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Published in final edited form as: J Am Acad Child Adolesc Psychiatry. 2025 Jan 20;64(12):1401–1411. doi: 10.1016/j.jaac.2025.01.009

Intergenerational Impacts of Historical Trauma on Contemporary Depression Symptoms Among Indigenous Communities

Ashley B Cole 1, Kelley J Sittner 2, Trisha Bruyere 3, Melissa L Walls 4
PMCID: PMC12980653  NIHMSID: NIHMS2049951  PMID: 39842634

Abstract

Introduction:

Indigenous communities in the U.S. and Canada have endured generations of historical trauma. In the face of ongoing marginalization, Indigenous Peoples persist, resist, and thrive. Simultaneously, the consequences of historical trauma are vast and enduring. For instance, there is significant variation in how depression symptoms unfold over the life course. The aim of this study is to examine longitudinal, intergenerational associations between historical trauma and depression symptoms among Indigenous young adults.

Method:

Analyses include data from target participants (i.e., children at baseline) and their primary female caregivers (e.g., parents) from Healing Pathways (HP), a community-based participatory study that began in 2001/2002 with families from 8 First Nations in the US and Canada. All eligible children (ages 10 to 12-years-old at baseline, enrolled tribal members, living on/near reserve land) and at least one of their caregivers were invited to participate, and were interviewed annually for eight years. Three additional years of interviews were conducted starting in 2017 with baseline enrolled children, now young adults. Caregivers and their now young adult children completed measures of depression symptoms, family boarding/residential school (BRS) history, and other family sociodemographic variables.

Results:

Group-based trajectory modeling identified 4 depression symptom trajectory groups: low (28.7%), decreasing (26.6%), increasing (22.4%), and high (22.3%). Multinomial logistic regression analyses, with the low symptom group as the referent group, revealed that familial BRS history doubled the odds of being in the high symptom group (OR = 2.05, p<.05) compared to the low symptom group. Being female, experiencing discrimination, and caregiver (e.g., parental) history of depression increased the odds of being in the high symptom group, while experiencing warm and supportive parenting decreased the odds of being in the high symptom group.

Conclusion:

The intergenerational effects of historical trauma remain ongoing and harmful to Indigenous populations. Current findings illuminate several factors that may be particularly salient among subsequent Indigenous generations, and provide implications for prevention efforts.

Diversity & Inclusion Statement:

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.

We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Keywords: Indigenous, historical trauma, intergenerational trauma, depression symptoms

INTRODUCTION

Indigenous Peoples of the North American continent represent diverse Tribal nations with distinct cultures, practices, belief systems, ceremonies, and origin stories; this vast diversity has important implications for health research and generalizability to other, culturally distinct communities.1 While Indigenous Peoples are heterogenous, there are shared experiences in a general context, including generations of historical trauma and loss on one hand and survivance (e.g., survival and endurance) and resilience on the other.2 Historical trauma entails targeted, harmful, and accumulated assaults (e.g., massacres, genocides, pandemics following the introduction of new diseases, forced relocation, and forced removal of children to Indian boarding/residential schools; BRS) upon a group of people with a shared identity imposed by outside forces of power; all generated with purposeful intent via processes of colonization.3–6 These historically traumatic events and losses have multilevel mental health impacts on individuals, families, and communities, and are root causes of contemporary Indigenous health inequities.3,7

The term “historical trauma” encompasses at least four distinct processes in the literature, including historical trauma as: 1) an etiological factor, 2) a particular type of trauma response and syndrome, 3) a stressor that interacts with other proximal stressors (e.g., collective loss), and 4) a pathway of poor health and social problems transferred across generations.7 The latter process (i.e., intergenerational effects) is the primary historical trauma focus for the current paper and is seen through the lens of Life Course Theory; most of which research focuses on caregiving/parenting and family dynamics.7,8 In this regard, Walters and colleagues7 drew upon an ecosocial theory (e.g., an epidemiological framework that integrates social and biological conceptualizations of health to articulate health inequities)9 and the Indigenist Stress Coping Model10 to argue that contemporary physical health among Indigenous Peoples reflects, in part, the embodiment of historical trauma.7 The authors posited that historical trauma events that disrupt ties to family, community, or place (e.g., placement in BRS; removal from homelands) may be associated with depression symptoms while historical trauma events that cause direct physical harm to body, land, community, or sacred sites may be associated with anxiety symptoms or symptoms of post-traumatic stress disorder (PTSD).6 Indigenous researchers and researchers with expertise on intergenerational trauma have posited that many Indigenous Peoples exposed to historical trauma remain healthy, and suggested that future research is needed to explore factors related to maintaining health in the face of historically traumatic events.7

