Our objective was to determine self-reported psychological wellbeing of American Indians (AIs). Data are from two surveys, a) 218 adults from the 2011 – 2012 Mino Giizhigad study including Ojibwe adults in Minnesota and Wisconsin, and b) 146 AI women aged 15 – 35 years from the 2011 Sacred Journey study residing in the Pacific Northwest. Reports of AI mental wellness/positive mental health were on par with or higher than found in previous studies with non-AI samples despite simultaneously disparate rates of AI anxiety, depressive symptoms, and differential exposure to sociohistorical stressors. Results are a paradoxical mismatch between mental wellness and mental stressors consistent across two separate, diverse samples of AI adults.

•    American indians
•    Psychological wellbeing
•    Native americans
•    Mental health

Walls M, Pearson C, Kading M, Teyra C (2016) Psychological Wellbeing in the Face of Adversity among American Indians: Preliminary Evidence of a New Population Health Paradox? Ann Public Health Res 3(1): 1034.

Walls M, Pearson C, Kading M, Teyra C (2016) Psychological Wellbeing in the Face of Adversity among American Indians: Preliminary Evidence of a New Population Health Paradox? Ann Public Health Res 3(1): 1034.

Among the longest standing empirically supported observations of population health is that members of the most disadvantaged sectors of society bear the greatest burden of physical and mental health problems [1,2]. Research results that negate this pattern are paradoxical, intriguing, and prompt deeper inquiry in the search for replication and explanation. For example, the “Latino Health Paradox” reveals higher risk exposure but better health among first generation Latino immigrants compared to U.S.-born counterparts [3,4]. In Keyes’ [5] “Black-White Paradox in Health,” Black Americans reported better mental health despite experiencing heightened stressors compared to Whites. This report presents the mental wellbeing of American Indians (AI) in two separate studies using two measures of positive mental health/psychological wellbeing (PMH [6]/PWB [7]). With many AIs experiencing socio-political marginalization and disproportionate psychological distress [8-12], these findings suggest the paradox of flourishing mental health despite socio-political adversity.

Data are from two separate community-based participatory research studies, each conducted in collaboration with tribal research teams/advisory boards and supported by tribal government resolutions. Informed consent was obtained from all participants and study protocols reviewed and approved by tribal partners and Institutional Review Boards.

Study 1, the Mino Giizhigad (A Good Day) Study, involved random selection of participants from tribal health clinic records for patients 18 years or older, with a type 2 diabetes diagnosis, and who self-identified as American Indian. Face-to-face interviewer administered surveys were completed in participants’ location of choice. Incentives were $30 and a gift of locally cultivated wild rice. Of total initial eligible sample of 289 individuals, 218 completed surveys for a response rate of 75.4%.

Study 2, Sacred Journey, is a cross-sectional study using a mixed sampling approach including respondent-driven (i.e., an advancement of snowball sampling in which seeds were identified based on diverse location, age, and risk factors. Seeds where interviewed, asked to recruit others in their network to the study), convenience, and venue-based recruitment methods. Venue-based recruitment focused on areas where young Indigenous women were known to socialize, such as tribal housing areas, local powwows, maternal health clinic, schools, and the local college. Audio computer-assisted self-interviews were completed by146 self-identified AIAN women ages 15-35 residing in a Pacific Northwest tribal community who received $40 as an incentive for participating. Additional methodological details for each study are available.

Measurement

Positive mental health (PMH) was measured in Mino Giizhigad by the Mental Health Continuum (MHC-SF [5]) including 14 items of emotional, social and psychological wellbeing, with recommended scoring for flourishing, moderate, or languishing Measurement Positive mental health (PMH) was measured in Mino Giizhigad by the Mental Health Continuum (MHC-SF [5]) including 14 items of emotional, social and psychological wellbeing, with recommended scoring for flourishing, moderate, or languishing Measurement Positive mental health (PMH) was measured in Mino Giizhigad by the Mental Health Continuum (MHC-SF [5]) including 14 items of emotional, social and psychological wellbeing, with recommended scoring for flourishing, moderate, or languishing the Mini-International Neuropsychiatric Interview [19]. DSM-IV Diagnosis was defined as ≥3 of the 6 items.

We searched for published comparison studies including: a) Keyes or Ryff’s PMH/PWB, and b) at least one measure of depression/anxiety. All authors searched PubMed, PsychInfo, and Google Scholar. We chose 3 of 12 comparisons to Mino Giizhigad using PMH; Six studies included Ryff’s PWB. For optimal comparability to Sacred Journey we chose the three studies reporting findings from non-clinical samples.

