Impact of Historical Loss on Mental Health Among Two-Spirit American Indians/Alaska Natives: The Protective Role of Social Support

Introduction: American Indian and Alaska Native (AIAN) populations have experienced a history of devastating colonial oppression, influencing their mental health. Sexual-minority (two-spirit) AIANs may be particularly vulnerable to disparities in health outcomes. Although facing numerous challenges, two-spirit AIANs also show great strength and resiliency in prevailing over generations of historical loss. There is a need to pay more attention to explore the protective factors that can promote mental health when faced with historical loss among two-spirit AIANs. Social support refers to a range of interpersonal relationships or connections that can support people’s functioning. Social support has been reported as a stress coping strategy that can address loss and promote better mental health. This current study examines the protective role of social support on two-spirit AIANs’ mental health despite exposure to historical loss.

 

Methods: The study used data from HONOR Project, a national study of 447 gay, lesbian, bisexual, and other sexual-minority AIANs. Historical loss was measured by the Historical Loss Scale (12 items; α=.94), which measures frequency of thoughts about historical losses (e.g., loss of land and spiritual practices). Social support (19 items; α=.97) was measured by the Medical Outcomes Study Social Support Survey (MOS-SS), which designed to measure four sub-concepts: emotional/information support, tangible support, affectionate support and positive social interaction. Mental health (5 items; α=.82) was assessed with the Medical Outcomes Study HIV Health Survey (MOS-HIV). We first conducted bivariate analyses to examine the associations between historical loss, social support and mental health. Meeting the criteria for a mediation analysis, we used a single mediation method to test the hypothesized causal sequence that historical loss may lead to positive mental health through having greater perception of social support. The Sobel-test was used to assess the significance of the mediation effect.

 

Results: The results indicated that thinking more about historical loss was associated with greater social support (t=1.96, p<.05) as well as associated with lower mental health scores (t=-3.46, p<.001). Additionally, greater social support was associated with higher mental health scores (t=8.14, p<.001). This suggested that strong social support might indicate positive mental health. In the mediation analysis, results of the Sobel-test suggested that social support partially mediated the negative relationship between thinking about historical loss and mental health, and the mediated effect was significant (z=1.96, p<.05). The results indicated that although perceived historical loss negatively impacts on two-spirit AIANs’ mental health, but it also can improve social support, which in turn can promote positive mental health.

 

Conclusions: To promote two-spirit AIANs’ mental health, findings suggest that improving social support is crucial to overcoming historical loss and trauma. With respect to policy, to help two-spirit AIANs cope with adversity, social support related interventions should be more widely disseminated and employed.