American Indian and Alaska Native Mental Health: Diverse Perspectives on Enduring Disparities
American Indian and Alaska Native Mental Health: Diverse Perspectives on Enduring Disparities
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DOI：
10.1146/annurev-clinpsy-032511-143127
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发表时间：
2012-01-01
期刊：
影响因子：
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通讯作者：
Trimble, Joseph E.
中科院分区：
文献类型：
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作者：
Gone, Joseph P.;Trimble, Joseph E.
作为美国土著人民的后代，美国印第安人和阿拉斯加土著自20世纪初以来经历了人口和前景的复兴。今天，与部落有联系的个人超过200万人，分布在565个联邦承认的部落社区和无数大都市和非保留地农村地区。虽然现有证据相对较少，但现有数据表明，与其他美国人相比，人工智能/AN成年人和年轻人遭受的心理健康问题负担不成比例。具体地说，在AI/AN药物滥用、创伤后应激、暴力和自杀方面出现了明显的差异。然而，精神卫生服务迅速扩展到AI/AN社区之前，往往会仔细考虑与这种护理的关键组成部分有关的各种问题，例如服务提供结构本身、临床治疗过程以及预防和康复计划评估。因此，这些社区的心理健康需求已经轻松超过并超过了联邦政府资助的旨在为这些人群服务的机构，印度医疗服务机构长期人手不足，资金不足，因此消除人工智能/心理健康差距只是一个遥远的梦想。尽管过去十年发表的研究大大提高了人们对AI/AN心理健康问题的了解，但探索这些文化差异人群的治疗效果和结果的研究要少得多。然而，除了对更多临床和研究资源的常规呼吁外，人工智能/AN社区成员本身也越来越多地倡导文化上的替代方法和机会，以满足他们自己的心理健康需求。
As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.