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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3042 — The Role of Cultural Affiliation in Accessing Mental Health Care Among Native American Veterans

Author List:
Perry JN (Minneapolis VA Medical Center & University of Minnesota)
Dieperink EW (Minneapolis VA Medical Center & University of Minnesota)
Thuras PD (Minneapolis VA Medical Center & University of Minnesota)
Westermeyer JJ (Minneapolis VA Medical Center & University of Minnesota)

Objectives:
Native Americans are thought to utilize mental health care less frequently than Caucasians. We investigated rates of mental health service use among a sample of Native American veterans. We examined overall predictors of utilization and also studied the role of Native American cultural affiliation in predicting: 1) access of any type of mental health services; 2) access of individual categories of services, whether complementary and alternative medicine (CAM) or biomedical; and 3) access of both CAM and biomedical services.

Methods:
The sample consisted of 549 Native American veterans. Data sources included a demography questionnaire, self-rated symptom scales, structured and semi-structured diagnostic interviews, and a treatment utilization questionnaire.

Results:
27.5% (N=151) of veterans reported having utilized some services for a mental health problem within the last year. Of those, 20.5% (N=31) utilized VA mental health services. Having any current mental health diagnosis was the strongest predictor of care-seeking (OR=5.4), with mood disorders being the strongest diagnosis predictor (OR=7.1). Native American cultural affiliation was a significant predictor of mental health care utilization. Although cultural affiliation did not predict CAM utilization only, it did predict CAM utilization in combination with biomedical services utilization. Education and living arrangement were also significant predictors of utilization.

Implications:
The mental health service utilization rate within this Native American veteran sample was comparable to published rates for Caucasians, suggesting that mental health care-seeking transcended potential cultural barriers. Availability of multiple sources of care may have contributed to higher-than-expected utilization rates. The strongest predictors of care-seeking typically found within Caucasian samples were also the strongest predictors within this sample. However, Native American cultural affiliation predicted utilization of services over and above the typical predictors. Use of CAM did not preclude veterans’ receiving biomedical services and may have facilitated it.

Impacts:
Despite potentially significant cultural barriers, Native American veterans do utilize a variety of mental health care services, including VA care. Involvement in CAM is prevalent and may facilitate veterans’ involvement in biomedical services. VA clinicians need to be aware of the potential influence of CAM practitioners and practices on their Native American patients and, accordingly, increase their understanding of relevant cultural issues.


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