RAND Corporation, Santa Monica, CA, USA.
UCLA Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
Soc Sci Med. 2022 Jan;292:114582. doi: 10.1016/j.socscimed.2021.114582. Epub 2021 Nov 18.
Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth. All participants (N = 142) completed surveys; a random subsample (n = 26) completed qualitative interviews to assess family and cultural dynamics related to sleep, which informed hypothesized direct and indirect effects that were tested using survey data. Narratives identified mechanisms of family cohesion (e.g., daily interactions that build perceived family togetherness and family-centered traditional activities) and the role that family cohesion plays in sleep (e.g., ensuring stability of sleep environments). Path analysis showed direct effects of improved family functioning on fewer depressive and anxiety symptoms, and indirect effects through lower self-reported sleep disturbance (but not through greater actigraphy-measured sleep duration or efficiency). Cultural identity did not moderate effects in quantitative tests. Our findings illustrate the complex associations among family functioning, sleep, and mental health in AI/AN youth. Family-based interventions to improve adolescent mental health should address modifiable intervention targets such as sleep, and address sources of both risk and resilience relevant to urban AI/AN families, including extended family and cultural practices.
心理健康问题是全球疾病负担的重要组成部分。部分由于家庭压力和睡眠不足，心理健康问题在社会经济地位较低的城市青少年中比例过高。在美国，美洲印第安人/阿拉斯加原住民（AI/AN）青年表现出过高的心理健康问题发生率。家庭功能与青少年心理健康密切相关，睡眠问题可能是家庭功能与心理健康之间的一个途径。本研究采用混合方法，在城市 AI/AN 青年样本中，调查了家庭功能、主观和活动记录仪测量的睡眠、心理健康（抑郁和焦虑症状）和文化认同之间的关联。所有参与者（N=142）都完成了问卷调查；随机抽取了一小部分（n=26）参与者完成了定性访谈，以评估与睡眠相关的家庭和文化动态，这些信息为使用调查数据检验假设的直接和间接影响提供了依据。研究结果表明，家庭凝聚力的机制（例如，日常互动可以增强家庭的凝聚力，家庭为中心的传统活动）和家庭凝聚力在睡眠中的作用（例如，确保睡眠环境的稳定性）。路径分析显示，家庭功能的改善直接影响抑郁和焦虑症状的减少，通过自我报告的睡眠障碍降低间接影响（但不通过活动记录仪测量的睡眠时间或效率增加间接影响）。文化认同在定量测试中没有调节作用。本研究结果说明了 AI/AN 青年中家庭功能、睡眠和心理健康之间的复杂关系。改善青少年心理健康的家庭为基础的干预措施应该针对可改变的干预目标，如睡眠，并针对与城市 AI/AN 家庭相关的风险和恢复力的来源，包括大家庭和文化实践。
