The very limited information available suggests that Native American women suffer from high rates of common psychological disorders, such as depression, anxiety, co-morbidity, and substance abuse disorders. Studies in other populations suggest that a significant proportion of the psychological problems among women are associated with current or a history of domestic violence, child physical, psychological and sexual abuse and other types of violence related trauma. Primary medical care settings where poor women present for attention to problems stemming from traumatic life experiences and therefore, may not receive appropriate mental health diagnosis and/or treatment. Patients with common psychological disorders are also known to use primary health care services more frequently than others, constituting a financial burden to the system. This three year research project will examine these issues further through (a) prevalence study to determine the proportion of Native American women with common psychological disorders who present in primary care (b) a case control study to determine the association between common psychological disorders and current or antecedent abuse and (c) a follow- up study to determine the course and outcome of common psychological disorders among Native American women in primary care. For the prevalence study, we plan to interview 500 Native American women between the uses of 18 and 44 presenting for primary care at thee IHS funded facilities. For the case control and follow-up study, we plan to interview 100 cases testing positive for psychological disorders and co-morbidity and 100 controls testing negative for a psychological disorder. The Indian Health Service has determine that the highest research priority in the area of Native American mental health is the need for more community based estimation of illness, and for a better understanding of service utilization and help-seeking behavior. This study addresses both of those identified needs.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Resource-Related Research Projects (R24)
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University of New Mexico
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Waitzkin, Howard; Schillaci, Michael; Willging, Cathleen E (2008) Multimethod evaluation of health policy change: an application to Medicaid managed care in a rural state. Health Serv Res 43:1325-47
Yager, Joel; Waitzkin, Howard; Parker, Tassy et al. (2007) Educating, training, and mentoring minority faculty and other trainees in mental health services research. Acad Psychiatry 31:146-51
Oetzel, John; Duran, Bonnie; Jiang, Yizhou et al. (2007) Social support and social undermining as correlates for alcohol, drug, and mental disorders in American Indian women presenting for primary care at an Indian Health Service hospital. J Health Commun 12:187-206
Waitzkin, Howard; Yager, Joel; Parker, Tassy et al. (2006) Mentoring partnerships for minority faculty and graduate students in mental health services research. Acad Psychiatry 30:205-17
Willging, Cathleen; Waitzkin, Howard; Wagner, William (2005) Medicaid managed care for mental health services in a rural state. J Health Care Poor Underserved 16:497-514
Chene, Roberto; Garcia, Lorenzo; Goldstrom, Margie et al. (2005) Mental health research in primary care: mandates from a community advisory board. Ann Fam Med 3:70-2
Duran, Bonnie; Malcoe, Lorraine Halinka; Sanders, Margaret et al. (2004) Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care. Child Abuse Negl 28:131-45
Duran, Bonnie; Walters, Karina L (2004) HIV/AIDS prevention in ""Indian country"": current practice, indigenist etiology models, and postcolonial approaches to change. AIDS Educ Prev 16:187-201
Schillaci, Michael A; Waitzkin, Howard; Carson, E Ann et al. (2004) Immunization coverage and Medicaid managed care in New Mexico: a multimethod assessment. Ann Fam Med 2:13-21
Escalona, Rodrigo; Achilles, Georgiana; Waitzkin, Howard et al. (2004) PTSD and somatization in women treated at a VA primary care clinic. Psychosomatics 45:291-6

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