Weaving Webs of Resilience: A Stepped-Wedge RCT to Promote Indigenous Mental Health

Abstract

Purpose

This research tests the efficacy of the Weaving Healthy Families intervention on postintervention improvements for mental health among U.S. Indigenous adults.

Method

Community-based participatory research, the rigorous stepped-wedge trial design, along with multilevel longitudinal modeling through 12-month postintervention (i.e., pretest, posttest, and 6-, 9-, and 12-month follow up) were used to test our working hypotheses that the adapted intervention would prevent and reduce poor emotional regulation; dysfunctional attitudes; and symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD).

Results

Even when accounting for sex differences, participants reported significant improvements in emotional regulation, dysfunctional attitudes, and anxiety and PTSD symptoms, with marginal improvement in depressive symptomatology (i.e., improvements for women through 12 months improvements for men through posttest).

Discussion

Given elevated rates of trauma and its connection with emotional regulation, anxiety, depression, and physical health, postintervention, cumulative, and holistic improvements co-occurring across these mental health factors are promising.

Clinical Trial

The Weaving Healthy Families Program: NCT03924167 (https://clinicaltrials.gov/study/NCT03924167)

Keywords

mental health indigenous Native American or American Indian clinical trials

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References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi/book/10.1176/appi.books.9780890425787

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

American Psychological Association. (2012, March 1). Understanding alcohol use disorders and their treatment. https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders

Arvin

Tuck

Morrill

(2013). Decolonizing feminism: Challenging connections between settler colonialism and heteropatriarchy. Feminist Formations, 25(1), 8–34. https://doi.org/10.1353/ff.2013.0006

Baio

Copas

Ambler

Hargreaves

Beard

Omar

R. Z.

(2015). Sample size calculation for a stepped wedge trial. Trials, 16(1), 1–15. https://doi.org/10.1186/s13063-015-0840-9

Beals

Belcourt-Dittloff

Garroutte

E. M.

Croy

Jervis

L. L.

Whitesell

N. R.

Mitchell

C. M.

Manson

S. M.

(2013a). Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Social Psychiatry and Psychiatric Epidemiology, 48(6), 895–905. https://doi.org/10.1007/s00127-012-0615-5

Beals

Manson

S. M.

Croy

Klein

S. A.

Whitesell

N. R.

Mitchell

C. M.

(2013b). Lifetime prevalence of posttraumatic stress disorder in two American Indian reservation populations. Journal of Traumatic Stress, 26(4), 512–520. https://doi.org/10.1002/jts.21835

Beals

Manson

S. M.

Whitesell

N. R.

Mitchell

C. M.

Novins

D. K.

Simpson

Spicer

, & American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project Team. (2005a). Prevalence of major depressive episode in two American Indian reservation populations: Unexpected ﬁndings with a structured interview. American Journal of Psychiatry, 162(9), 1713–1722. https://doi.org/10.1176/appi.ajp.162.9.1713

Beals

Manson

S. M.

Whitesell

N. R.

Spicer

Novins

D. K.

Mitchell

C. M.

, & AI-SUPERPFP Team. (2005b). Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry, 62(1), 99–108. https://doi.org/10.1001/archpsyc.62.1.99

10.

Beck

A. T.

Rush

A. J.

Shaw

B. F.

Emery

DeRubeis

R. J.

Hollon

S. D.

(2024). Cognitive therapy of depression. Guilford Publications.

11.

Beck

A. T.

Weissman

Lester

Trexler

(1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865. https://doi.org/10.1037/h0037562

12.

Bieling

P. J.

Israeli

A. L.

Antony

M. M.

(2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36(6), 1373–1385. https://doi.org/10.1016/S0191-8869(03)00235-6

13.

Boyd-Ball

A. J.

Véronneau

M. H.

Dishion

T. J.

Kavanagh

(2014). Monitoring and peer influences as predictors of increases in alcohol use among American Indian youth. Prevention Science, 15(4), 526–535. https://doi.org/10.1007/s11121-013-0399-1

14.

Breiding

M. J.

Chen

Black

M. C.

(2014). Intimate partner violence in the United States—2010. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/21961

15.

Brockie

T. N.

Dana-Sacco

Wallen

G. R.

Wilcox

H. C.

Campbell

J. C.

(2015). The relationship of adverse childhood experiences to PTSD, depression, poly-drug use and suicide attempt in reservation-based Native American adolescents and young adults. American Journal of Community Psychology, 55(3-4), 411–421. https://doi.org/10.1007/s10464-015-9721-3

16.

Brooks

J. M.

Patton

Maroukel

Perez

A. M.

Levanda

(2022). The differential impact of COVID-19 on mental health: Implications of ethnicity, sexual orientation, and disability status in the United States. Frontiers in Psychology, 13, 1–15. https://doi.org/10.3389/fpsyg.2022.902094

17.

Brown

C. A.

Lilford

R. J.

(2006). The stepped wedge trial design: A systematic review. BMC Medical Research Methodology, 6(1), 1–9. https://doi.org/10.1186/1471-2288-6-54

18.

