New research published in the journal Cultural Diversity and Ethnic Minority Psychology has exposed the troubling connection between the underutilization of mental health services among American Indians and Alaska Native (AIAN) populations and experiences of racism in the healthcare system.
The study, conducted by researchers Tracy J. Stewart and Vivian M. Gonzalez, has identified historical trauma and racial discrimination as critical factors contributing to this concerning phenomenon fueled by historical trauma. The AIAN population experiences higher rates of social injustices and adverse mental health outcomes than other ethnic groups in the United States. Despite the urgent need for mental health care, members of this community often avoid seeking professional help.
According to Stewart and Gonzalez, a deep-rooted distrust of the healthcare system (HCS) lies at the heart of this issue. In addition, the authors argue that the violent colonization, forced removal from ancestral lands, broken treaties, and forced assimilation through tactics such as boarding schools and adopting out Native children to non-AIAN families contribute to this lingering mistrust.
“The histories of AIAN people often include violent colonization, forced removal from and loss of ancestral lands, broken treaties, and forced assimilation through tactics such as boarding schools and adopting out AIAN children to non-AIAN families (…). This history and its lingering effects, as well as more contemporary racial discrimination, may contribute to distrust of the healthcare system (…) and act as a substantial barrier for seeking mental health services.”
The researchers hypothesized that higher levels of perceived historical trauma or racial discrimination would lead to a lower inclination to seek mental health care among the Native population. They also proposed that this relationship is mediated by distrust of healthcare systems.
To test these hypotheses, the study recruited 392 AIAN students (mean age 28.4, ranging from 18 to 68) from the University of Alaska. Participants completed a series of self-reported questionnaires that assessed their perceived historical trauma, racial discrimination, healthcare system distrust, and attitudes toward seeking help for mental health.
The results supported both hypotheses, revealing that frequent thoughts of historical loss and heightened levels of perceived racism were associated with higher distrust of HCS and lower help-seeking behavior.
Indeed, frequent thoughts of historical loss were indirectly associated with lower help-seeking behavior through its relationship with HLAS and distrust towards HCS. Individuals who had more thoughts of historical loss were likely to have more distress related to such thoughts and were likely to have a higher suspicion of healthcare systems. Ultimately, such high distrust of health systems was associated with lower help-seeking behavior.
A similar relationship was found between perceived racism and mental health help-seeking behaviors. Heightened levels of perceived racism were associated with higher distrust of HCS which in turn was also associated with lower help-seeking tendencies. Interestingly, however, unlike perceived historical trauma, perceived racism was directly associated with an individual’s help-seeking tendencies. This suggests that addressing racism beyond its relationship to HCS can potentially impact the AIAN population’s help-seeking behavior regarding mental health.
Although the study’s cross-sectional methodology prevents the establishment of cause-and-effect relationships, it nonetheless highlights key factors contributing to the underutilization of mental health care within Native populations. Further, it does not consider potential key individual characteristics, such as previous experience with HCS or personal mental health history. Despite such limitations, the study highlights key factors that may be contributing to the underutilization of mental health care within the AIAN population, which can be considered for future solutions.
The authors emphasize the urgency of addressing these issues, as failure and delays in seeking services at the early onset of mental health symptoms can lead to more severe disorders and diminish the opportunity for preventing suicidality.
In conclusion, the findings of this study underscore the importance of considering the long history and ongoing forms of racism, oppression, and mistreatment of the AIAN population by the dominant Western culture when addressing mental health outcomes and utilization of mental health services.
Stewart, T. J., & Gonzalez, V. M. (2023). Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students. Cultural Diversity and Ethnic Minority Psychology. Advanced online publication. https://doi.org/10.1037/cdp0000587 (Link)