A Native Path to Courage

美洲原住民(NA)在生命早期患焦虑和抑郁的风险更大，有10%到39%的NA 报告焦虑或抑郁的临床水平的年轻人。这是考虑到潜在的负面影响 这些情况贯穿整个生命周期(药物使用、自杀)。可提供适应文化的预防和 对北美青年的焦虑和抑郁的早期干预(PEI)是有限的。其中两个被指明为有风险 青年(例如，创伤)；一个普遍的PEI没有效果；社区利益攸关方充当顾问 没有年轻人或父母参与；评估使用了最低限度的混合方法。因此，有一个关键的 发展和评估文化和谐、简短预防和早期干预的必要性 (PEI)使用包括青年和父母在内的CBPR方法在北美青年中进行焦虑和抑郁 混合方法评价。我们的短期目标是为社区提供一个潜在的成功的PEI 为了缓解洛奇男孩青少年的焦虑和抑郁，将文化和传统整合在一起 学校。拟议研究的具体目的是：1)使指南针在文化上适应勇气 (由我们的CAB选择)用于NA青年；2)评估文化适应的可行性和可接受性 指南针与NA Rocky Boy青年；以及3)估计焦虑和抑郁的影响大小变化 适应文化的指南针与天真青年的症状。我们计划在我们强大的基础上 社区关系和CBPR方法来实现这些目标。我们将与出租车合作，以 在CBPR框架内为一年级的NA青年，包括Rocky Boy青年，在文化上调整指南针 还有父母。在第二年，我们将培训三个NA Rocky Boy提供商，并在30个人中试行适应的PEI 洛奇男孩，8至12岁，在两所学校为保留地2年级和3年级的青少年提供服务。我们将 使用混合方法评估可行性和可接受性，包括关键利益相关者的重点小组 (青少年、父母和教师)，并估计焦虑和抑郁症状变化的影响大小 采用事前、单组设计。我们假设《洛奇男孩》的年轻人会发现改编的 指南针干预是可接受的、愉快的和文化上合适的，并将有预 干预后焦虑和抑郁症状的减少。我们的长期目标是继续提炼 并定制适应的COMPASS干预措施，并评估其有效性和可持续性。我们计划 提交R01(临床试验)以响应FOA干预研究以改善本地 美国健康(PAR-20-238)在第三年进行了一项全面的临床试验，该试验将根据我们的发现进行通知。

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.