Bulté

Onghena

(2009). Randomization tests for multiple-baseline designs: An extension of the SCRT-R package. Behavior Research Methods, 41(2), 477–485. https://doi.org/10.3758/BRM.41.2.477

19.

Burnette

C. E.

(2015a). Disentangling indigenous women’s experiences with intimate partner violence in the United States. Critical Social Work, 16(1), 1–20. https://doi.org/10.22329/csw.v16i1.5913

20.

Burnette

C. E.

(2015b). From the ground up: Indigenous women’s after-violence experiences with the Formal Service System in the United States. The British Journal of Social Work, 45(5), 1526–1545. https://doi.org/10.1093/bjsw/bcu013

21.

Burnette

C. E.

(2015c). Historical oppression and intimate partner violence experienced by indigenous women in the United States: Understanding connections. Social Service Review, 89(3), 531–563. https://doi.org/10.1086/683336

22.

Burnette

C. E.

(2016). Historical oppression and Indigenous families: Uncovering potential risk factors for Indigenous families touched by violence. Family Relations, 65(2), 354–368. https://doi.org/10.1111/fare.12191

23.

Burnette

C. E.

(2018). Family and cultural protective factors as the bedrock of resilience and growth for Indigenous women who have experienced violence. Journal of Family Social Work, 21(1), 45–62. https://doi.org/10.1080/10522158.2017.1402532

24.

Burnette

C. E.

Boel-Studt

Renner

L. M.

Figley

C. R.

Theall

K. P.

Miller Scarnato

Billiot

(2020). The family resilience inventory: A culturally grounded measure of current and family-of-origin protective processes in Native American families. Family Process, 59(2), 695–708. https://doi.org/10.1111/famp.12423

25.

Burnette

C. E.

Figley

C. R.

(2017). Historical oppression, resilience, and transcendence: Can a holistic framework help explain violence experienced by Indigenous Peoples? Social Work, 62(1), 37–44. https://doi.org/10.1093/sw/sww065

26.

Burnette

C. E.

Renner

L. M.

Figley

C. R.

(2019). The framework of historical oppression, resilience and transcendence to understand disparities in depression amongst Indigenous Peoples. The British Journal of Social Work, 49(4), 943–962. https://doi.org/10.1093/bjsw/bcz041

27.

Burnette

C. E.

Sanders

Butcher

H. K.

Rand

J. T.

(2014). A toolkit for ethical and culturally sensitive research: An application with indigenous communities. Ethics and Social Welfare, 8(4), 364–382. https://doi.org/10.1080/17496535.2014.885987

28.

Burton

A. L.

Brown

Abbott

M. J.

(2022a). Overcoming difficulties in measuring emotional regulation: Assessing and comparing the psychometric properties of the DERS long and short forms. Cogent Psychology, 9(1), Article 20060629. https://doi.org/10.1080/23311908.2022.2060629

29.

Burton

Adlam

J. E.

Murphy-Belcaster

Thompson-Robinson

Francis

C. D.

Traylor

Anderson

Ricker-Boles

King

(2020b). Stress and coping among American Indian and Alaska Natives in the age of COVID-19. American Indian Culture and Research Journal, 44(2), 49–70. https://doi.org/10.17953/aicrj.44.2.burton

30.

Centers for Disease Control and Prevention. (2018). Behavioral Risk Factor Surveillance System (BRFSS) Survey Questionnaire. https://www.cdc.gov/brfss/index.html

31.

Cloitre

Khan

Mackintosh

M.-A.

Garvert

D. W.

Henn-Haase

C. M.

Falvey

E. C.

Saito

(2019). Emotion regulation mediates the relationship between ACES and physical and mental health. Psychological Trauma: Theory, Research, Practice and Policy, 11(1), 82–89. https://doi.org/10.1037/tra0000374

32.

Connolly

Jacobs

Notzon

F. C.

(2021). COVID-19 among American Indians and Alaska Natives in the United States: An early look. Statistical Journal of the IAOS, 37(1), 25–36. https://doi.org/10.3233/SJI-210790

33.

D’Amico

E. J.

Palimaru

A. I.

Dickerson

D. L.

Dong

Brown

R. A.

Johnson

C. L.

Klein

D. J.

Troxel

W. M.

(2020). Risk and resilience factors in urban American Indian and Alaska Native youth during the coronavirus pandemic. American Indian Culture and Research Journal, 44(2), 21–48. https://doi.org/10.17953/aicrj.44.2.damico

34.

Dobson

K. S.

Breiter

H. J.

(1983). Cognitive assessment of depression: Reliability and validity of three measures. Journal of Abnormal Psychology, 92(1), 107–109. https://doi.org/10.1037//0021-843x.92.1.107

35.

Duran

Oetzel

Parker

Malcoe

L. H.

Lucero

Jiang

(2009). Intimate partner violence and alcohol, drug, and mental disorders among American Indian women from southwest tribes in primary care. American Indian and Alaska Native Mental Health Research, 16(2), 11–27. https://doi.org/10.5820/aian.1602.2009.11

36.

