Lumbee Rite of Passage: A Suicide Prevention Model for American Indian Youth

描述（由申请人提供）：自杀是对所有美国人健康的威胁，但一些种族比其他种族受到的影响更大。有限的数据表明，与非拉丁裔白人相比，美国印第安人（AI）青年的自杀完成率、自杀企图率和自杀意念率都很高。许多因素导致AI青年产生自杀意念，包括抑郁症状、低自尊、药物滥用、绝望、被迫适应文化和缺乏社会支持。文化干预措施（利用文化习俗干预健康结果的干预措施，区别于仅仅在文化上适当的干预措施）最近与人工智能和其他族裔群体的积极健康结果有关。然而，尽管强烈建议针对人工智能青年精神疾病的干预措施考虑与健康相关的文化结构，但迄今为止很少有研究使用这种方法。北卡罗来纳州是密西西比河以东人工智能人口最多的州。蓝比印第安部落是一个非保留地部落，人口约5万，是该州最大的部落，主要集中在罗布森县。这项探索性研究的总体目标是确定文化项目的影响，特别是由蓝比部落在三个部落拥有的男孩和女孩俱乐部举办的文化课，对12至17岁的美国印第安青少年的自杀意念。该研究将需要兰比社区的参与，并将作为维克森林大学医学院（WFUSM）的玛雅·安杰洛健康公平中心（MACHE）、北卡彭布罗克大学（UNCP）和北卡兰比部落之间的伙伴关系进行。本探索性R21将实现两个具体目标：(1)评估对自杀行为和自杀风险因素的认知，并检查北卡罗来纳州罗布森县蓝比印第安青年（12-17岁）的心理健康需求和服务；(2)确定部落文化项目对自杀意念及其危险因素的影响。具体目标2的第二个目的是检验人口统计学变量（包括性别）、性取向和肥胖对参加文化课和自杀意念之间关系的调节作用。对于目标1，我们计划对社区看门人进行深入访谈，了解心理健康资源的可用性和质量，并与蓝比青年进行焦点小组访谈，以确定对心理健康问题的印象，特别是关于社区中的自杀及其风险因素。在第二项目标中，研究人员将与蓝比部落一起进行可行性研究，以测量参与文化项目（包括土著舞蹈、帕瓦歌唱、北卡印第安人历史、串珠和陶器）后自杀意念的变化及其风险因素。将参与者随机分为干预组和延迟干预组（对照），通过问卷调查收集干预前和干预后自杀意念的测量结果及其相关因素。

DESCRIPTION (provided by applicant): Suicide is a threat to the health of all Americans, but some ethnic groups are more affected than others. Limited data indicate that American Indian (AI) youth experience high rates of suicide completions, suicide attempts, and suicidal ideation compared to their non-Latino white counterparts. Many factors contribute to suicidal ideation in AI youth, including depressive symptoms, low self-esteem, substance abuse, hopelessness, forced acculturation, and lack of social support. Cultural interventions (interventions that utilize cultural practices to intervene on health outcomes, as distinguished from interventions that are merely culturally appropriate) have recently been associated with positive health outcomes in AIs as well as other ethnic groups. Still, while it is highly recommended that interventions targeting mental illness in AI youth consider cultural constructs related to health, very few studies have used this approach to-date. North Carolina (NC) is home to the largest AI population east of the Mississippi River. The Lumbee Indian tribe, a non- reservation tribe with a population of about 50,000, is the largest tribe in the state and is largely concentrated in Robeson County. The overall goal of the proposed exploratory study, Lumbee Rite of Passage for Life, is to determine the impact of cultural programs, specifically a culture class conducted by the Lumbee tribe at three tribally owned Boys and Girls Clubs, on suicide ideation in American Indian adolescents between the ages of 12 and 17 years. The study will entail participation from the Lumbee community and will be conducted as a partnership between the Maya Angelou Center for Health Equity (MACHE) at Wake Forest University School of Medicine (WFUSM), the University of NC at Pembroke (UNCP), and the Lumbee Tribe of NC. This exploratory R21 will accomplish two specific aims: (1) to assess perceptions regarding suicidal behavior and risk factors for suicide and examine mental health needs among and services for Lumbee Indian youth (ages 12-17 years) in Robeson County, NC; and (2) to determine the impact of a tribally-run cultural program on suicidal ideation and its risk factors. A secondary aim to Specific Aim 2 is to examine the moderating effects of demographic variables (including gender), sexual orientation, and obesity on the relationship between participation in the culture classes and suicidal ideation. For Aim 1, we plan in-depth interviews with community gatekeepers regarding availability and quality of mental health resources and focus groups with Lumbee youth to identify impressions of mental health issues, particularly regarding suicide and its risk factors in their community. For Aim 2, investigators will conduct a feasibility study in conjunction with the Lumbee tribe to measure changes in suicidal ideation and its risk factors that occur as a result of participation in a cultural program that includes native dancing, pow-wow singing, NC Indian history, beading, and pottery. Participants will be randomized into intervention and delayed intervention (comparison) groups, and pre- and post-intervention measures of suicide ideation and factors associated with it will be collected via surveys. PUBLIC HEALTH RELEVANCE: Suicide and its risk factors remain a major public health concern in the United States, and American Indians bear an unequal burden of completed suicides, suicide attempts, and suicidal ideation compared to whites. The proposed exploratory study is a partnership with the Lumbee Indian tribe of North Carolina and will test the feasibility of using a tribally run culture class to promote positive mental health outcomes and reduce suicidal behaviors among Lumbee adolescents. While we acknowledge that culture may only be one of many things that promote good mental health among young people, innovative research such as this could lead to more comprehensive treatment and prevention interventions and therefore add to the body of public health knowledge.