School of Social Work, Tulane University, New Orleans, USA.
City, Community, and Culture PhD Program, School of Social Work, Tulane University, New Orleans, USA.
Ethn Health. 2021 Feb;26(2):186-205. doi: 10.1080/13557858.2018.1493439. Epub 2018 Jul 2.
Despite cancer and depression being disproportionately high for American Indian and Alaska Native (AI/AN) women, such cancer survivors' help-seeking practices and perceptions related to depression are absent in extant research. A broader context of historical oppression has set the stage for unequal health outcomes and access to quality services. The purpose of this article was to explore AI women cancer survivors' experiences with conventional mental health services and informal and tribally-based assistance, as well as barriers related to mental health service utilization. A qualitative descriptive study methodology, with qualitative content analysis, was used to examine the experiences of AI women cancer survivors as they related to help-seeking experiences for depressive symptoms. The sample included 43 AI women cancer survivors (= 14 breast cancer, = 14 cervical cancer, and = 15 colon and other types of cancer survivors). Since receiving a cancer diagnosis, 26 (62%) participants indicated they had feelings of depression. Some participants (= 13) described mixed perceptions of the mental health service system. Generally, participants viewed families and informal support systems as primary forms of assistance, whereas conventional services were reported as a supplementary or 'as needed' forms of support, particularly when the informal support system was lacking. Participants received help in the forms of psychotropic medications and psychotherapy, as well as help from family and AI-specific healing modalities (e.g. sweat lodges and healing ceremonies). Stigma and confidentiality concerns were primary barriers to utilizing conventional services as described by 12 (29%) participants. Participants' help primarily came from family and tribally-based entities, with conventional mental health care being more salient when informal supports were lacking. The mixed perceptions espoused by participants may be related to a broader context of historical oppression; family and social support and tribally-based services may be protective factors for cancer survivors with depression.
尽管美国印第安人和阿拉斯加原住民（AI/AN）妇女中癌症和抑郁症的发病率不成比例地高，但在现有的研究中，这些癌症幸存者寻求帮助的做法和对抑郁症的看法却没有得到体现。历史上的压迫给他们带来了不平等的健康结果和获得高质量服务的机会。本文的目的是探讨 AI 女性癌症幸存者在常规心理健康服务和非正规及部落为基础的援助方面的经验，以及与心理健康服务利用相关的障碍。采用定性描述性研究方法，进行定性内容分析，以检查 AI 女性癌症幸存者在寻求抑郁症治疗方面的经验。样本包括 43 名 AI 女性癌症幸存者（=14 名乳腺癌幸存者、=14 名宫颈癌幸存者和=15 名结肠癌和其他类型癌症幸存者）。自被诊断出癌症以来，26 名（62%）参与者表示他们有抑郁情绪。一些参与者（=13 名）对心理健康服务系统有复杂的看法。一般来说，参与者认为家庭和非正式支持系统是主要的援助形式，而常规服务则被认为是补充或“按需”的支持形式，尤其是在非正式支持系统缺失的情况下。参与者接受了抗精神病药物和心理治疗的帮助，以及来自家庭和特定于 AI 的治疗方式（例如汗屋和治疗仪式）的帮助。12 名（29%）参与者表示，耻辱感和保密性问题是利用常规服务的主要障碍。参与者的帮助主要来自家庭和部落实体，在非正式支持不足的情况下，常规心理健康护理更为重要。参与者所表达的复杂看法可能与更广泛的历史压迫背景有关；家庭和社会支持以及部落服务可能是抑郁症癌症幸存者的保护因素。