Dusenbury

(2000). Family-based drug abuse prevention programs: A review. Journal of Primary Prevention, 20, 337–352. https://doi.org/10.1023/A:1021366721649

37.

Ehlers

Gizer

Gilder

Yehuda

(2013). Lifetime history of traumatic events in an American Indian community sample: Heritability and relation to substance dependence, affective disorder, conduct disorder, and PTSD. Journal of Psychiatric Research, 47(2), 155–161. https://doi.org/10.1016/j.jpsychires.2012.10.002

38.

Emerson

M. A.

Montoya

(2021). Confronting legacies of structural racism and settler colonialism to understand COVID-19 impacts on the Navajo Nation. American Journal of Public Health, 111(8), 1465–1469. https://doi.org/10.2105/ajph.2021.306398

39.

Evans-Campbell

Walters

K. L.

Pearson

C. R.

Campbell

C. D.

(2012). Indian Boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska Natives. The American Journal of Drug and Alcohol Abuse, 38(5), 421–427. https://doi.org/10.3109/00952990.2012.701358

40.

Felitti

V. J.

(2002). The relationship of adverse childhood experiences to adult health: Turning gold into lead. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 48(4), 359–369. https://doi.org/10.13109/zptm.2002.48.4.359

41.

Fisher

C. B.

Tao

Yip

(2023). The effects of COVID-19 victimization distress and racial bias on mental health among AIAN, Asian, Black, and Latinx young adults. Cultural Diversity and Ethnic Minority Psychology, 29(2), 119–131. https://doi.org/10.1037/cdp0000539

42.

Fok

C. C. T.

Henry

Allen

(2015). Maybe small is too small a term: Introduction to advancing small sample prevention science. Prevention Science, 16(7), 943–949. https://doi.org/10.1007/s11121-015-0584-5

43.

Gameon

J. A.

Skewes

M. C.

(2021). Historical trauma and substance use among American Indian people with current substance use problems. Psychology of Addictive Behaviors, 35(3), 295–309. https://doi.org/10.1037/adb0000729

44.

Gone

J. P.

Kirmayer

L. J.

(2020). Advancing Indigenous mental health research: Ethical, conceptual and methodological challenges. Transcultural Psychiatry, 57(2), 235–249. https://doi.org/10.1177/1363461520923151

45.

Gone

J. P.

Trimble

J. E.

(2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8(1), 131–160. https://doi.org/10.1146/annurev-clinpsy-032511-143127

46.

Gratz

K. L.

Roemer

(2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94

47.

Hawkins

B. A.

Diniz-Filho

J. A. F.

Mauricio Bini

De Marco

Blackburn

T. M.

(2007). Red herrings revisited: Spatial autocorrelation and parameter estimation in geographical ecology. Ecography, 30(3), 375–384. https://doi.org/10.1111/j.0906-7590.2007.05117.x

48.

Hemming

Taljaard

McKenzie

J. E.

Hooper

Copas

Thompson

J. A.

Dixon-Woods

Aldcroft

Doussau

Grayling

Kristunas

Goldstein

C. E.

Campbell

M. K.

Girling

Eldridge

Campbell

M. J.

Lilford

R. J.

Weijer

Forbes

A. B.

Grimshaw

J. M.

(2018). Reporting of stepped wedge cluster randomised trials: Extension of the CONSORT 2010 statement with explanation and elaboration. British Medical Journal, 363, 1–26. https://doi.org/10.1136/bmj.k1614

49.

Herron

J. L.

Venner

K. L.

(2023). A systematic review of trauma and substance use in American Indian and Alaska Native individuals: Incorporating cultural considerations. Journal of Racial and Ethnic Health Disparities, 10(2), 603–632. https://doi.org/10.1007/s40615-022-01250-5

50.

A. K.

Thorpe

C. T.

Pandhi

Palta

Smith

M. A.

Johnson

H. M.

(2015). Association of anxiety and depression with hypertension control: A U.S. multidisciplinary group practice observational study. Journal of Hypertension, 33(11), 2215–2222. https://doi.org/10.1097/hjh.0000000000000693

51.

Hodgson

C. R.

DeCoteau

R. N.

(2022). An updated systematic review of risk and protective factors related to the resilience and well-being of Indigenous youth in the United States and Canada. American Indian and Alaska Native Mental Health Research, 29(3), 136–195. https://coloradosph.cuanschutz.edu/research-and-practice/centers-programs/caianh/journal https://doi.org/10.5820/aian.2903.2022.136

52.

Hoyert

D. L.

(2012). Deaths: Preliminary data for 2011. National vital statistics reports (Vol. 61, No. 6). National Center for Health Statistics. http://large.stanford.edu/courses/2014/ph240/poplawski2/docs/nvsr61_06.pdf

53.

Hunter

Richards

Ali-Joseph

Camplain

(2022). Between two worlds: Impacts of COVID-19 on the AI/AN health research workforce. American Indian and Alaska Native Mental Health Research, 29(2), 183–198. https://doi.org/10.5820/aian.2902.2022.183

54.