Many previous investigations of intergenerational historical trauma processes were limited by cross-sectional data.11–14 While these studies are crucial to understanding historical trauma and its consequences, the intergenerational impacts of historical trauma on the health and mental health of subsequent generations remain unclear. Furthermore, Indigenous researchers and clinicians alike have recommended studying the intergenerational transmission of maladaptive behavior patterns and resiliency among Indigenous populations.15,16 There is also significant variation in how depression symptoms unfold over the life course,17–20 with some previous research identifying relatively low depression symptoms among Indigenous youth despite high exposure to early life risks.21–23 Research investigating patterns of depression symptoms across Indigenous generations is important for understanding the nuances of generational experiences, transmission patterns, and healing.24–27

Prior in-depth investigations among Indigenous families in the U.S. and Canada revealed impacts of intergenerational historical trauma on mental health, particularly on depression symptoms in subsequent generations.28,29 Elders discussed how their parents’ traumatic experiences affected their own lives, such as not being allowed to participate in traditional activities or to speak the Alaska Native (Inupiaq) language.29 The adult children of Aboriginal parents in Canada who attended BRS exhibited greater depression symptoms compared to individuals whose parents did not attend.30 Parental BRS attendance was associated with greater adverse childhood experiences (ACEs), frequency of adult traumas, and perceived discrimination among their offspring.30 Greater levels of discrimination among adult offspring of parents with BRS attendance, together with stronger Aboriginal identity, were associated with an increased likelihood of appraising negative intergroup scenarios as a result of discrimination and as threatening to their well-being.31 In turn, these threat appraisals were associated with greater depression symptoms relative to adults without parental BRS involvement.31 Another study with First Nations adults demonstrated that having one family member experience BRS involvement was associated with increased risk for lifetime suicidal ideation and suicide attempts compared to those without familial BRS involvement.32 Furthermore, having two generations of familial BRS involvement was associated with greater odds of attempting suicide compared to those with one generation of familial BRS invovlement.32 Despite these bleak associations, these intergenerational studies have also identified cultural strengths and resilience across generations of Indigenous Peoples, with subsequent generations reporting fewer mental health problems compared to their parents despite shared familial BRS history.28–31

Our team has quantitatively investigated intergenerational trauma using data from the Healing Pathways (HP) project; prior HP investigations and the full methodology have been described previously.33 HP is a community-based participatory research study in partnership with four American Indian and four Canadian First Nation reservations/reserves. Among our findings, results include observation of direct and mediating effects of parental substance use on adolescent early onset alcohol use across two generations of HP Indigenous families.34 In another HP paper, grandparents’ relocation experiences were directly associated with their own and their children’s (i.e., adult caretakers of adolescents) substance use problems, as well as with their female children’s depression symptoms, thereby making their parenting less effective and placing their grandchildren at increased risk for early substance use initiation and other risky behaviors.35

Collectively, previous research has demonstrated that historically traumatic experiences, such as BRS involvement, among Indigenous populations in the U.S. and Canada negatively impacted subsequent generations. Specifically, historical trauma impacts on subsequent generations of Indigenous Peoples can be seen through their own experiences of mental health problems, including depression and suicidality. However, few studies have examined risk factors for depression simultaneously over time nor have they consistently incorporated intergenerational data. Additional research is thus needed to inform culturally-relevant services for those with familial BRS histories and to rectify ongoing sociopolitical harm to Indigenous Peoples. Thus, the aim of the current study was to examine longitudinal associations between historical trauma and depression symptoms among Indigenous young adults (children at baseline) and their female caregivers (e.g., parents). In this paper, we use “parent” to represent the child’s/target participant’s caregivers. Most caregivers in this sample were the child’s/target participant’s biological mothers; however, a smaller proportion of female caregivers in this sample also included grandmothers, aunties, adopted mothers, and other kinship of female caregivers. There is significant variation in how depression symptoms unfold during adolescence and into young adulthood among youth in general17 and among our sample of Indigenous youth specifically.21,33 Thus, we applied group-based trajectory modeling to explicitly model this heterogeneity. If familial BRS history acts as an intergenerational risk factor for poorer mental well-being, it would have a greater impact on those with trajectories showing the poorest mental health. Additional risk and protective factors were drawn from our adapted conceptual model (Figure 1), which was derived from Whitbeck and colleagues’ conceptual model of factors influencing Indigenous adolescent development.19 As shown in Figure 1, historically traumatic events, such as family BRS history, cut across the family and adolescent/young adult spheres. Applying this conceptual model to the group-based trajectory analysis, we hypothesized that familial historical trauma would be associated with the higher depression symptom trajectories. Drawing from the intergenerational family context, we also hypothesized that lower family socioeconomic status and caregiver lifetime depression would each be associated with the higher depression symptom trajectories. Family warmth and supportiveness were hypothesized to be associated with the lowest depression symptom trajectories. Drawing from the adolescent sphere, we hypothesized that perceived discrimination and female sex would each be associated with higher depression symptom trajectories.

