American Indian Youths are often reported to have high rates of mental health problems. However, not all Indian youths have significant problems, and problem levels may manifest important developmental variations and correlates. Variations in trajectories of problems and the predictors and correlates of different trajectories were identified by researchers using data from the American Indian Multisector Help Inquiry (Stiffman, Alexander-Eitzman, Silmere, Osborne, & Browne, 2007). Samples of 12- to 19-year-old Indian youths living on a reservation or in an urban area were asked to complete the YSR four times at 1-year intervals.

Those who completed the YSR at Time 1 and at least one subsequent time were included in trajectory analyses that identified the following groups on the basis of their Total Problems scores: (a) Very High Chronic (N = 5), whose scores were very high at Time 1 and remained very high; (b) High Improving (N = 30), whose scores were high at Time 1 but declined so much that they approximated the mean scores of the lowest group by the 3rd and 4th assessments; (c) High Chronic (N = 33), whose scores were high at Time 1 and remained high; (d) Low Stable (N = 142), whose scores were low at Time 1 and remained at about the same level thereafter; and (e) Low Improving (N = 175), whose low initial scores became still lower thereafter. Because the Very High Chronic group included only 5 youths, the authors focused on differences between the High Chronic group and the High Improving group that might illuminate the improvements in the latter group.

The High Improving group actually had significantly higher Total Problem scores (mean = 81.8) at Time 1 than the High Chronic group (mean = 72.2). At Time 1, the biggest difference was that 77% of the High Improving group lived on the reservation vs. 40% of the High Chronic group. The High Improving group also reported significantly more family satisfaction and significantly fewer school problems than the high Chronic group at Time 1. Over the assessment period, the High Improving group reported significantly less substance use and fewer alcohol symptoms, drug abuse symptoms, and suicidal thoughts than the High Chronic group. By the final assessment, the High Improving group reported significantly fewer family problems, parent mental health problems, substance-using peers, neighborhood problems, and recent stressors.

The differences in trajectories of YSR Total Problem scores were thus significantly associated with important initial differences between the groups (reservation vs. urban residence; family satisfaction, school problems) and with subsequent improvements in several areas (substance use, suicidal thoughts, family problems, parent mental health, peer and neighborhood problems, stressors). Although controlled tests of the effects of reservation vs. urban living may not be feasible, the authors suggest that multiple improvements that occurred in reservation living conditions during the assessment period could have helped the High Improving group, 91% of whom lived on the reservation by the final assessment, compared to 41% of the High Chronic group.

Reference: Stiffman, A.R., Alexander-Eitzman, B., Silmere, H., Osborne, V., & Brown, E. (2007). From early to late adolescence: American Indian youths’ behavioral trajectories and their major influences. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 849-858.