Hussey

M. A.

Hughes

J. P.

(2007). Design and analysis of stepped wedge cluster randomized trials. Contemporary Clinical Trials, 28(2), 182–191. https://doi.org/10.1016/j.cct.2006.05.007

55.

Indian Health Services. (2019). Disparities. https://www.ihs.gov/newsroom/includes/themes/responsive2017/display_objects/documents/factsheets/disparities.pdf

56.

Jacobs-Wingo

J. L.

Espey

D. K.

Groom

A. V.

Phillips

L. E.

Haverkamp

D. S.

Sandte

(2016). Causes and disparities in death rates among urban American Indian and Alaska Native populations, 1999–2009. American Journal of Public Health, 106(5), 906–914. https://doi.org/10.2105/ajph.2015.303033

57.

Jennissen

Holl

Mai

Wolff

Barnow

(2016). Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model. Child Abuse & Neglect, 62(0145-2134), 51–62. https://doi.org/10.1016/j.chiabu.2016.10.015

58.

John-Henderson

N. A.

Counts

C. J.

Strong

N. C. B.

Larsen

J. M.

Jeffs

(2024). Investigating the role of emotion regulation in the relationship between childhood trauma and alcohol problems in American Indian adults. Journal of Affective Disorders, 344, 440–445. https://doi.org/10.1016/j.jad.2023.10.043

59.

John-Henderson

N. A.

Ginty

A. T.

(2020). Historical trauma and social support as predictors of psychological stress responses in American Indian adults during the COVID-19 pandemic. Journal of Psychosomatic Research, 139, Article 110263. https://doi.org/10.1016/j.jpsychores.2020.110263

60.

Johnson-Jennings

(2023). Finding balance: Indigenous youth and counseling. In Hightower

(Ed.), Native American psychosocial identity (pp. 121–138). Cognella. http://cognella-titles-sneakpreviews.s3.amazonaws.com/84156-1B-URT/84156-1B_SP.pdf

61.

Johnson-Jennings

M. D.

Belcourt

Town

Walls

M. L.

Walters

K. L.

(2014). Racial discrimination’s influence on smoking rates among American Indian Alaska Native two-spirit individuals: Does pain play a role? Journal of Health Care for the Poor and Underserved, 25(4), 1667–1678. https://doi.org/10.1353/hpu.2014.0193

62.

Johnson-Jennings

Billiot

Walters

(2020a). Returning to our roots: Tribal health and wellness through land-based healing. Genealogy, 4(3), 1–21. https://doi.org/10.3390/genealogy4030091

63.

Johnson-Jennings

Duran

Hakes

Paffrath

Little

M. M.

(2020b). The influence of undertreated chronic pain in a national survey: Prescription medication misuse among American Indians, Asian Pacific Islanders, Blacks, Hispanics and Whites. SSM-Population Health, 11, 1–8. https://doi.org/10.1016/j.ssmph.2020.100563

64.

Johnson-Jennings

Jennings

(2023). Decolonizing psychology: Weaving thrivance to disrupt colonial eugenics and shift educational practices within Indigenous psychology. In Tierney

R. J.

Rizvi

Erkican

(Eds.), International encyclopedia of education (4th ed., pp. 171–180). Elsevier. https://doi.org/10.1016/B978-0-12-818630-5.06026-7

65.

Johnson-Jennings

Paul

Olson

LaBeau

Jennings

(2020c). Ode’imin Giizis: Proposing and piloting gardening as an indigenous childhood health intervention. Journal of Health Care for the Poor and Underserved, 31(2), 871–888. https://doi.org/10.1353/hpu.2020.0066

66.

Johnson-Jennings

Punjabi

Paul

Jones

Jennings

(2021). Little earth strong: A community-level, culturally appropriate diabetes prevention pilot targeting urban American Indians. Progress in Community Health Partnerships: Research, Education, and Action, 15(1), 3–14. https://doi.org/10.1353/cpr.2021.0001

67.

Johnson-Jennings

M. D.

Reid

Jiang

Huyser

K. R.

Brega

A. G.

Steine

J. F.

Manson

S. M.

Chang

Fyfe-Johnson

A. L.

Hiratsuka

Conway

O’Connell

(2023). American Indian Alaska Native (AIAN) adolescents and obesity: The influence of social determinants of health, mental health, and substance use. International Journal of Obesity, 47(4), 297–305. https://doi.org/10.1038/s41366-022-01236-7

68.

Jrapko

Ward

Hazelton

Foster

T. L.

(2005). Family treatment drug court head start program: Annual report. http://www.celebratingfamilies.net/PDF/annual_report_amended_03_04.pdf

69.

Ka’apu

Burnette

C. E.

(2019). A culturally informed systematic review of mental health disparities among adult Indigenous men and women of the USA: What is known? The British Journal of Social Work, 49(4), 880–898. https://doi.org/10.1093/bjsw/bcz009

70.

Kinugasa

Tachibana

Yoshimura

Ueda

Fujii

Dhar

D. K.

Nakamoto

Nagasue

(2004). Postoperative pulmonary complications are associated with worse short-and long-term outcomes after extended esophagectomy. Journal of Surgical Oncology, 88(2), 71–77. https://doi.org/10.1002/jso.20137

71.

