The role of individual and community level social and cultural connectedness in modifying the effect of childhood adversity on anxiety and depression in American Indian college students

BACKGROUND

While causes of anxiety and depression are multifactorial, chronic and acute stress experiences play an important role. Adverse Childhood Experiences (ACEs), are sources of childhood stress for which a dose-response relationship with anxiety and depression symptoms across the lifespan has been well established. American Indian and Alaskan Natives (AIANs) experience significantly more ACEs compared to whites; and depression and anxiety symptoms at similar or higher rates compared to the general U.S. population. AIAN families endure a disproportionately high burden of social, cultural, and economic stressors associated with poor health; largely attributable to a history of attempted genocide, forced assimilation, and resulting historical trauma. Despite this, AIANs have demonstrated resilience and strength in surviving and overcoming adversity, both individually and collectively. An important priority for health research is to identify, describe, and document AIAN resiliency factors and the ways they buffer against adverse biological and psychosocial effects of stressors. This study uses an indigenist stress-coping framework to examine how individual and community level social and cultural connectedness factors protect against symptoms of depressive and anxiety disorders in AIAN college students with a history of childhood adversity.

METHODS

This study is a secondary analysis of data collected in collaboration with Tribal Colleges and Universities across the US using Community Based Participatory Research (CBPR) methods. Our study data from AIAN college students was drawn from a convenience sample of 14 TCUs (N = 1,143). Descriptive statistics are presented. Bivariate correlations of ACEs, anxiety, depression, and five social and cultural connectedness measures at the individual-level (social support, ethnic identity, participation in Tribal practices, and perception of Tribal community fit) and two at the college community-level (opportunities for student communication and availability of cultural events) are assessed. Multivariable logistic regression models were used to examine associations of ACEs with anxiety and depression. To evaluate moderation by social and cultural connectedness factors, we added interaction terms containing the ACEs variable and each binary indicator of social and cultural connectedness.

RESULTS

In this study sample, 14.7% of respondents reported elevated depression symptoms and 12.3% of respondents reported elevated anxiety. For each unit increase of ACEs, the odds of having depression increased by 19% (OR = 1.19; 95% CI: 1.14-1.24), and the odds of having anxiety increased by 20% (OR= 1.20; 95% CI: 1.16-1.25). Of the seven social and cultural connectedness measures tested, only emotional and instrumental social support factors were significantly associated with mental health outcomes (p<0.001). No interaction terms were statistically significant. Thus, we did not find evidence for moderation of the association between ACEs and mental health by social and cultural connectedness factors.

CONCLUSIONS

Our results indicate that exposure to ACEs adversely affects the mental wellbeing of AIAN college students. This finding that is consistent with existing research. Our hypothesis that the association between ACES and depression and anxiety would be weaker among AIAN college students who reported high levels of social and cultural connectedness was not supported by the results. However, social support displayed a strong independent association with mental health of AIAN college students in our sample. This study adds to the body of evidence on adverse effects of childhood trauma and provides evidence that fostering social support among AIAN college students promotes mental wellbeing for students with and without a history of childhood adversity. More research should be done to explore the connection between social and cultural connectedness and mental wellbeing in AIAN communities.