title: Multilevel context of depression in two American Indian tribes.
abstract: OBJECTIVE
  Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions.
  
  
  METHODS
  We used data from a large representative psychiatric epidemiological study among American Indians in 2 reservation communities to estimate nested individual and multilevel models of past-year major depressive episode (MDE) accounting for family, cultural, and community conditions.
  
  
  RESULTS
  We found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in 1 tribe even after accounting for individual-level characteristics.
  
  
  CONCLUSIONS
  Accounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings.
authors.affiliation: Centers for American Indian and Alaska Native Health.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Kaufman
authors.forename: Janette
authors.initials: J
authors.lastname: Beals
authors.forename: Calvin
authors.initials: C
authors.lastname: Croy
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Novins
mesh_terms: D000293:Adolescent; D000328:Adult; D003466:Cultural Characteristics; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005195:Family Relations; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D055361:Multilevel Analysis; D010552:Personality Assessment; D012307:Risk Factors; D012931:Social Environment; D013223:Statistics as Topic; D014481:United States; D055815:Young Adult
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