For Native American populations, mental disorder prevalence, distribution and subsequent treatment seeking is not well known. Evidence from the few studies that have been published and research underway now, however, suggests a serious disparity in the prevalence of mental disorders for this population compared to the general US population and a very low utilization of mental health services. Research Plan: Two complementary studies are proposed. The first is a small qualitative investigation of illness experience and contextual factors related to treatment seeking among Native American women with current and lifetime psychological pathology. The second is a quantitative secondary analysis of pathways to mental health treatment and care seeking among Native women. Both studies aim to provide descriptive and analytic information on utilization by type of disorder and treatment system and identify other influences on care seeking as suggested by the Network-Episode Model theory. The research will test models regarding the pathways into care that consider social, community and system variables as determinants of access to treatment and provide narratives to contextualize the results. One data set to be used for the secondary analysis is drawn from the largest psychiatric epidemiologic, risk and protective factors study ever conducted among Native Americans (the SUPERPFP study N=3200). The other data set is from the candidates own study of the same variables drawn from Native women in a primary care setting (Mental Health and Abuse Among Native Women in Primary Care N=234) Career Development Program: This study will be conducted within the broader context of an expert-led training program. The proposed 5-year course of study includes instruction in advanced quantitative research design and statistical methods, multi-level and mixed method approaches, psychiatric nosology, and the operationalization of theory in pathways to mental health care research. The ultimate goal of this revised Career Development Award is for the candidate to have the skills, knowledge, and experience to teach and conduct rigorous, culturally competent mental health services research for Native Americans and other culturally distinct groups.
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