23 Year Old Native American Male With Anxiety
M.R. is a 23-year-old Native American male who is experiencing anxiety. He is seeking treatment for his symptoms. He has stated that he has been consuming alcohol and marijuana to help his symptoms. He has concerns that he will not get into heaven if he continues his lifestyle. The patient denies taking any prescription medications or other non-prescription drugs. His family history includes diabetes, hypertension, and alcoholism.
Mental disorders are among the top ten leading causes of Indian Health Services (HIS) hospitalization and ambulatory care visits. Approximately 70% of Native American men meet the criteria of some type of mental disorder. It is also reported that common psychiatric disorders tend to be most prevalent among the American Indian (AI) population when compared to the rest of the population. Substance abuse, alcohol use, drug use, mood, anxiety, and personality disorders are commonly reported among the AI population. AI men suffer anxiety more than women (Brave Heart et al., 2016).
According to Adakai et al. (2018), AI have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions compared with other racial/ethnic groups (Adakai et al., 2018). Suicide is the second leading cause of death for Native youth aged 15-24. They are also at a higher risk for depression and substance abuse (Asher BlackDeer & Patterson Silver Wolf, 2020).
When taking into consideration the high risks of mental disorders and substance abuse, it is important to gain as much information as possible from the patient to build an adequate health history and develop a diagnosis and treatment plan. I would start with the following targeted questions:
#1: How long have you been experiencing anxiety? Does it occur daily or all the time? Have you experienced or witnessed any type of trauma that you feel has affected you? Has anyone in your immediate family ever been diagnosed with any mental illness or disorder?
#2: Do you feel that you partake in unusual risky behaviors? Promiscuous behavior? Are you impulsive or have extreme mood swings? Do you feel sad or depressed? Has anyone in your family said that you are acting different or strange?
#3: How much alcohol do you consume? Do you drink every day? How many drinks per day/week? Has your alcohol use affected your job or relationships? Has anyone told you that you drink too much?
#4: How often and how much “pot” do you smoke? Does it make you feel better? How long have you been smoking pot?
#5: What are your religious/spiritual beliefs? Would you like a chaplain or a spiritual leader to give you guidance and support?
Based on the AI culture, it is important to incorporate traditional healing approaches to assist the patient with their health needs. Clinicians should be culturally aware and utilize the DSM-5 Culture Formulation Interview to increase the validity of the diagnostic process during patient encounters with Native Americans (Brave Heart et al., 2016). Future endeavors should seek to combine both Indigenous and Western approaches to practice with a particular focus on holistic wellness (Asher BlackDeer & Patterson Silver Wolf, 2020). By utilizing the tools available as mentioned, AI patients should be more comfortable and confident with the treatment provided.
Adakai, M., Sandoval-Rosario, M., Xu, F., Aseret-Manygoats, T., Allison, M., Greenlund, K. J., & Barbour, K. E. (2018). Health disparities among american indians/alaska natives — arizona, 2017. MMWR. Morbidity and Mortality Weekly Report, 67(47), 1314–1318. https://doi.org/10.15585/mmwr.mm6747a4
Asher BlackDeer, A., & Patterson Silver Wolf, D. A. (2020). Evidence mapping: Interventions for american indian and alaska native youth mental health. Journal of Evidence-Based Social Work, 17(1), 49–62. https://doi.org/10.1080/26408066.2019.1624237
Brave Heart, M., Lewis-Fernández, R., Beals, J., Hasin, D. S., Sugaya, L., Wang, S., Grant, B. F., & Blanco, C. (2016). Psychiatric disorders and mental health treatment in american indians and alaska natives: Results of the national epidemiologic survey on alcohol and related conditions. Social Psychiatry and Psychiatric Epidemiology, 51(7), 1033–1046. https://doi.org/10.1007/s00127-016-1225-4