undercounted the number of Native peoples accounting for part of the increase in the population reported in the Census (Liebler and Ortyl 2014). In the 2010 Census, American Indians and Alaska Natives living on reservations were undercounted by 4.9 percent, while they were undercounted in 1990 by 12.2 percent (Connolly and Jacobs 2020), but the increase in the population between these years was over one million people (Liebler and Ortyl 2014), which is substantially more than could be attributed to this under count.

  11. Due to small sample sizes in 2020 in these figures combine 2020 data with 2019.

  12. Moreover, in the 2000 Census a million people reported race as Native American but did not report that race in the 1990 Census according to estimates by Liebler and Ortyl (2014). In addition, this rise cannot be solely due to changing identity options in the Census: the number of people identifying as Native American increased between 2000 and 2010 above birth and death rates despite fixed Census questions on race (Liebler and Ortyl 2014; Liebler et al. 2016). Some have suggested that part of the rise of people identifying as Native American is at least in part due to the political mobilization of Native Americans during the 1960s and 1970s and associated pride movements, which may have resulted in less stigma associated with being identified as Native (Thornton 1997; Sturm 2011; and Nagel 2020).

  13. The 2011 survey saw a change in weighting methodology and the addition of cell-phone-only respondents, because an increasing number of US citizens were known to be using cell phones. Evaluations conducted by Centers for Disease Control using 2010 and 2011 BRFSS data indicate that the addition of cellular-telephone-only households improves survey coverage for certain population groups. For example, it was found that the proportion of interviews conducted with respondents with lower incomes, lower educational levels, or are in younger age groups increases, because these groups more often exclusively rely on cellular telephones for personal communications. We include the cellphone indicator to account for any changes or systematic differences between those that us a cellphone and those that do not that may be corrected with race and extreme distress.

  14. The results are as follows: for 15–30 days:0.0084 (9.96); 20–30 days: 0.0098 (13.14); 25–30 days: 0.0097 (14.30); 28–30 days: 0.0100 (15.53); 29–30 days: 0.0099 (15.37); and finally, 30 days: 0.0098 (15.29). The coefficients are listed first with the t-statistics in parenthesis.

  15. The age maxima are simply obtained by differentiating with respect to age and solving so in column 1 of Table 4 the equation is .0535 + .0026Age -.000033Age2. Differentiating with respect to age gives a maximum of .0026/(2*.000033) = 39.

  16. We should be cautious here with the effects over for the oldest age group of seventy and older given Hudomiet et al.’s (2021) finding that there is a mortality selection bias in the USA is happiness data over the age of seventy.

  17. Of note is that Case and Deaton (2020) do not even refer to the experience of Native Americans or American Indians.

  18. Other tests are included in Appendix. Table 15 provides BRFSS chronic distress estimates for different time periods, with the first three columns being without personal controls and the last three columns with them. In each case, the coefficient on the Native variable is significant and positive. In Table 16 we show the same results hold for prime age individuals.

  19. Marmaros and Sacerdote (2006) find, in a study of Dartmouth student and recent alumni interactions, that physical proximity and racial similarity have positive impacts on whether students interact with each other. Pescosolido et al. (2020) show for some minority populations being around a larger community results in better outcomes. Also see Mayer and Puller (2008) and Hill (2009),

  20. A stronger test of this would be to examine how chronic distress varies for those within a tribal statistical area and those living outside of these areas. Unfortunately, we do not have the geographic information to do this. In addition, it is difficult to draw any strong conclusions about the role of reservations in this story due to the absence of directly comparable literature.

  21. Although this paper is about extreme mental ill-being, and not about deaths per se, it appears that high despair and distress, as with Whites, seem to go with high deaths of despair for Native Americans as found in Heron (2019).

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Acknowledgements

We thank editor Alfonso Flores-Lagunes and three reviewers for helpful comments. We also thank Andrew Oswald for his significant contributions to this work.

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All authors certify that they have no affiliations with or no involvement in any organization or entity with any financial interest or no-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Dartmouth College, Hanover, NH, USA

    David G. Blanchflower

  2. University of Glasgow, Scotland, UK

    David G. Blanchflower

  3. University of Victoria, Victoria, Canada

    Donn. L. Feir

  4. Federal Reserve Bank of Minneapolis, Minneapolis, MN, USA

    Donn. L. Feir

  5. IZA, Bonn, Germany

    Donn. L. Feir

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  1. David G. Blanchflower
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Blanchflower conducted the data analysis, and both authors equally wrote the paper and determined its structure.

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Correspondence to David G. Blanchflower.

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Responsible editor: Alfonso Flores-Lagunes

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This article reflects the views of the authors but not necessarily those of the Center for Indian Country Development (CICD) or anyone in the Federal Reserve System. As a research and policy institute, the CICD focuses on supporting tribal communities in achieving their economic objectives. This article series contributes to that mission by providing evidence and ideas that may be useful to decision-makers in Indian Country.

Appendix

Appendix

Table 13 Numbers of American Indians and Alaska Natives in the USA, not Hispanic: by age group
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Table 14 Respondent-assessed health, 2018 (%)
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Table 15 OLS Chronic distress equations over time, BRFSS, 1993–2021
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Table 16 Chronic distress equations for prime age and prime age less educated, 1993–2021
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Fig. 4
figure 4

Despair and age, 1993–2021 Native Americans (year dummies only)

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Blanchflower, D.G., Feir, D.L. Native Americans’ experience of chronic distress in the USA. J Popul Econ 36, 885–909 (2023). https://doi.org/10.1007/s00148-022-00910-4

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