Factors Associated with Depression Among American Indian/Alaskan Native Caregivers

Zach Monahan; Joanna George; Dalton Hockett; Tucker Hopkins; Doug Nolan; Amy Hendrix-Dicken; Micah Hartwell

doi:10.1007/s40615-025-02504-8

Factors Associated with Depression Among American Indian/Alaskan Native Caregivers

J Racial Ethn Health Disparities. 2025 Jun 5. doi: 10.1007/s40615-025-02504-8. Online ahead of print.

Authors

Zach Monahan¹, Joanna George², Dalton Hockett², Tucker Hopkins^{2

3}, Doug Nolan², Amy Hendrix-Dicken^{3

4}, Micah Hartwell^{2

5}

Affiliations

¹ Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, 19500 E Ross St, Tahlequah, OK, 74464, USA. zach.monahan@okstate.edu.
² Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, 19500 E Ross St, Tahlequah, OK, 74464, USA.
³ Citizen of the Cherokee Nation, Tahlequah, OK, USA.
⁴ Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.

PMID: 40471443
DOI: 10.1007/s40615-025-02504-8

Abstract

Background: American Indian/Alaskan Native (AI/AN) caregivers report significantly higher rates of depression and poor mental health compared to caregivers of other races. Although population data on physical and mental health disparities of the AI/AN population have been previously studied, research into factors that are associated with poor mental health among AI/AN caregivers is scarce.

Methods: Utilizing the Behavioral Risk Factor Surveillance Survey (BRFSS) 2019-2022, we conducted a cross-sectional study to assess rates of depression and FPMHDs among caregivers. We compared the presence of depression and 14 + FPMHDs by self-reported races and ethnicities and among AI/AN caregivers by type of insurance, education, income, level of care, and the care recipient's condition.

Results: AI/AN caregivers had the highest reported rates of depression (34.58%) and 14 + FPMHDs (30.27%). These were significantly higher than that of non-Hispanic White caregivers, in both depression (28.29%, p = .044) and 14 + FPMHDs (19.55%, p < .0001). Rates of depression among AI/AN caregivers significantly varied by insurance (p = .0006) and the condition of the care recipient (p = .001). AI/AN caregivers insured by military-related insurance (46.91%) and Medicaid (45.74%) had the highest rates of depression. Higher rates of depression were also found in caregivers of people with mental illnesses (71.19%), cardiovascular disease (50.95%), or chronic respiratory conditions (47.67%).

Conclusion: Analysis of the factors that contribute to depression among AI/AN caregivers can inform policy and social support networks to address key facets of caregiver strain.

Keywords: Alaskan Native; American Indian; Caregiver depression; Caregiver strain; Caregivers.