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Transcript
Mental Health Status of Older Adults Traditional Conceptions & Current Research University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Supported by: Objectives Knowledge of traditional tribal conceptions of mental health and illness Familiarity with the studies of American Indian elder mental health in the research literature Specific knowledge of the experience of depression in tribal cultures in America Traditional Concept of Mental Health There is no separate concept referred to as “mental health” Traditional concepts of wellness include emotional, mental, physical, and spiritual realms of the individual and extend beyond the self to family, clan, tribe, and the physical environment All must be in balance to have health or wellness Note: This slide also appears in the Beliefs about Health PowerPoint (slide 3) Traditional Conceptions of Mental Illness “Native peoples generally do not have a notion of ‘insane’ or ‘mentally ill.’ I have been unable to locate a Native Nation whose indigenous language has a word for that condition. The closest I can come is a word more closely aligned with ‘crazy,’ which means someone is either very funny, or too angry to think straight”. Yellowbird, P. (p.4) 1 Note: This slide also appears in the Mental Health Service to Native Elders Traditional Explanations for Western Conceptions of Mental Illness & Symptoms Symptoms that Westerners would define as indicative of a mental disorder Are the result of imbalance within the self, the family, clan, tribe, or the physical world An individual may not be living up to their roles or obligations to their self or to the larger entities Symptoms A symptom can occur in any of the realms (emotional, mental, physical, spiritual) Note: This slide also appears in the Beliefs about Health PowerPoint (slide 4) Mental Health Research Limited with Focus on Depression AI/AN Elders are not well represented in mental health research Six studies of AI/AN Elders are cited by Surgeon General 2 5 studies focused on depression with rates of symptoms or depressive disorder ranging 18% to 30% 1 study focused on primary care with 20% of sample reporting psychiatric symptoms Compared to 10% to 16% of the general older population with severe depressive symptoms Depression and the Elderly in the General Society3 Major Depression in the General Elderly Population Less than 1% to about 5% for those living in the community 13.5% for those that who require home healthcare 11.5% for those in hospitals Subsyndromal Depression When a person has depressive symptoms that are reported and potentially debilitating, but the full criteria to receive a major depression diagnosis is not present 5 million experience subsyndromal depression More common among elderly Depression Risk Increases When other illnesses are present When ability to function becomes limited. When subsyndromal depression exists Depression and Suicide in the General Older American Population3 Suicide is experienced at higher rates in older Americans People ages 65 and over represented 16% of suicides in 2004. Even thought they comprise only 12% of the population Research indicates that a large percentage (up to 75%) of older adults met with a physician within one month before their suicide None of the references referred to older American Indian elders Assessment of Depression Center for Epidemiology Studies Depression Scale (CES-D) The scale used the most in studies of American Indians and depression A paper and pencil self report questionnaire intended to measure depressive symptomatology across four factors depression, positive affect, somatic/retarded activity, and interpersonal 4 Three factor structure has been found for AI/AN groups in which the depressed affect and somatic factors collapse into one factor versus separate symptoms 5, 6, 7 One study by reported the original four factor structure in their study of American Indians adults without the affective and somatic symptoms constituting an undifferentiated factor 8 Great Lakes Native Elders & Depression 9 Current Depression Predicted by: Later Depression (18 months to 2 years later) Predicted by: Health problems Functional health High levels of stress due Presence of other illnesses Life events Problems with finances Lower education Increased reports of functional disability Stress from life events Residence (rural are less depressed than off reservation or reservation) Qualitative Research Flathead Reservation 10 Participants reported that a majority of the tribe was depressed. The meaning of depression was remarkably different from American society. Flathead individuals appear to define their worth in terms of their connection to a larger group. Sadness for these tribal people rests on feelings of loneliness. Instead of a pathological bias to the disorder known as depression, the feelings are viewed as a natural response to disconnection. Researcher guards against equating Flathead loneliness with Euro-American conceptions of loneliness. Social Work Implications The majority of the findings indicate that Western measures may not accurately capture depression for AI/AN Assess for depression Aware that AI/AN Elders may emphasize different symptoms Assess the extent of debilitation of potential depression Need to ask the meaning of the symptoms for the elder Any indication of suicidal behavior needs to be further assessed Intervention Micro level interventions such as medication/therapy/traditional healers Consider mezzo, macro level interventions to address loneliness if present in elder Create interventions that are founded on the traditional values that hold elders in high esteem References 1. Yellowbird, P. (no date). Wild Indians: Native perspectives on the Hiawatha asylum for insane Indians. Washington, DC: Substance Abuse Mental Health Services. Administration. Retrieved July 16, 2008 from http://dsmc.info/pdf/canton.pdf 2. U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity, a supplement to mental health: A report of the surgeon general. Rockville, MD: Author 3. National Institute of Mental Health. (no date). Older adults: Depression and suicide facts. Washington, DC: author. Retrieved July 16, 2008 from http://www.nimh.nih.gov/health/publications/older-adultsdepression-and-suicide-facts.shtml 4. Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401. 5. Beals, J., Manson, S.M., Keane, E.M., & Dick, R.W. (1991). Factorial structure of the Center for Epidemiological Studies-Depression Scale among American Indian college students. Psychological Assessment, 3, 623-627. 6. Dick, R.W., Beals, J., Keane, E.M., & Manson, S.M. (1994). Factorial structure of the CES-D among American Indian adolescents. Journal of Adolescence, 17, 73-79. 7. Somervell, P.D., Beals, J., Kinzie, J.D., Boehnlein, J., Leung, P., & Manson, S.M. (1993). Use of the CES-D in an American Indian Village. Culture, Medicine, and Psychiatry, 16, 503-517. 8. Whitbeck, L.B., McNorris, B.J., Hoyt, D.R., Stubben, J.D., & LaFromboise, T. (2002). Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest. Journal of Health and Social Behavior, 43, 400-418. 9. Chapeleski, E.E., Kaczynski, R., Gerbi, S.A., & Lichtenberg, P.A. (2004). American Indian elders and depression: Short-and-long term effects of life events. Journal of Applied Gerontology, 23(40), 40-57. 10. O’Nell, T.D. (1996). Disciplined hearts, history, identity, and depression in an American Indian community. Berkeley, CA: University of California Press.