Year of Award

2023

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Duncan Campbell

Commitee Members

Allen Szalda-Petree, Stuart Hall, Julie Olomi, Kari Jo Harris

Keywords

Alaska Natives, American Indians, First Nations, health disparities, older adults, resilience

Abstract

Background: Multiple major health disparities have been documented in Indian Country, including cardiovascular disease (Howard et al., 1999), diabetes (Acton et al., 2003), asthma (Mannino et al., 2002), and arthritis (Barbour et al., 2017). Prior research has shown that the prevalence rates of these conditions in American Indians and Alaska Natives (AI/ANs) are among the highest in the United States. Given these health disparities, aging older adults in Indian Country may be especially vulnerable to the development of concurrent negative mental health outcomes, particularly depression (Garrett et al., 2015). Nonetheless, AI/AN older adults continue to age successfully and exhibit substantial mental health resilience in the face of the major health disparities (Lewis, 2016; Schure et al., 2013).

Methods: The current study begins with a detailed overview of CVD, diabetes, arthritis, and asthma in Indian Country. The study transitions to a narrative review of resilience in American Indian, Alaska Native, and Canadian First Nations older adults (50 years and older). The goals of the narrative review are to: (a) examine the state of knowledge of resilience in these populations; (b) assess the degree to which the available resilience literature attends to CVD, diabetes, asthma, and arthritis; and (c) use the available literature to identify resilience strategies that can be used to enhance resilience in AI/AN/FN older adults with chronic health conditions.

Results: Based on systematic reviews of PsycINFO and PubMed, 14 individual articles and 6 literature reviews were identified. The individual studies included five quantitative studies, eight qualitative studies, and one mixed qualitative-quantitative design. The current state of knowledge on resilience in AI/AN/FN older adults is summarized, including seven common themes. Currently, research on the overlap between these four specific health disparities and resilience is essentially non-existent in these populations. Sources of resilience and resilience strategies in AI/AN/FN older adults are presented under four main themes: (a) social support, connectedness, family, and community; (b) Indigenous culture and identity; (c) spiritual connection and strength; and (d) positive coping and personal healing. The review concludes with a critical examination of the limitations of the current literature and outlines future research directions.

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