Transcript Strengthening Aging and Gerontology Education for Social

Mental Health Status of
Older Adults
Traditional Conceptions & Current Research
University of Oklahoma
School of Social Work
Master’s Advanced Curriculum Project
Supported by:
Objectives
 Knowledge of traditional tribal conceptions
of mental health and illness
 Familiarity with the studies of American
Indian elder mental health in the research
literature
 Specific knowledge of the experience of
depression in tribal cultures in America
Traditional Concept of Mental Health
 There is no separate concept referred to as “mental
health”
 Traditional concepts of wellness include emotional,
mental, physical, and spiritual realms of the
individual and extend beyond the self to family, clan,
tribe, and the physical environment
 All must be in balance to have health or wellness
Note: This slide also appears in the Beliefs about Health PowerPoint (slide 3)
Traditional Conceptions of Mental Illness
“Native peoples generally do not have a
notion of ‘insane’ or ‘mentally ill.’ I have
been unable to locate a Native Nation
whose indigenous language has a word for
that condition. The closest I can come is a
word more closely aligned with ‘crazy,’
which means someone is either very
funny, or too angry to think straight”.
Yellowbird, P. (p.4)
1
Note: This slide also appears in the Mental Health Service to Native Elders
Traditional Explanations for Western
Conceptions of Mental Illness & Symptoms
 Symptoms that Westerners would define as
indicative of a mental disorder
 Are the result of imbalance within the self, the family,
clan, tribe, or the physical world
 An individual may not be living up to their roles or
obligations to their self or to the larger entities
 Symptoms
 A symptom can occur in any of the realms (emotional,
mental, physical, spiritual)
Note: This slide also appears in the Beliefs about Health PowerPoint (slide 4)
Mental Health Research
Limited with Focus on Depression
 AI/AN Elders are not well represented in mental health
research
 Six studies of AI/AN Elders are cited by Surgeon
General
2
 5 studies focused on depression with rates of symptoms or
depressive disorder ranging 18% to 30%
 1 study focused on primary care with 20% of sample
reporting psychiatric symptoms
 Compared to 10% to 16% of the general older population
with severe depressive symptoms
Depression and the Elderly
in the General Society3
 Major Depression in the General Elderly Population

Less than 1% to about 5% for those living in the community

13.5% for those that who require home healthcare

11.5% for those in hospitals
 Subsyndromal Depression

When a person has depressive symptoms that are reported and potentially
debilitating, but the full criteria to receive a major depression diagnosis is
not present

5 million experience subsyndromal depression

More common among elderly
 Depression Risk Increases

When other illnesses are present

When ability to function becomes limited.

When subsyndromal depression exists
Depression and Suicide in the
General Older American Population3
 Suicide is experienced at higher rates in older
Americans
 People ages 65 and over represented 16% of suicides
in 2004.
 Even thought they comprise only 12% of the population
 Research indicates that a large percentage (up to
75%) of older adults met with a physician within one
month before their suicide
 None of the references referred to older American
Indian elders
Assessment of Depression
Center for Epidemiology Studies Depression Scale (CES-D)
 The scale used the most in studies of American Indians
and depression
 A paper and pencil self report questionnaire intended to
measure depressive symptomatology across four factors
 depression, positive affect, somatic/retarded activity, and
interpersonal 4
 Three factor structure has been found for AI/AN groups
in which the depressed affect and somatic factors
collapse into one factor versus separate symptoms
5, 6, 7
 One study by reported the original four factor structure
in their study of American Indians adults without the
affective and somatic symptoms constituting an
undifferentiated factor 8
Great Lakes Native Elders & Depression
9
Current Depression
Predicted by:
Later Depression (18 months to 2
years later) Predicted by:
 Health problems
 Functional health
 High levels of stress due
 Presence of other illnesses
 Life events
 Problems with finances
 Lower education
 Increased reports of
functional disability
 Stress from life events
 Residence (rural are less depressed
than off reservation or reservation)
Qualitative Research
 Flathead Reservation 10
 Participants reported that a majority of the tribe was
depressed.
 The meaning of depression was remarkably different from
American society.
 Flathead individuals appear to define their worth in terms of
their connection to a larger group. Sadness for these tribal
people rests on feelings of loneliness.
 Instead of a pathological bias to the disorder known as
depression, the feelings are viewed as a natural response to
disconnection.
 Researcher guards against equating Flathead loneliness with
Euro-American conceptions of loneliness.
Social Work Implications
 The majority of the findings indicate that Western
measures may not accurately capture depression for
AI/AN
 Assess for depression
 Aware that AI/AN Elders may emphasize different symptoms
 Assess the extent of debilitation of potential depression
 Need to ask the meaning of the symptoms for the elder
 Any indication of suicidal behavior needs to be further assessed
 Intervention
 Micro level interventions such as medication/therapy/traditional
healers
 Consider mezzo, macro level interventions to address loneliness if
present in elder
 Create interventions that are founded on the traditional values that
hold elders in high esteem
References
1.
Yellowbird, P. (no date). Wild Indians: Native perspectives on the Hiawatha asylum for insane Indians.
Washington, DC: Substance Abuse Mental Health Services. Administration. Retrieved July 16, 2008 from
http://dsmc.info/pdf/canton.pdf
2.
U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity, a
supplement to mental health: A report of the surgeon general. Rockville, MD: Author
3.
National Institute of Mental Health. (no date). Older adults: Depression and suicide facts. Washington,
DC: author. Retrieved July 16, 2008 from http://www.nimh.nih.gov/health/publications/older-adultsdepression-and-suicide-facts.shtml
4.
Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general
population. Applied Psychological Measurement, 1(3), 385-401.
5.
Beals, J., Manson, S.M., Keane, E.M., & Dick, R.W. (1991). Factorial structure of the Center for
Epidemiological Studies-Depression Scale among American Indian college students. Psychological
Assessment, 3, 623-627.
6.
Dick, R.W., Beals, J., Keane, E.M., & Manson, S.M. (1994). Factorial structure of the CES-D among
American Indian adolescents. Journal of Adolescence, 17, 73-79.
7.
Somervell, P.D., Beals, J., Kinzie, J.D., Boehnlein, J., Leung, P., & Manson, S.M. (1993). Use of the CES-D
in an American Indian Village. Culture, Medicine, and Psychiatry, 16, 503-517.
8.
Whitbeck, L.B., McNorris, B.J., Hoyt, D.R., Stubben, J.D., & LaFromboise, T. (2002). Perceived
discrimination, traditional practices, and depressive symptoms among American Indians in the upper
midwest. Journal of Health and Social Behavior, 43, 400-418.
9.
Chapeleski, E.E., Kaczynski, R., Gerbi, S.A., & Lichtenberg, P.A. (2004). American Indian elders and
depression: Short-and-long term effects of life events. Journal of Applied Gerontology, 23(40), 40-57.
10.
O’Nell, T.D. (1996). Disciplined hearts, history, identity, and depression in an American Indian community.
Berkeley, CA: University of California Press.