Prevalence and manifestations vary depending on background difference and areas of residence (Manson, Shore, Bloom, 1985). There is concern about the validity of using western measures of depression with American Indian populations due to vast differences in cultural beliefs about mental illness, cultural labeling of different emotions, variability of manifestations of depression (rarely DSM IV criteria), and conceptual language differences (Manson, et al, 1985). The Indian Depression Schedule (IDS) was developed by Manson and colleagues, which includes consideration of local cultural context (Baron, Manson, Ackerson, & Brenneman, 1990). Chapleski (1997) used the Center for Epidemiological Studies Depression Scale (CES-D) in a study of 309 Great Lakes American Indian elderly from urban, rural, and reservation settings, with good internal consistency of the tool (Curyto, Chapleski, Lichtenberg, Hodges, Kaczynski, & Sobeck, 1997). This study also corroborated earlier findings of an association between stressful life events, depressive symptoms and decline in functional health status.
In a large national study (the Behavioral Risk Factor Surveillance System), 3,940 American Indian adults were surveyed in 36 states concerning drinking patterns. Respondents were compared by age and sex to non-Hispanic White respondents. Contrary to stereotypes, American Indian men reported lower levels of chronic drinking than non-Hispanic white men at older ages. American Indian reported less current drinking but about the same amount of binge drinking as non-Hispanic Whites by age and sex, with all groups of women reporting low levels of chronic drinking. (Denny &Taylor, 2001.)
Older American Indians have much lower suicide rates compared to older Whites of the same age and sex; American Indian suicide rates are the highest between the ages of 15 and 24 years (John, 1999). Rates also vary by tribe and over time. Research in New Mexico showed age-adjusted rates (1980-87) for Apache at 48.8 per 100,000, Pueblo at 32.0 per 100,000, and Navajo at 18.2 per 100,000. Suicide rates also cycled differently over time, with peaks every 5 to 6 years among Apache, and every 7 to 8 years among Pueblo. (Van Winkle, 2000, p.132)
Little is known about the prevalence of dementia in the American Indian community. It has been hypothesized that as the Indian population ages relative to the White population, that vascular type dementias may be more common than other types of dementia due to the high prevalence of diabetes (Henderson, 2001), but as yet we do not have any prevalence data on the various causes of dementia in the American Indian population.
American Indian cultural standards are different from the non-Indian community. Most cases of elder abuse reported in Indian country are for neglect, although financial abuse is probably more widespread, but clouded by the cultural norm of sharing one’s material possessions, food and housing with other family members. Many American Indian elderly live in tribally subsidized housing and receive SSI income, which may be the only source of income for a family. Elder Abuse Codes have been adopted by some tribes, but the process has met with considerable resistance in some areas due to denial of the problem and the fact that “reporting” may have grave political consequences for family standing in the community. In addition, some American Indian’s may not be aware that their behavior is considered abuse. (For example, improperly medicating or withholding medication, or not providing proper nutrition.)
Research in Indian Country has shown that:
- The abuse is probably financial or neglect
- The abuser is probably a family member
- The victim is usually female, frail, and disabled
- The victim may not recognize the situation as abuse
(Clouse, et al, 1998)