A Native Path to Courage

点击翻译按钮获取中文摘要

Native Americans (NA) are at greater risk for anxiety and depression early in life, with 10 to 39% of NA youth reporting clinical levels of anxiety or depression. This is concerning given potential negative effects of these conditions across the lifespan (substance use, suicide). Available culturally adapted prevention and early interventions (PEIs) for anxiety and depression in NA youth are limited. Two are indicated for at-risk youth (e.g., trauma); one universal PEI was not efficacious; community stakeholders served as consultants with no youth or parents involved; and evaluation used minimal mixed methods. Thus, there is a critical need for the development and evaluation of a culturally consonant, brief prevention and early intervention (PEI) for anxiety and depression in NA youth using a CBPR approach that includes youth and parents and mixed-method evaluation. Our short-term goal is to provide the community with a potentially successful PEI to mitigate Rocky Boy youths’ anxiety and depression that integrates culture and traditions for delivery in schools. The Specific Aims of the proposed research are to: 1) culturally adapt COMPASS for Courage (chosen by our CAB) for NA youth; 2) evaluate the feasibility and acceptability of the culturally adapted COMPASS with NA Rocky Boy youth; and 3) estimate effect size changes in anxiety and depressive symptoms of the culturally adapted COMPASS with NA youth. We propose to build upon our strong community relationships and CBPR methods to achieve these aims. We will partner with the CAB to culturally adapt COMPASS for NA youth in Year 1 within a CBPR framework, including Rocky Boy youth and parents. In Year 2, we will train three NA Rocky Boy providers and pilot-test the adapted PEI among 30 Rocky Boy 8- to 12-year-olds in two schools serving youth from the reservation in Years 2 and 3. We will evaluate feasibility and acceptability using mixed methods, including focus groups of key stakeholders (youth, parents, and teachers), and estimate effect sizes of changes in anxiety and depressive symptoms using a pre-post, single-group design. We hypothesize that Rocky Boy youth will find the adapted COMPASS intervention to be acceptable, enjoyable, and culturally appropriate and there will be pre- to post-intervention reductions in anxiety and depressive symptoms. Our long-term goal is to continue refining and tailoring the adapted COMPASS intervention and evaluate its efficacy and sustainability. We plan to submit an R01 (Clinical Trial) in response to the FOA Intervention Research to Improve Native American Health (PAR-20-238) in Year 3 for a full-scale clinical trial that will be informed by our findings.