PSYCHIATRIC-DISORDERS AMONG AMERICAN-INDIAN AND WHITE YOUTH IN APPALACHIA - THE GREAT SMOKY MOUNTAINS STUDY

Objectives. This study examined prevalence of psychiatric disorders, s ocial and family risk factors for disorders, and met and unmet needs f or mental health care among Appalachian youth. Methods. All 9-, 11-, a nd 13-year-old American Indian children in an 11-county area of the so uthern Appalachians were recruited, together with a representative sam ple of the surrounding population of White children. Results. Three-mo nth prevalences of psychiatric disorders were similar (American Indian , 16.7%; White, 19.2%). Substance use was more common in American Indi an children (9.0% vs 3.8% in White children), as was comorbidity of su bstance use and psychiatric disorder (2.5% vs 0.9%). American Indian p overty, family adversity (e.g., parental unemployment, welfare depende ncy), and family deviance (parental violence, substance abuse, and cri me) rates were higher, but the rate of family mental illness, excludin g substance abuse, was lower. Child psychiatric disorder and mental he alth service use were associated with family mental illness in both et hnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian c hildren used fewer mental health services. Conclusions. This study sug gests that poverty and crime play different roles in different communi ties in the etiology of child psychiatric disorder.