Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students.

Abstract

In the American Indian and Alaska Native (AIAN) population there is a discrepancy between high rates of mental health needs and low utilization rates of mental health services. This study sought to explore whether historical trauma and racial discrimination are associated with health care system (HCS) distrust and negative attitudes toward seeking mental health services. Participants were AIAN college students (n = 392) who completed a cross-sectional online survey. A sequential mediation analysis examined whether historical trauma (thoughts and associated symptoms) was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. A second mediation analysis examined whether perceived racial discrimination was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. Greater reported historical trauma (thoughts and associated symptoms) and racial discrimination were associated with greater distrust of the HCS, which in turn was associated with less favorable attitudes toward seeking mental health services. Perceived racial discrimination was also directly associated with less favorable attitudes toward seeking mental health services. Historical trauma and perceived racial discrimination appear to contribute to less favorable attitudes toward seeking mental health services through their association with distrust of the HCS. This suggests that attempts to address the underutilization of mental health services in the AIAN population should consider the potential roles of historical trauma, racial discrimination, and distrust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).