Depressive symptoms and work in Indigenous people

Background: Adverse social and environmental factors outside of the health system play an important role in disparate mental health (MH) outcomes, including access to quality employment. American Indian/Alaskan Native (AIAN) workers are at risk but have been left out of research. Aim: To describe the characteristics of AIAN adults with depressive symptoms and to examine their sociodemographic, health, functional and disability characteristics by work status. Methods: Utilizing the National Health Interview Survey (NHIS) data for years 2020 and 2022, we evaluated differences in MH symptoms, diagnoses, and treatment between working and non-working AIAN adults. We undertook a descriptive analysis of socio-demographic and health characteristics. Three sets of multivariable logistic regression models were undertaken to (1) evaluate the association between employment status and MH outcomes, (2) associations with MH outcomes in working AIAN adults, (3) associations with mental health outcomes in non-working AIAN adults. Results: AIAN adults not currently employed had higher odds (1.55, 95%CI:1.03–2.33) of reporting weekly/daily depressive symptoms and ever being diagnosed with depression (1.50, 95%CI:1.02–2.21) compared to employed AIAN adults. Predictors of MH health outcomes differed between working and non-working AIAN adults, including age, education level, location, health care usage and delay of MH treatment. Conclusions: There is evidence of the impact of work on the MH of indigenous people. An occupational health agenda should include better survey tools, and engagement with AIAN communities, workers, employers and health services to build on the evidence and support local level strategies.