Klostermann

Kelley

M. L.

Mignone

Pusateri

Fals-Stewart

(2010). Partner violence and substance abuse: Treatment interventions. Aggression and Violent Behavior, 15(3), 162–166. https://doi.org/10.1016/j.avb.2009.10.002

72.

Kraanen

F. L.

Vedel

Scholing

Emmelkamp

P. M. G.

(2013). The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: A randomized controlled trial. BMC Psychiatry, 13(1), 189–189. https://doi.org/10.1186/1471-244X-13-189

73.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

74.

Kumpfer

K. L.

(2006). Year one (FY05-06) evaluation report for celebrating families. TM. Grant. LutraGroup.

75.

Kumpfer

K. L.

Alvarado

Smith

Bellamy

(2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3(3), 241–246. https://doi.org/10.1023/A:1019902902119

76.

Kumpfer

K. L.

Pinyuchon

de Melo

A. T.

Whiteside

H. O.

(2008). Cultural adaptation process for international dissemination of the Strengthening Families Program. Evaluation & the Health Professions, 31(2), 226–239. https://doi.org/10.1177/0163278708315926

77.

Kumpfer

K. L.

Whiteside

H. O.

Greene

J. A.

Allen

K. C.

(2010). Effectiveness outcomes of four age versions of the Strengthening Families Program in statewide field sites. Group Dynamics: Theory, Research, and Practice, 14(3), 211–229. https://doi.org/10.1037/a0020602

78.

Kupfer

D. J.

Frank

Phillips

M. L.

(2012). Major depressive disorder: New clinical, neurobiological, and treatment perspectives. The Lancet, 379(9820), 1045–1055. https://doi.org/10.1016/s0140-6736(11)60602-8

79.

Lawal

M. A.

Shalaby

Chima

Vuong

Hrabok

Gusnowski

Surood

Greenshaw

A. J.

Agyapong

V. I. O.

(2021). COVID-19 pandemic: Stress, anxiety, and depression levels higher among Indigenous Peoples in Alberta. Behavioral Sciences, 11(9), 115–128. https://doi.org/10.3390/bs11090115

80.

Logan

J. D.

(2008). An introduction to nonlinear partial differential equations (Vol. 89). John Wiley & Sons. https://doi.org/10.1002/9780470287095

81.

LutraGroup. (2007). Final outcome evaluation May 2007 report for Lucile Packard Foundation for Children’s Health. Celebrating Families!.

82.

Mata-Greve

Johnson

Blanchard

B. E.

(2022). A longitudinal examination of cultural risk factors of suicide and emotion regulation. American Journal of Orthopsychiatry, 92(5), 635–645. https://doi.org/10.1037/ort0000629

83.

McCullen

J. R.

Counts

C. J.

Oosterhoff

John-Henderson

N. A.

(2024). Emotion regulation profiles and mental health outcomes in American Indian adults. Current Psychology, 43(8), 7588–7595. https://doi.org/10.1007/s12144-023-04936-z

84.

McKinley

C. E.

(2023). Understanding Indigenous gender relations and violence against Indigenous women: Becoming gender AWAke. Springer Nature. https://doi.org/10.1007/978-3-031-18583-0

85.

McKinley

C. E.

(2024). Dismantling the colonial mindset, becoming gender AWAke in research and practice: From gendered complicity to embodying praxis. Social Science & Medicine, 351, Article 116291. https://doi.org/10.1016/j.socscimed.2023.116291

86.

McKinley

C. E.

Boel-Studt

Renner

L. M.

Figley

C. R.

(2021). Risk and protective factors for symptoms of depression and anxiety among American Indians: Understanding the roles of resilience and trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 13(1), 16–25. https://doi.org/10.1037/tra0000950

87.

McKinley

C. E.

Figley

C. R.

Woodward

S. M.

Liddell

J. L.

Billiot

Comby

Sanders

(2019). Community-engaged and culturally relevant research to develop behavioral health interventions with American Indians and Alaska Natives. American Indian and Alaska Native Mental Health Research, 26(3), 79–103. https://doi.org/10.5820/aian.2603.2019.79

88.

McKinley

C. E.

Lilly

Liddell

Knipp

Solomon

T. A.

Comby

Haynes

Ferris

Goldberg

(2023a). Developing the Weaving Healthy Families Program to promote wellness and prevent substance abuse and violence: Approach, adaptation, and implementation. Families in Society, 104(3), 245–261. https://doi.org/10.1177/10443894221146351

89.

McKinley

C. E.

Saltzman

L. Y.

Theall

K. P.

(2023b). Centering historical oppression in prevention research with Indigenous Peoples: Differentiating substance use, mental health, family, and community outcomes. Journal of Social Science Research, 49(2), 133–146. https://doi.org/10.1080/01488376.2023.2178596

90.

McKinley

C. E.

Theall

K. P.

(2021). Weaving Healthy Families Program: Promoting resilience while reducing violence and substance use. Research on Social Work Practice, 31(5), 476–492. https://doi.org/10.1177/1049731521998441

91.

