Depression management interests among Alaska Native and American Indian adults in primary care

J Affect Disord. 2018 Oct 15;239:214-219. doi: 10.1016/j.jad.2018.05.075. Epub 2018 Jun 7.


Background: Depression remains the second leading cause of disability worldwide. Symptoms of depression are expressed and experienced differently across cultural groups, impacting treatment decisions. Patient preferences predict service utilization, treatment selection and persistence, as well as health outcomes for medical and behavioral health conditions, including depression. We identified depression management preferences of Alaska Native and American Indian (AN/AI) people who receive care within a comprehensive, integrated, tribally owned and operated healthcare facility in Anchorage, Alaska.

Methods: Adult AN/AI patients who screened positive for depression (10 or greater on the Patient Health Questionnaire - 9 (PHQ-9)) completed a culturally-tailored decision-support tool to assess their depression management interests.

Results: The 125 eligible patients, who screened positive for depression, preferred counseling and medications to peer support groups, herbal remedies, and spiritual support. Those 18-39 years of age were more likely to prefer medications and less likely to prefer spirituality and peer support than those 40 years of age and older. Patients with moderate and severe depression were more likely to prefer exercise, healthy eating, and stress reduction than individuals with mild depression.

Limitations: Women comprised 78% of the sample. Responses may not adequately represent the views of men.

Conclusions: Counseling and medications should consistently be made available earlier in the course of depression management. Patient interest in exercise, stress reduction, and healthy eating to manage depression, especially among those with moderate and severe depression, offers opportunity for additional collaboration in an integrated care setting.

Keywords: American Indian/Alaska Native people; Depression management; Integrated care; Medical decision-making; Traditional healing; Treatment preferences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Alaskan Natives*
  • Antidepressive Agents / therapeutic use*
  • Attitude to Health / ethnology*
  • Depressive Disorder / therapy*
  • Diet, Healthy
  • Exercise
  • Female
  • Humans
  • Indians, North American*
  • Life Style
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / ethnology*
  • Patient Health Questionnaire
  • Primary Health Care*
  • Relaxation Therapy
  • Spirituality*
  • United States
  • Young Adult


  • Antidepressive Agents