Self-reported Illness Experiences and Psychosocial Outcomes for Reservation-Area American Indian Youth During COVID-19

Abstract

IMPORTANCEImpacts of COVID-19 on reservation-area American Indian youth are unknown and may be substantial owing to the significant COVID-19 morbidity and mortality experienced by American Indian populations. OBJECTIVE To measure self-reported illness experiences and changes in psychosocial factors during the COVID-19 pandemic among reservation-area American Indian youth. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a random sample of US schools on or near US Indian reservations during Spring 2021, stratified by region, with students in grades 6 to 12 completing cross-sectional online surveys. All enrolled self-identifying American Indian students in grades 6 to 12 attending the 20 participating schools were eligible to be surveyed; participants represented 60.4% of eligible students in these schools. Data were analyzed from January 5 to July 15, 2022. EXPOSURES Onset of the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Outcomes of interest were COVID-19 self-reported illness outcomes for self and family and close friends; perceived changes in family and friend relationships, school engagement, social isolation, and other psychological factors since the COVID-19 pandemic began; and worry over COVID-19-related health outcomes. RESULTS A total of 2559 American Indian students (1201 [46.9%] male; 1284 [50.2%] female; 70 [2.7%] another gender; mean [SD] 14.7 [8.9] years) were included in the analysis. Approximately 14%of the sample reported having had a test result positive for SARS-CoV-2 infection (14.3% [95% CI, 11.4%-17.6%]), a higher rate than for all cases nationally at the time of the survey. Regarding prevalence of COVID-19 among family and close friends, 75.4% (95% CI, 68.8%-80.9%) of participants reported having at least 1 family member or friend who had contracted COVID-19, while 27.9% (95% CI, 18.8%-39.3%) of participants reported that at least 1 family member or close friend had died of COVID-19. Regarding psychosocial impacts, COVID-19 was associated with strained friend relationships (eg, 34.0% [95% CI, 28.4%-40.0%] of students reported worry over losing friends), lower school engagement, and less social connectedness (eg, 62.2% [95% CI, 56.7%-67.4%] of students reported feeling less socially connected to people), although more than 60% of students also reported feeling no change or a decrease in negative emotions. Males were less likely to report perceived negative impacts, especially for negative emotions such as sadness (29.2% [95% CI, 23.3%-35.9%] of males vs 46.1% [95% CI, 43.9%-48.3%] of females reported feeling more sad) and anxiety (21.8% [95% CI, 18.2%-25.8%] of males vs 39.2% [95% CI, 34.1%-44.6%] of females reported feeling more anxious).

A Comparison of COVID-19 Outcomes Between Reservation-Area American Indian and U.S. National Students

“…Levels of negative emotional states among reservation-area AI 6th–12th-grade students since the start of COVID-19 were relatively high, with substantial numbers of students reporting feeling a negative emotional state often or very often. 25 For example, 47.2% of the AI sample reported feeling sad or lonely often or very often, whereas 69.6% reported feeling bored often or very often. Given that fewer AI students noted an increase in negative effects than NS students, it is possible that negative emotional states were higher in reservation-area AI adolescents than nationally before the pandemic, a preexisting ceiling effect.…”

Summarizing Implementation Support for School-Based COVID-19 Testing Programs in Southwest American Indian Communities

“…13 Disruptions to the educational systems in reservation-based communities, combined with the pandemic's ongoing toll, have profoundly affected AI/AN youth's mental health and academic self-efficacy. 14 With the urgent need to reopen schools for inperson learning, the Centers for Disease Control and Prevention (CDC), in July 2020, released recommendations for schools that wanted to implement in-person learning. 15,16 Their guidance, supported and promoted by the American Academy of Pediatrics, incorporated layered mitigation strategies, including social distancing, cohorting, universal masking, handwashing, sanitization, temperature screening, and home-based symptom screenings.…”

“…School connectedness, which includes a sense of belonging and feeling supported at school, has also been identified as a protective influence on youth mental health even after controlling for marginalization and discrimination 13. Disruptions to the educational systems in reservation-based communities, combined with the pandemic's ongoing toll, have profoundly affected AI/AN youth's mental health and academic self-efficacy 14…”