Depression and Drinking In American Indian Adolescents: The Importance of Family Factors

A study in Alcoholism: Clinical and Experimental Research has underscored the importance of family in protecting against alcohol use among American Indian adolescents, especially those struggling with depression. Although rates of alcohol use among American Indians vary widely, overall this population experiences disproportionate alcohol-related harm. American Indian adolescents who drink alcohol tend to start drinking early, and many drink heavily. To address health disparities, there is a need to identify risk and protective factors for alcohol use among this population. Depression is a known risk factor for drinking among adolescents in the general population, but despite American Indian adolescents having higher rates of depression, there is a lack of research on the link between depression and drinking specific to this population. Family factors may be especially important when considering such links, owing to the importance of kinship in American Indian communities. “Family warmth” is a central feature of these close-knit communities, and has been separately linked to lower rates of depression and alcohol use; however, it is unknown how all three factors inter-relate. Another family factor that may be important is “parental monitoring” (i.e. attention to a child’s whereabouts and activities). Parental monitoring may influence adolescents’ perceptions that their family cares about them, thereby affecting the link between depressive symptoms and family warmth. Indeed, family warmth may be protective against alcohol use only when parents are also effectively monitoring teens’ behavior. The new study aimed to examine the roles of perceived family warmth and parental monitoring in the association between depressive symptoms and alcohol use in a large, nationally representative sample of American Indian adolescents.

The data were from 3,500 American Indian 7^th−12^th graders who lived on or near a reservation, and had completed a survey on their depressive symptoms, family factors, and alcohol use. Because this study was a secondary analysis of existing data, it was not possible to incorporate input from the American Indian community into its design and analysis; however, this should be a priority for future research. Statistical analysis of the data showed that depressive symptoms were associated with greater alcohol use. Additionally, greater family warmth (as perceived by the young person) was associated with both lower depressive symptom scores and lower alcohol use, supporting previous findings that families are a key source of strength and resilience for American Indian adolescents. These links were further moderated by parental monitoring, such that the association between family warmth and lower drinking was stronger at high (versus low) levels of monitoring. This suggests that family warmth and parental monitoring both reflect important components of family functioning. Parental monitoring may increase the positive effects of family warmth, or offset the negative alcohol-related effects of low family warmth.

The findings have important implications for treatment and prevention. For instance, there may be a role for supporting parents with strategies to communicate warmth and to monitor adolescents, particularly within the context of intergenerational trauma resulting from forced residential schooling and adoption in the American Indian population. Prevention and treatment programs targeting youth depression and drinking may also benefit from family inclusion. Further, American Indian adolescents presenting for treatment as a result of alcohol use should be assessed for depression, and vice versa, given that each increases the risk of the other. Future research should also investigate whether interventions for adolescent depression, and for alcohol use, may have a reciprocal positive impact.

The researchers note that there are likely other influences, besides family factors, that would more fully explain the link between adolescent depression and drinking in this population. Socioeconomic status, stigma, and mistrust of medical providers, for example, may be barriers to accessing mental health services for depression, thereby increasing the risk of individuals turning to maladaptive coping strategies such as alcohol. Future studies should consider these and other important contextual factors.

Depression and alcohol use in American Indian adolescents: The influence of family factors. M. R. Schick, T. Nalven, E. D. Thomas, N. H. Weiss, N. S. Spillane (pages xxx).

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