Pathways of Indigenous Substance Use and Mental Health over the Early Life Course

Introduction:Substance use and mental health problemsdisproportionately touch many American Indian/Canadian First Nations reservations/reserves and represent significant public health problems. Longitudinal investigations of these concerns for Indigenous people are few and have yet to focus on transitional periods of the life-course (e.g., shift from adolescence to adulthood). This represents a problematic gap in knowledge given evidence from non-Native research indicating that patterns of disorder are highly variable over the life course. The purpose of this study is to describe rates and trajectories of Indigenous substance use (SUD) and mental health disorders across adolescence and early adulthood.

Methods:Data are from the Healing Pathways epidemiological panel study of 735 Indigenous youth spanning 9 waves from childhood (in 2002 at wave 1, mean age = 11 years) to early adulthood (in 2018 at wave 9, average age = 26 years). The project represents nearly 20 years of community-based participatory research with 8 tribal communities in the Midwestern U.S. and Canada. Childhood DSM-IV-TR assessments were gathered by trained community interviewers using the DISC-R (Shaffer, et al., 1993); wave 9 adult assessments used the WHO-CIDI.

Results: Preliminary resultsreveal peak rates of 12-month SUDs between ages 14 – 16 years that decreased into early adulthood. At wave 9,rates of alcohol abuse = 7.5%, alcohol dependence = 4.2%, marijuana abuse = 2%, marijuana dependence = 2.7%. Lifetime SUDs showed an upward trajectory over the early life course, reaching 50.1% for alcohol abuse and 20% for marijuana abuse by Wave 9. Nearly 70% of participants met lifetime criteria for a SUD. Rates of generalized anxiety disorder, major depressive disorder, and ADHD each remained less than 5% from late adolescence to early adulthood. We saw significant continuity in alcohol and mood disorders from adolescence to adulthood, but not marijuana use disorder. Additional demographic and disorder-specific findings along with comorbidity estimates will be shared.

Conclusions: These findings suggest potential culturally unique patterns of disorder for Indigenous people characterized by earlier onset SUDs, higher rates of lifetime and childhood SUDs, lower estimates of internalizing disorders, and rapid, earlier desistance of early adulthood 12-month SUDs relative to general population estimates. These patterns signal need for culturally tailored, targeted, early life-course points of intervention for AI communities and call for investigation of epidemiological trends in other Indigenous groups.