Figure 1.

Figure 1.

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Adapted Conceptual Model of Indigenous Adolescent Development

METHOD

Participants and Procedures

The current study includes data from the Healing Pathways (HP) project,33 a community-based participatory study of 735 Indigenous adolescents and at least one caregiver, conducted in partnership with four American Indian and four Canadian First Nations reservation/reserves. The communities share a common cultural heritage and language, and they represent one of the largest Indigenous cultural groups in the United States and Canada. We do not name the group out of respect for confidentiality agreements with the communities. All eligible children (ages 10–12 years old at baseline, enrolled tribal member, living on or proximate to reservation/reserve land) with at least one caregiver were invited to participate, and received cash incentives for each interview. The recruitment rate was 79.4%. All procedures were approved by university Institutional Review Boards and Tribal community research councils. A full description of the original study design and sampling procedure are available in Whitbeck and colleagues’ (2014) study.33

Phase one of the study began in 2001/2002 to answer questions about health, mental health, and substance use. Youth participants and at least one of their caregivers were interviewed annually for eight years. Retention rates were high, ranging from 96.2% at wave 2 to 81.9% at wave 8. The second phase of the study began in 2017 when the target participants were ages 24 to 29, and it included three additional waves of data collection. Both phases used interviewer-administered surveys and computer-assisted diagnostic interviews. Retention rates were lower for phase two: 64.3% at wave 9 (seven years after the original study ended); 73.2% at wave 10; 49.4% at wave 11 (which was disrupted by the COVID-19 pandemic). The percentage of the sample who were interviewed at least once in adult waves was 83.6%, and the percentage of the sample who were interviewed at least once in adult waves 9 or 11 was 75.3%.

The current study included data from the target participants, i.e., “children at baseline,” at multiple waves (detailed below) and from their primary female caregivers, i.e., “parents” at the first wave of the study, which was the only year that ancestral historically traumatic events and caregiver mental health were measured. Slightly more than 30% of the target participants had two caregivers who participated at baseline; approximately 62% had only a female caregiver, and 8% had only a male caregiver. We restricted the analysis to include only those families with a participating female caregiver at baseline to more directly test our intergenerational hypotheses and to eliminate potential confounds.

Measures

Depression Symptoms (Child/Target Participant).

The full 20-item Center for Epidemiological Studies Depression scale36 was administered in waves 1, 2, 3, 5, and 7 (only diagnostic interviews were administered in waves 4 and 6, and the CES-D was not included at wave 8). A shortened, 9-item version of CES-D that was used and validated in the Longitudinal Study of Adolescent Health37 was adopted in waves 9 and 11. In total, there were seven waves of CES-D data. For measurement consistency, we used the same 9 items at all waves. The CES-D-9 demonstrated acceptable to excellent reliability in the current sample over time, with Cronbach’s α coefficients ranging from .72 at wave 1 to .93 at wave 9.

Family Boarding/Residential School (BRS) History (Parental).

The female caregivers were asked at the first wave of the study about their personal and ancestral experiences with historically traumatic events, measured by boarding and residential school attendance. Specifically, they were asked if they, a grandparent, or another member of their family, had attended boarding/residential school, coded 1 = family BRS history, 0 = no BRS history.

