Key takeaways
- American Indian and Alaska Native (AIAN) adults in California who identified as AIAN-Latino or AIAN-multiracial were 1.5 times as likely to have experienced serious psychological distress and moderate psychological distress in the past year compared to AIAN adults who are not mixed race or ethnicity.
- 61% of all American Indian and Alaska Native adults with serious or moderate psychological distress had not seen a medical provider in the past year.
- 68% of AIAN adults with serious or moderate psychological distress experienced problems with family relationships, their job duties, socializing, or doing household chores.
While more than 1 in 3 American Indian and Alaska Native adults in California experienced moderate or serious psychological distress in the past year, 61% of the individuals in that group had not seen a medical provider, according to a new study from the UCLA Center for Health Policy Research.
Using pooled data from the California Health Interview Survey (CHIS) for the years 2019–2023, the study goes further than previous research into AIAN mental health outcomes to provide disaggregated data for three subgroups: those who identify as AIAN-alone (non-Latino), those who identify as both AIAN and Latino and those who identify as both AIAN and one or more other races.
In analyzing the disaggregated data, AIAN-Latino (23%) and AIAN-multiracial (24%) adults were 1.5 times as likely to have experienced serious psychological distress compared to AIAN-alone (15%) adults. Data showed similar trends with AIAN-Latino and AIAN-multiracial adults experiencing higher rates of moderate psychological distress compared to AIAN-alone.
"Our research reinforces the fact that American Indians and Alaska Natives are not a monolith, and in studying disaggregated data we see that multiracial and multiethnic AIAN groups often have worse mental health outcomes," said Imelda Padilla-Frausto, the study's author and a research scientist at the UCLA Center for Health Policy Research (CHPR).
Examined separately, AIAN-Latino adults were more likely than AIAN-multiracial adults to have had unmet mental health care needs (67% vs. 54%), while 59% of AIAN-alone adults had an unmet mental health care need. Unmet mental health care need was defined as not seeing a mental health or medical provider in the past year.
These findings are consistent with other research conducted by the UCLA CHPR that has shown that multiracial and multiethnic Black, Latino and Asian adults have worse mental health outcomes than their monoracial and monoethnic counterparts, Padilla-Frausto said.
The study also found that 68% of all AIAN adults who experienced moderate or serious psychological distress in the previous 12 months said that their mental health severely impaired various aspects of their lives, including family relationships, work, socializing and household chores. The percentages were similar for all three AIAN subgroups.
Those levels of psychological distress combined with severe impairment in one or more of these areas in the previous year are often used to identify mental health care as an urgent need or medically necessary.
AIAN individuals are 2-5 times as likely as other ethnic or racial groups to experience serious psychological distress, and they have the highest percentage of impairment from mental health challenges, according to a 2021 study by the Health Resources and Services Administration.
"The history of European colonization and racism along with other social drivers of health are important factors that have led to mental health problems in American Indian and Alaska Native communities," Padilla-Frausto said. "To really improve mental health among all American Indian and Alaska Native populations, we have to address the systemic issues and improve access to culturally and linguistically appropriate mental health prevention, intervention and care."
The prevalence of mental health struggles and unmet care needs comes despite the fact that federally recognized AIAN individuals and their descendants are entitled to health care, including mental health services, through the Indian Health Service.
Some of the recommendations in the study include:
- Increase diversity among mental health providers to include providers from all AIAN subgroups.
- Collaborate with the Indian Health Service, tribal scholars and elders, community- and faith-based organizations, community health workers and peers with lived experience to promote mental health.
- Standardize the collection, analysis and reporting of disaggregated data for American Indians and Alaska Natives across all care systems, support services and population health surveillance.
