Mental health, family functioning, and sleep in cultural context among American Indian/Alaska Native urban youth: A mixed methods analysis

• Published in: Social science & medicine (1982) 2022-01, Vol.292, p.114582-114582, Article 114582
• Main Authors: Palimaru, Alina I., Dong, Lu, Brown, Ryan A., D'Amico, Elizabeth J., Dickerson, Daniel L., Johnson, Carrie L., Troxel, Wendy M.
• Format: Article
• Language: English
• Subjects: Actigraphy; Adolescent; Adolescents; Alaska Natives; American Indian or Alaska Native; American Indians; Anxiety; Child & adolescent mental health; Cultural identity; Extended family; Families & family life; Family; Family cohesion; Family Health; Family relations; Health problems; Humans; Indians, North American - psychology; Indigenous peoples; Indirect effects; Intervention; Mental depression; Mental disorders; Mental Health; Mental health services; Mixed methods; Mixed methods research; Native American; Path analysis; Polls & surveys; Research methodology; Resilience; Sleep; Sleep disorders; Sociocultural factors; Socioeconomic status; Stress; Symptoms; United States - epidemiology; Urban; Urban areas; Youth
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2021.114582

Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth. All participants (N = 142) completed surveys; a random subsample (n = 26) completed qualitative interviews to assess family and cultural dynamics related to sleep, which informed hypothesized direct and indirect effects that were tested using survey data. Narratives identified mechanisms of family cohesion (e.g., daily interactions that build perceived family togetherness and family-centered traditional activities) and the role that family cohesion plays in sleep (e.g., ensuring stability of sleep environments). Path analysis showed direct effects of improved family functioning on fewer depressive and anxiety symptoms, and indirect effects through lower self-reported sleep disturbance (but not through greater actigraphy-measured sleep duration or efficiency). Cultural identity did not moderate effects in quantitative tests. Our findings illustrate the complex associations among family functioning, sleep, and mental health in AI/AN youth. Family-based interventions to improve adolescent mental health should address modifiable intervention targets such as sleep, and address sources of both risk and resilience relevant to urban AI/AN families, including extended family and cultural practices. •Narratives show family cohesion through family traditional practice.•Narratives show role family cohesion plays in sleep, e.g., stable sleep environment.•Better family functioning had direct effect on less depression and anxiety.•Better family functioning had indirect effects through lower sleep disturbance.•Cultural identity was not a significant moderator in the tested pathways.