McKinley

C. E.

Walters

K. L.

(2023). “It’s always about sharing, and caring, and loving, and giving”: Decolonized and transcendent Indigenist foodways fostering health and resilience. Adversity and Resilience Science, 4(1), 89–103. https://doi.org/10.1007/s42844-022-00086-6

92.

Mdege

N. D.

Man

M. S.

Taylor

C. A.

Torgerson

D. J.

(2011). Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. Journal of Clinical Epidemiology, 64(9), 936–948. https://doi.org/10.1016/j.jclinepi.2010.12.003

93.

Mishra

A. K.

Varma

A. R.

(2023). A comprehensive review of the generalized anxiety disorder. Cureus, 15(9), Article e46115. https://doi.org/10.7759/cureus.46115

94.

Mississippi Band of the Choctaw Indians. (2011, September 23). Tribal profile. https://www.choctaw.org/documents/

95.

Mollons

M. O.

Penner

K. E.

Elsom

A. L.

Cameron

E. E.

Hunter

Woods

Tomfohr-Madsen

L. M.

Nijdam-Jones

Roos

L. E.

(2023). COVID-19 and Indigenous youth wellbeing: A review. Current Opinion in Psychology, 53, 1–11. https://doi.org/10.1016/j.copsyc.2023.101659

96.

Mushquash

A. R.

Neufeld

Malik

Toombs

Olthuis

J. V.

Schmidt

Dunning

Stasiuk

Bobinski

Ohinmaa

Newton

Stewart

S. H.

(2024). Increasing access to mental health supports for 12–17-year-old Indigenous youth with the JoyPop mobile mental health app: Study protocol for a randomized controlled trial. Trials, 25(1), 234. https://doi.org/10.1186/s13063-024-08076-y

97.

National Institute of Mental Health. (2015). Major depressive episodes and prevalence. https://www.nimh.nih.gov/health/statistics/major-depression

98.

National Institute of Mental Health. (2021). Mental health statistics. https://www.nimh.nih.gov/health/statistics/index.shtml

99.

Nyklíček

Vingerhoets

Zeelenberg

(2011). Emotion regulation and well-being: A view from different angles. In Nyklíček

Vingerhoets

Zeelenberg

(Eds.), Emotion regulation and well-being (pp. 1–9). Springer. https://doi.org/10.1007/978-1-4419-6953-8_1

100.

O’Connell

J. M.

Novins

D. K.

Beals

Spicer

, & AI-SUPERPFP Team, (2005). Disparities in patterns of alcohol use among reservation-based and geographically dispersed American Indian populations. Alcoholism: Clinical and Experimental Research, 29(1), 107–116. https://doi.org/10.1097/01.alc.0000153789.59228.fc

101.

O’Connor

C. E.

Theall

Kàapu

Johnson-Jennings

Blume

A. W.

(2026). The Weaving Healthy Families Program preventing alcohol misuse among U.S. Indigenous adults and youth. Substance Use & Misuse, 1–16. https://doi.org/10.1080/10826084.2026.2623531

102.

Oliver

Baumgart

E. P.

(1985). The Dysfunctional Attitude Scale: Psychometric properties and relation to depression in an unselected adult population. Cognitive Therapy and Research, 9(2), 161–167. https://doi.org/10.1007/BF01204847

103.

Phillips Smith

Gorman-Smith

Quinn

W. H.

Rabiner

D. L.

Tolan

P. H.

Winn

D.-M.

(2004). Community-based multiple family groups to prevent and reduce violent and aggressive behavior: The GREAT Families Program. American Journal of Preventive Medicine, 26(1), 39–47. https://doi.org/10.1016/j.amepre.2003.09.018

104.

Pisani

A. R.

Wyman

P. A.

Petrova

Schmeelk-Cone

Goldston

D. B.

Xia

Gould

M. S.

(2013). Emotion regulation difficulties, youth–adult relationships, and suicide attempts among high school students in underserved communities. Journal of Youth and Adolescence, 42(6), 807–820. https://doi.org/10.1007/s10964-012-9884-2

105.

Poole

J. C.

Dobson

K. S.

Pusch

(2018). Do adverse childhood experiences predict adult interpersonal difficulties? The role of emotion dysregulation. Child Abuse & Neglect, 80, 123–133. https://doi.org/10.1016/j.chiabu.2018.03.006

106.

Prins

Bovin

M. J.

Kimerling

Kaloupek

D. G.

Marx

B. P.

Pless Kaiser

Schnurr

P. P.

(2022). The primary care PTSD screen for DSM-5 (PC-PTSD-5). National Center for PTSD. https://doi.org/10.1037/t92032-000

107.

Proeschold-Bell

R. J.

Miles

Toth

Adams

Smith

B. W.

Toole

(2013). Using effort-reward imbalance theory to understand high rates of depression and anxiety among clergy. The Journal of Primary Prevention, 34(6), 439–453. https://doi.org/10.1007/s10935-013-0321-4

108.