Covariates/Controls

We included three variables from wave 1 to examine family factors associated with depression symptoms in the context of historical trauma. Socioeconomic status was assessed as family per capita income, measured using caregiver (parental) reports of total household income divided by 1000 to set the metric in thousands of dollars. We then divided it by the number of people living in the household to calculate per capita income. Female caregiver (parental) lifetime Major Depressive Disorder (MDD) was assessed using the University of Michigan Composite International Diagnostic Interview, which was based on DSM-III criteria. The variable is coded 1 = met criteria for lifetime depression, 0 = did not meet criteria. Parenting practices were assessed as adolescent-reported Caregiver Warmth and Support (child/target participant report), adapted from the Iowa Youth and Families Project.38 The adolescents were asked five questions regarding how often they experienced a warm, supportive environment (e.g., they talk to their family about things that bother them). Response options ranged from 0 (never) to 2 (always) and were averaged into a mean score of warmth and supportiveness. Reliability of the caregiver warmth and support variable was α = .61 in the current sample.

Two adolescent context variables from the first wave of the study were added. Child/target participant sex is a binary indicator coded as 1 = female, 0 = male. Perceived discrimination (child/target participant) was assessed using an adapted version of the Schedule of Racist Events39 as a mean indicator of the frequency of experiencing instances of discrimination. Adolescents were asked 12 questions regarding how often they had ever experienced negative treatment from others because of their Indigenous culture, with response options ranging from 0 (never) to 2 (many times). We excluded two items: differential treatment in the court system was dropped because at this age because fewer than 5% had ever experienced this form of discrimination, and differential treatment of school staff members was dropped because it was not asked at all locations. Responses across the remaining 10 items were averaged, and the measure demonstrated good reliability (Cronbach’s α = .83) in the current sample.

Data Analytic Strategy

The data were analyzed using group-based trajectory modeling,40,41 a semi-parametric finite mixture model using the traj add-on in Stata-SE Version 17.42 This type of model allows for the identification of distinct groups of adolescents who followed similar developmental trajectories of depression symptoms over seven waves, which spanned from the ages of 10 to 28 years old. We estimated trajectory models using a zero-inflated Poisson distribution to accommodate our dependent variable (i.e., depression symptoms), which was a count variable with excess zeroes.

Model fit was judged with the following criteria (Table 1): The largest Bayesian information criterion (BIC), a BIC that is at least 10 greater than that of the previous model,43 entropy greater than 0.8,44 and group sizes greater than 5% of the total sample.41 Because our analytic plan included predicting trajectory group membership with multinomial logistic regression, we also factored statistical power into our model selection criteria. Following the recommendation of 10 cases per independent variable,45,46 a model with six independent variables requires at least 60 cases in the smallest group, or a group size of 11.4% in a sample of 525.

Table 1.

Model Fit Statistics (Group Size in %s)

No. of groups BIC Entropy Smallest group size
1 −11014.91
2 −9635.68 0.891 49.31
3 −9342.55 0.848 27.23
4 −9145.8 0.827 21.33
5 −9089.78 0.798 10.71
6 −8990.09 0.794 13.84
7 −8929.93 0.786 6.01
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Note: BIC = Bayesian information criterion

Although the four-group model did not have the largest BIC (−9145.80), it had a higher entropy compared to successive models (.827) and also had sufficiently large group sizes. For example, the 6-group model had a higher BIC (−8990.09) with adequate group sizes, but entropy was .794. After determining the appropriate number of trajectory groups, the groups were refined to identify the optimal shape of each trajectory using polynomial functions. The best fitting model had an intercept term for the first group, a linear term for the second group, and a quadratic term for the third and fourth groups (shown in Figure 2).

Figure 2.

Figure 2.

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Trajectories of CES-D Symptoms Across Adolescence and Early Adulthood

We used two diagnostic indicators and recommended cut-offs to assess model adequacy (Table 2). Average posterior probabilities (AvgPP) greater than .70 indicate that at least 70% of individuals are correctly classified in their trajectory group.41 The odds correct classification (OCC) exceeding 5 indicates high accuracy with which group assignments are made.41 In the final four-group model, AvgPP and OCC values were all well above recommended thresholds.

Table 2.

Diagnostic Indicators Assessing Model Adequacy

Group Group n Proportion classified in groupa AvgPP OCC
Low 144 0.27 0.92 30.94
Decreasing 135 0.26 0.89 22.34
Increasing 118 0.23 0.87 23.85
High 128 0.25 0.94 45.58
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Note: AvgPP = Average posterior probability; OCC = Odds of correct classification.

a

Based on maximum posterior probability assignment method.

