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

描述(申请人提供)：自杀对所有美国人的健康都是一种威胁，但某些种族比其他种族受影响更大。有限的数据表明，与非拉美裔白人青年相比，美国印第安人(AI)青年经历了较高的自杀未遂、自杀未遂和自杀意念。许多因素导致了AI青年的自杀意念，包括抑郁症状、自卑、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，区别于仅仅适用于文化的干预措施)最近在人工智能机构和其他族裔群体中被认为与积极的健康结果有关。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构建，但到目前为止，很少有研究使用这种方法。北卡罗来纳州(北卡罗来纳州)是密西西比河以东人工智能人口最多的地方。伦比印第安人部落是一个非保留性部落，人口约5万人，是该邦最大的部落，主要集中在罗伯逊县。这项拟议的探索性研究名为Lumbee Rite of Passage for Life，其总体目标是确定文化项目的影响，特别是伦比部落在三个部落拥有的男孩和女孩俱乐部开设的文化课程，对12至17岁的美国印第安人青少年的自杀意念的影响。这项研究将需要Lumbee社区的参与，并将作为维克森林大学医学院(WFUSM)的玛雅·安杰卢健康公平中心(MACH)、北卡罗来纳大学彭布罗克分校(UNCP)和北卡罗来纳州伦比部落之间的合作伙伴关系进行。这项探索性的R21将实现两个具体目标：(1)评估人们对自杀行为和自杀风险因素的看法，并调查北卡罗来纳州罗伯逊县Lumbee印第安人青年(12-17岁)的心理健康需求和服务；(2)确定部落运营的文化项目对自杀意念及其风险因素的影响。具体目标2的第二个目的是考察人口统计变量(包括性别)、性取向和肥胖对参加文化课与自杀意念之间的关系的调节作用。对于目标1，我们计划就心理健康资源的可用性和质量与社区看门人进行深入访谈，并与Lumbee青少年进行焦点小组访谈，以确定对心理健康问题的印象，特别是关于他们社区中的自杀及其危险因素。对于目标2，调查人员将与Lumbee部落一起进行一项可行性研究，以衡量由于参与一个文化项目而发生的自杀意念及其风险因素的变化，该文化项目包括原住民舞蹈、魔术歌唱、NC印第安人历史、珠子和陶器。参与者将被随机分为干预和延迟干预(对照)组，并通过调查收集干预前后自杀意念及其相关因素的测量结果。 公共卫生相关性：自杀及其危险因素在美国仍然是一个主要的公共卫生问题，与白人相比，美国印第安人在自杀、自杀未遂和自杀意念方面承担着不平等的负担。这项拟议的探索性研究是与北卡罗来纳州的Lumbee印第安人部落合作进行的，将测试使用部落开办的文化课程来促进积极的心理健康结果并减少Lumbee青少年自杀行为的可行性。虽然我们承认，文化可能只是促进年轻人良好心理健康的众多因素之一，但像这样的创新研究可能会导致更全面的治疗和预防干预措施，从而增加公共卫生知识。

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.