Radford

Toombs

Zugic

Boles

Lund

Mushquash

C. J.

(2022). Examining adverse childhood experiences (ACEs) within Indigenous populations: A systematic review. Journal of Child & Adolescent Trauma, 15(2), 401–421. https://doi.org/10.1007/s40653-021-00393-7

109.

Rhoda

D. A.

Murray

D. M.

Andridge

R. R.

Pennell

M. L.

Hade

E. M.

(2011). Studies with staggered starts: Multiple baseline designs and group-randomized trials. American Journal of Public Health, 101(11), 2164–2169. https://doi.org/10.2105/AJPH.2011.300264

110.

Richards

T. N.

Schwartz

J. A.

Wright

(2021). Examining adverse childhood experiences among Native American persons in a nationally representative sample: Differences among racial/ethnic groups and race/ethnicity-sex dyads. Child Abuse & Neglect, 111, 1–16. https://doi.org/10.1016/j.chiabu.2020.104812

111.

Rieckmann

McCarty

Kovas

Spicer

Bray

Gilbert

Mercer

(2012). American Indians with substance use disorders: Treatment needs and comorbid conditions. American Journal of Drug and Alcohol Abuse, 38(5), 498–504. https://doi.org/10.3109/00952990.2012.694530

112.

Ritschel

L. A.

Tone

E. B.

Schoemann

A. M.

Lim

N. E.

(2015). Psychometric properties of the Difficulties in Emotion Regulation Scale across demographic groups. Psychological Assessment, 27(3), 944–954. https://doi.org/10.1037/pas0000099

113.

Robin

R. W.

Chester

Rasmussen

J. K.

Jaranson

J. M.

Goldman

(1997b). Prevalence, characteristics, and impact of childhood sexual abuse in a southwestern American Indian tribe. Child Abuse & Neglect, 21(8), 769–787. https://doi.org/10.1016/s0145-2134(97)00038-0

114.

Sarche

Spicer

(2008). Poverty and health disparities for American Indian and Alaska Native children. Annals of the New York Academy of Sciences, 1136(1), 126–136. https://doi.org/10.1196/annals.1425.017

115.

Satyanarayana

V. A.

Nattala

Selvam

Pradeep

Hebbani

Hegde

Srinivasan

(2016). Integrated cognitive behavioral intervention reduces intimate partner violence among alcohol dependent men, and improves mental health outcomes in their spouses: A clinic based randomized controlled trial from South India. Journal of Substance Abuse Treatment, 64, 29–34. https://doi.org/10.1016/j.jsat.2016.02.005

116.

Sherry

S. B.

Gautreau

C. M.

Mushquash

A. R.

Sherry

D. L.

Allen

S. L.

(2014). Self-critical perfectionism confers vulnerability to depression after controlling for neuroticism: A longitudinal study of middle-aged, community-dwelling women. Personality and Individual Differences, 69, 1–4. https://doi.org/10.1016/j.paid.2014.04.035

117.

Shiels

M. S.

Chernyavskiy

Anderson

W. F.

Best

A. F.

Haozous

E. A.

Hartge

Rosenberg

P. S.

Thomas

Freedman

N. D.

de Gonzalez

A. B.

(2017). Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: An analysis of death certificate data. The Lancet, 389(10073), 1043–1054. https://doi.org/10.1016/S0140-6736(17)30187-3

118.

Snyder

K. S.

Luchner

A. F.

Tantleff-Dunn

(2024). Adverse childhood experiences and insecure attachment: The indirect effects of dissociation and emotion regulation difficulties. Psychological Trauma: Theory, Research, Practice, and Policy, 16(Suppl 1), S20–S27. https://doi.org/10.1037/tra0001532

119.

Spitzer

R. L.

Kroenke

Williams

J. B.

Löwe

(2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

120.

Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/

121.

Thomas

L. R.

Donovan

D. M.

Sigo

R. L.

Austin

Alan Marlatt

, & The Suquamish Tribe. (2009). The community pulling together: A tribal community–university partnership project to reduce substance abuse and promote good health in a reservation tribal community. Journal of Ethnicity in Substance Abuse, 8(3), 283–300. https://doi.org/10.1080/15332640903110476

122.

Tutty

(2013). An evaluation of strengthening families: The Calgary Counselling Centre’s program for couples dealing with intimate partner violence and substance use. Yarro Creek Enterprises. https://d1wqtxts1xzle7.cloudfront.net/38577669/strengthening_families_evaluation_report_revised_final_2014-libre.pdf

123.

Tyra

A. T.

Ginty

A. T.

John-Henderson

N. A.

(2021). Emotion regulation strategies predict PTSD during the COVID-19 pandemic in an American Indian population. International Journal of Behavioral Medicine, 28(6), 808–812. https://doi.org/10.1007/s12529-021-09964-2

124.

Tyra

A. T.

Ginty

A. T.

Johnson

L. R.

Lafromboise

M. E.

Malatare

Salois

John-Henderson

N. A.

(2023). Emotion regulation strategies relate to ambulatory cardiovascular activity in an American Indian community. Psychosomatic Medicine, 85(1), 2–7. https://doi.org/10.1097/PSY.0000000000001140

125.

