The highest research priority in the area of American Indian mental health is the need for community-based estimation of illness and adjustment, and for a better understanding of service utilization and help-seeking for these problems. Despite significant ethnogologic work and a wealth of anecdotal information on American Indian mental health, we lack even in most basic knowledge about psychiatric epidemiology and service utilization. The lack of this critical information seriously handicaps both services research and etiologic planning. In order to address this important deficit, the specific aims of the proposal are: 1) To obtain prevalence rates of the major mental disorders among Navajo and Lakota, two of the largest American Indian nations, using a culturally sensitive diagnostic instrument as well as to obtain prevalence rates for culture- specific syndromes and symptoms, and to compare their distribution with DSM-based diagnoses. 2) To ascertain service utilization patterns for mental health services including those provided by the Indian Health Service, other biomedical service providers, and by traditional medicine men and healers; 3) To examine the impact on psychiatric morbidity of selected risk factors including demographics (age, education, employment, gender), life stress, social support, ethnic identity, and family psychiatric history. 4) To compare the results of specific aims 1-3 on prevalence rates, presence of associated risk factors, and service utilization patterns with similar data obtained in the National Comorbidity Study (NCS) and the Turner Toronto study. The Epidemiologic Catchment Area (ECA) study will also provide a comparison group for diagnoses that were not changed between DSM-III-R. 5) To obtain ethnographic data necessary to culturally contextualize the results of the foregoing specific aims and thereby to determine the cross-cultural generalizability of these results. This will include examinations of conceptions of mental illness and explanatory models off illness episodes in these two distinct cultures, the cultural relevance of DSM-III-R and DSM-IV categories by identifying and describing the range, frequency, expression, and treatment of symptoms associated with psychiatric disorder in these 2 cultures, the cultural dimensions of help-seeking for mental illness, with particular attention to the function of extended families in treatment decisions, and the development of culturally contextualized case studies of a set of survey respondents diagnosed with depressive and alcohol dependence disorders in their family environment in order to illuminate cultural and social factors affecting the experience, expression, and treatment of psychiatric disorder in these communities. This 5-year project will be conducted by the interdisciplinary team of the National Center for American Indian and Alaska Native mental Health Research (NCAIANMHR) at the University of Colorado health Sciences Center with Field Offices in the reservations in question. When completed, this project will result ina a unique data set which will provide many of the answers the fields of epidemiology and services research needs about American Indians.
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