Mental Health Disorders Among an Invisible Minority: Depression and Dementia Among American Indian and Alaska Native Elders

Abstract

According to the 2010 Census, 5.2 million people identified themselves as American Indian or Alaska Native (AIAN) in the United States. This was an increase of 39% from the prior Census, making AIANs one of the nation's fastest growing populations. The health and social programs reaching them, however, have experienced documented devastating shortfalls. Decades of inadequate resources have resulted in significant health and socioeconomic disparities. AIANs are often considered an "invisible minority." In 2012, there were 266,000 AIAN elders 65 or older who claimed one race alone. That number is projected to almost triple by 2030-when the nation's baby boomers move into the ranks of the older population. This article provides an overview of two primary mental health issues-depression and dementia-that will confront this emerging AIAN elder population. Although other health and social issues exist, this article addresses depression and dementia because they are hidden from the community and from health care agencies. This paper focuses both on the unique characteristics of the AIAN population and why it is important to address depression and dementia. The conclusion explores pragmatic policy recommendations for improving the health and long-term mental health care status of AIAN elders.

Factors Associated with American Indian Mental Health Service Use in Comparison with White Older Adults

“…Indeed, according to Kramer [45], over 30% of AI/AN older adults visiting an urban Indian Health Services (IHS) outpatient medical facility reported significant depressive symptoms. This statistic is substantially higher than most published estimates of the prevalence of depression among older Whites with chronic illnesses (9–31%) ([49], cited in [27]). In another clinic-based examination, the National Institute of Mental Health [54] (2001) indicated that nearly 20% of AI/AN elders who received primary care reported significant psychiatric symptoms, with rates increasing as a function of age.…”

“…In another clinic-based examination, the National Institute of Mental Health [54] (2001) indicated that nearly 20% of AI/AN elders who received primary care reported significant psychiatric symptoms, with rates increasing as a function of age. Strikingly, the number of AI/AN elders with depression is expected to nearly quadruple to 81,702 cased by 2050 (in comparison with 20,950 cases reported in 2010 [27]).…”

“…Older adults are particularly vulnerable to psychological distress and unmet mental health needs [6, 27]. In particular, research consistently suggests that AI/AN older adults suffer more psychological distress than their White counterparts due to their experiences with the historical oppression and trauma related to colonization and subjugation and the associated numerous broken treaties, discrimination, poverty, and violence [10, 13, 65].…”

“…Despite the rapid growth of the nation’s elderly populations and persistent disparities in AI/AN mental health service use, little is known about the racial/ethnic, cultural, and attitudinal factors affecting the gaps in mental health service utilization, particularly among AI/AN older adults in a rural area [27, 61]. Race/ethnicity and culture inextricably shape beliefs, attitudes, and expression of symptoms, and hence have a significant impact on the types of mental health services accessed [50].…”

Cognition, Depressive Symptoms and Vascular Factors among Southwest Tribal Elders

“…2 Among AI/NAs, we expect to identify 23,850 persons aged >65 years with dementia in 2010, increasing to 100,980 by 2050. 3 However, a PubMed search readily shows that rigorous studies of aging and cognitive disorders in AI populations are rare.…”