Urbaniak

G. C.

Plous

(2013). Research randomizer. Social psychology network.

126.

Urban Indian Health Institute. (2014, February). Supporting sobriety among American Indians and Alaska Natives: A literature review. https://www.uihi.org/wp-content/uploads/2017/08/supporting-sobriety_a-literature-review_web.pdf

127.

Wallerstein

N. B.

Belone

(2015). Family listening program: Multi-tribal implementation and evaluation. National Institutes of Health. http://grantome.com/grant/NIH/R01-DA037174-01

128.

Wallerstein

N. B.

Duran

(2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312–323. https://doi.org/10.1177/1524839906289376

129.

Walters

K. L.

Johnson-Jennings

(2023). Invoking war shields of transformative resistance and persistence: Thrivance among American Indian and Alaska Native Two-Spirit women. In Pihama

Green

(Eds.), Honouring our Ancestors: Takatāpui, Two-Spirit and Indigenous LGBTQI+ well-being. Te Herenga Waka University Press.

130.

Walters

K. L.

Johnson-Jennings

Stroud

Rasmus

Charles

John

Allen

Kaholokula

J. K.

Look

M. A.

de Silva

Lowe

Baldwin

J. A.

Lawrence

Brooks

Noonan

C. W.

Belcourt

Quintana

Semmens

E. O.

Boulafentis

(2020). Growing from our roots: Strategies for developing culturally grounded health promotion interventions in American Indian, Alaska Native, and Native Hawaiian communities. Prevention Science, 21(Suppl 1), 54–64. https://doi.org/10.1007/s11121-018-0952-z

131.

Walters

K. L.

Simoni

J. M.

(2002). Reconceptualizing Native women’s health: An “Indigenist” stress-coping model. American Journal of Public Health, 92(4), 520–524. https://doi.org/10.2105/ajph.92.4.520

132.

Warne

Dulacki

Spurlock

Meath

Davis

M. M.

Wright

McConnell

K. J.

(2017). Adverse childhood experiences (ACE) among American Indians in South Dakota and associations with mental health conditions, alcohol use, and smoking. Journal of Health Care for the Poor and Underserved, 28(4), 1559–1577. https://doi.org/10.1353/hpu.2017.0133

133.

Weissman

A. N.

(1979). The dysfunctional attitude scale: A validation study (Publication No. 7919533) [Doctoral dissertation, University of Pennsylvania]. ProQuest Dissertations and Theses Global. https://www.proquest.com/openview/4c74cabc5ed1c50f954e5cdd53757de4/1

134.

Weissman

A. N.

Beck

A. T.

(1978). Development and validation of the dysfunctional attitude scale: A preliminary investigation (ED167619). ERIC. http://files.eric.ed.gov/fulltext/ED167619.pdf

135.

Whitbeck

L. B.

(2006). Some guiding assumptions and a theoretical model for developing culturally specific preventions with native American people. Journal of Community Psychology, 34(2), 183–192. https://doi.org/10.1002/jcop.20094

136.

Whitbeck

L. B.

(2015). A RCT of a family-centered Ojibwe substance abuse prevention. National Institute of Health. http://grantome.com/grant/NIH/R01-DA037177-01A1

137.

Whitbeck

L. B.

Chen

Hoyt

D. R.

Adams

G. W.

(2004). Discrimination, historical loss and enculturation: Culturally specific risk and resiliency factors for alcohol abuse among American Indians. Journal of Studies on Alcohol and Drugs, 65(4), 409–418. https://doi.org/10.15288/jsa.2004.65.409

138.

White Bison. (2015). Wellbriety & Celebrating Families! https://whitebison.org/wp-content/uploads/2024/01/WCF-2024.pdf

139.

Whitesell

N. R.

Beals

Crow

C. B.

Mitchell

C. M.

Novins

D. K.

(2012). Epidemiology and etiology of substance use among American Indians and Alaska Natives: Risk, protection, and implications for prevention. The American Journal of Drug and Alcohol Abuse, 38(5), 376–382. https://doi.org/10.3109/00952990.2012.694527

140.

Woertman

de Hoop

Moerbeek

Zuidema

S. U.

Gerritsen

D. L.

Teerenstra

(2013). Stepped wedge designs could reduce the required sample size in cluster randomized trials. Journal of Clinical Epidemiology, 66(7), 752–758. https://doi.org/10.1016/j.jclinepi.2013.01.009

141.

Wolfe

(1999). Settler colonialism. A&C Black.

142.

Yellow Horse

A. J.

Yang

Huyser

K. R.

(2022). Structural inequalities established the architecture for COVID-19 pandemic among Native Americans in Arizona: A geographically weighted regression perspective. Journal of Racial and Ethnic Health Disparities, 9(1), 165–175. https://doi.org/10.1007/s40615-020-00940-2

143.

Yiğitoğlu

G. T.

Keskin

(2019). Relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients: A sample of Turkey. Indian Journal of Psychiatry, 61(5), 508–519. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_285_17