Risk and Protective Factors for Depression and Health Outcomes in American Indian and Alaska Native Adolescents

Many studies indicate that health and well-being in the United States are likely to vary by ethnic or racial status (Williams, Lavizzo-Mourey, and Warren 1994; U.S. Department of Health and Human Services 1985), and this has been well documented for adolescents in particular (Office of Technology Assessment 1991). The health status of American Indian and Alaska Native adolescents has also been identified as poorer than that of adolescents of other racial or ethnic groups (Office of Technology Assessment 1990, 1986; Indian Health Service 1998). For American Indian and Alaska Native adolescents, social and health indicators illustrate increased risk for poor outcomes on almost all well-being measures. Overall, in American Indian and Alaska Native adolescents (ages 15 to 24), the mortality ratio is approximately three times greater (2.7:1) than for U.S. all races (Office of Technology Assessment 1986). American Indian and Alaska Native adolescents are exposed to poverty and racial discrimination, which severely limit individual, family, and community prosperity. In these environments, personal values and integrity may be discouraged or corrupted and human potential limited.

In a self-administered health survey of American Indian and Alaska Native adolescents, 2% reported poor health, and another 20% reported only fair health. The level of self-perceived health status was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies (Blum et al. 1992). For males, this identification of fair or poor health status is approximately three times greater than for same-aged white rural Minnesota youth. For females, there is two times the differential in fair or poor health. Frequencies of risk behaviors in this survey were also high. Forty-four percent reported never wearing seatbelts, 38% reported drinking and driving, and 22% reported riding with a driver who had been drinking. Eight percent had been physically abused, 5% had been sexually abused, and an additional 5% had been both physically and sexually abused; in other words, 18% had been physically and/or sexually abused. These adolescents showed signs of stress, poor coping, and anxiety. Almost 6% of the sample showed signs of severe emotional distress (Blum 1992). In general, these findings suggest that American Indian and Alaska Native adolescents are a vulnerable, high-risk population for behaviors leading to various types of mental health impairment including adolescent depression.

Risk and Protective Factors in Adolescent Health

A substantial body of research has shown that adolescents exposed to social and individual risk factors are more likely to engage in health-compromising behaviors and then exhibit poor health and diminished well-being outcomes (Brener and Collins 1998; Jessor 1993; Fitzpatrick 1997). Risk factors lead to vulnerability and can be expressed in health-compromising behavior, emotional impairment, and poor health outcomes (Ensminger and Juon 1998; Brener and Collins 1998; Hauser and Bowlds 1990). However, among adolescents who are exposed to risk factors, there are some individuals who successfully negotiate potential detrimental outcomes (Werner 1989a, 1989b). Protective factors, by contrast, may mediate or buffer the effects of risk factors (Rutter 1987, 1990; Garmezy 1985, 1993).

This study examines if protective factors intervene to reduce detrimental outcomes (self-perceived health and well-being status) resulting from adolescent depression. In other words, do protective factors reduce the effects of depression in American Indian and Alaska Native adolescents?

Literature Review

Depression and Impaired Mental Health

The number of American Indian and Alaska Native adolescents reporting depression and emotional disturbance is cause for concern. Rates of depression vary for different tribal groups (Office of Technology Assessment 1990). Among American Indian and Alaska Native adolescents in grades 7 to 12, 20% reported being depressed in the last month, and 34% reported feeling sad, discouraged, and hopeless. High-risk...