Table 1: Mean Positive Mental Health Continuum Scores (MHC) by Dichotomous Demographic and Mental Health Characteristics in the Mino Giizhigad Study of Midwest American Indian Adults (N = 218) and Sacred Journey Study of Pacific Northwest Rural American Indian Women (N = 146).

Table 2: American Indian Mental Health Status in the Mino Giizhigad and Sacred Journey Studies: Comparisons to Previously Published Work in Non-Native Samples.

In Mino Giizhigad, 51.5% of the participants reported flourishing PMH, 17.1% reached clinical cutoff for depression, and 24.9% reported moderate/severe anxiety. Mean PWB in Sacred Journey = 29.9 with 40% of participants reporting depressive symptoms and 26.7% reporting anxiety. Wellbeing by dichotomized demographic variables appears in Table 1. Significant differences in wellness by demographics emerged only in Sacred Journey: participants with lower PWB scores were significantly less likely to have a high school education or be employed and had lower median incomes.

Table 2 compares our results to prior studies. PMH in Mino Giizhigad is greater than/on par with findings from healthy college students and yoga practitioners; depression and anxiety rates are generally higher than comparisons except for depression in the yoga sample, which relied on self-reported lifetime history Table 2 compares our results to prior studies. PMH in Mino Giizhigad is greater than/on par with findings from healthy college students and yoga practitioners; depression and anxiety rates are generally higher than comparisons except for depression in the yoga sample, which relied on self-reported lifetime history

Given the widely documented exposure to contemporary and historical stressors across AI communities, these results are paradoxical. Relative to comparison studies, we documented similar or higher levels of positive mental health simultaneous with heightened rates of psychological distress. The trends are triangulated in two independently designed studies with AIs, thus strengthening our confidence in findings.

We found higher PMH among Mino Giizhigad patients living with type 2 diabetes, a chronic condition with increased risk for depression [26], than reported in two previously published studies with non-AIs. The Sacred Journey PWB scores were somewhat similar to other non-AI community samples, yet the comparison studies did not demonstrate accompanied high rates of depression or anxiety.

Limitations of this report include heterogeneity of methods between our studies and comparisons; findings cannot be generalized to all tribal groups. Because of the preliminary nature of these analyses, possible confounding factors that might influence reports of wellness should be investigated in future work.

We offer several possible explanations for these paradoxical findings that might stimulate additional investigations. First, heightened reports of AI wellbeing may be due in part to a larger reserve capacity against stress. For instance, resilience and coping factors including sense of identity and purpose, engagement with cultural beliefs, practices, and values, and social connectedness and supports [27-29] may produce stress buffering effects that promote mental wellness. In addition, some people find greater meaning and purpose and may experience spiritual and/or emotional growth following a traumatic event or stressor [30,31]. AI-specific cultural health beliefs may also be a factor. For example, some Indigenous people view connection to the land or environment, group and individual activism, and the reclamation of cultural traditions and languages as core aspects of wellness [32,33]. Concepts like positive mental health might be viewed holistically as a balance between the mind, body, and spirit [34] as opposed to a dichotomy of “sickness” and “wellness.”Another consideration is whether or not the widely documented correlation between stressors and distress applies to negative outcomes only; that is, disadvantage may promote deficits, but perhaps has less impact on positive outcomes. That a majority of participants in both samples reported positive mental health statuses could provide clues for strength-based treatment initiatives in these communities and is worthy of further investigation in other AI cultures.

The Mino Giizhigad Team includes Community Research Council members: Doris Isham, Julie Yaekel-Black Elk, Tracy Martin, SidneeKellar, Robert Miller, Geraldine Whiteman, Peggy Connor, Michael Connor, Stan Day, Pam Hughes, Jane Villebrun, Beverly Steel, Muriel Deegan and Ray Villebrun. The authors respectfully acknowledge the commitment and participation of project team members and their thoughtful review of this manuscript. We also thank Mr. Leo Egashira for his helpful editorial assistance on earlier drafts of this paper. Research reported in this paper was supported by the National Institute of Mental Health under Award Number MH085852 M. Walls, Principal Investigator; National Institute of Drug Abuse R34 DA034529 C. Pearson, Principal Investigator; and the Indigenous Wellness Research Institute Center of Excellence NIMHD P60MD006909, K. Walters Principal Investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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