The Role of Individual and Community Level Social and Cultural Connectedness in Modifying the Effect of Childhood Adversity on Anxiety and Depression in American Indian College Students

Thesis (Master's)--University of Washington, 2018Background: While causes of anxiety and depression are multifactorial, chronic and acute stress experiences play an important role. Adverse Childhood Experiences (ACEs), are sources of childhood stress for which a dose-response relationship with anxiety and depression symptoms across the lifespan has been well established. American Indian and Alaskan Natives (AIANs) experience significantly more ACEs compared to whites; and depression and anxiety symptoms at similar or higher rates compared to the general U.S. population. AIAN families endure a disproportionately high burden of social, cultural, and economic stressors associated with poor health; largely attributable to a history of attempted genocide, forced assimilation, and resulting historical trauma. Despite this, AIANs have demonstrated resilience and strength in surviving and overcoming adversity, both individually and collectively. An important priority for health research is to identify, describe, and document AIAN resiliency factors and the ways they buffer against adverse biological and psychosocial effects of stressors. This study uses an indigenist stress-coping framework to examine how individual and community level social and cultural connectedness factors protect against symptoms of depressive and anxiety disorders in AIAN college students with a history of childhood adversity. Methods: This study is a secondary analysis of data collected in collaboration with Tribal Colleges and Universities across the US using Community Based Participatory Research (CBPR) methods. Our study data from AIAN college students was drawn from a convenience sample of 14 TCUs (N = 1,143). Descriptive statistics are presented. Bivariate correlations of ACEs, anxiety, depression, and five social and cultural connectedness measures at the individual-level (social support, ethnic identity, participation in Tribal practices, and perception of Tribal community fit) and two at the college community-level (opportunities for student communication and availability of cultural events) are assessed. Multivariable logistic regression models were used to examine associations of ACEs with anxiety and depression. To evaluate moderation by social and cultural connectedness factors, we added interaction terms containing the ACEs variable and each binary indicator of social and cultural connectedness. Results: In this study sample, 14.7% of respondents reported elevated depression symptoms and 12.3% of respondents reported elevated anxiety. For each unit increase of ACEs, the odds of having depression increased by 19% (OR = 1.19; 95% CI: 1.14-1.24), and the odds of having anxiety increased by 20% (OR= 1.20; 95% CI: 1.16-1.25). Of the seven social and cultural connectedness measures tested, only emotional and instrumental social support factors were significantly associated with mental health outcomes (p