After fitting the model to the data, we used multinomial logistic regression with variables collected at Wave 1 to identify whether family BRS history and our other independent variables predict membership in the depression trajectory groups. In a multinomial logistic regression, the exponentiated coefficients that we present can be interpreted as the relative risk of being in a given trajectory group compared to the reference group. Stata traj models the group membership simultaneously with the trajectories to reduce classification error.

Missing Data

As previously stated, only female parent reports of family BRS history were included. Cases with missing family BRS reports or missing on the baseline covariates were deleted prior to estimating the trajectories. Although group-based trajectory models use maximum likelihood to estimate the trajectory model parameters and accommodate uneven numbers of assessments and attrition,47 only children with at least four depression symptoms observations were included. Four time points are the minimum number needed to estimate group-based trajectories with cubic polynomial functions. This resulted in a final analytic sample of 525 (71.4% of the full sample). We examined whether those participants who were excluded from analysis were different than those included on the baseline covariates, and only per capita family income emerged as significantly different between the two groups. Specifically, it was higher in the group excluded from the analysis.

RESULTS

Child/Target Participant Depression Symptom Trajectory Groups

The four trajectory groups are shown in Figure 2. The Low Symptoms group was characterized by virtually no depression symptoms from age 10 to 20 and comprised 28.7% of the sample. The Decreasing Symptoms group (26.6%) began with higher initial levels of depression symptoms, which then decreased throughout adolescence, and then had a slight increase in early adulthood. The Increasing Symptoms group, 22.4% of the sample, had few initial symptoms but increased across adolescence and into young adulthood. The High Symptoms group, comprising 22.3% of the sample, had consistently high levels of depression symptoms during adolescence and an increase in early adulthood.

Descriptive Statistics and Baseline Profiles of Trajectory Groups

A large majority (77.9%) of the caregivers (parents) reported that they or someone else in their family had attended a boarding or residential school. Average per capita income was $5,500 at baseline. Nearly 20% (18.48%) of parents met criteria for lifetime MDD. Slightly more than half (52.19%) of children were female. All descriptive statistics and the trajectory group profiles are displayed in Table 3.

Table 3.

Descriptive Statistics and Trajectory Group Profiles (Means and Trajectory Groups in %s)

CES-D Trajectory Groups
M SD Low Decreasing Increasing High X2/F test p
Parental BRS Family history 77.90 70.51a 80.28a 80.81a 82.05a 7.16 0.067
Parental Family income 5.50 3.99 5.68a 6.02a 5.32a 4.79a 2.23 0.083
Parental Depression 18.48 13.46a 17.61ab 17.27ab 27.35b 8.90 0.031
Child/Target Participant Warmth & support 1.40 0.38 1.46a 1.34a 1.44a 1.34a 3.60 0.013
Child/Target Participant Female sex 52.19 43.59a 46.48a 57.27ab 65.81b 16.32 0.001
Child/Target Participant Discrimination 0.31 0.29 0.24a 0.24ab 0.28b 0.38b 5.87 0.000
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Note: Trajectory group values in a row that do not share subscripts are significantly different (p<.05).

Table 3 also displays the baseline profiles of the trajectory groups. There were no significant differences between the trajectory groups in the prevalence of BRS history, in per capita family income, or in warmth and support. More than one-quarter of the High Symptoms group (27.35%) had a caregiver with depression, a significantly higher percentage than the Low Symptoms group. The High Symptoms group had a larger proportion of females (65.81%) than the Low Symptoms (43.59%) and the Decreasing Symptoms (46.48%) groups. The Increasing Symptoms (0.28) and High Symptoms (0.38) groups reported more perceived discrimination than the Low Symptoms group (0.24).

Multinomial Logistic Regression Predicting Group Membership

For the multinomial logistic regression analyses, shown in Table 4, the Low Symptoms group was the reference group to which all other groups were compared. As noted in the descriptive statistics, family BRS history was prevalent in this sample of Indigenous adolescents/young adults, but not all who had a familial BRS history experienced poor mental wellbeing. Family BRS history doubled the odds of being in the High Symptoms group (O.R. = 2.05, p<.05) compared to the Low Symptoms group. Having a caregiver with a history of depression, compared to no caregiver depression, increased the odds of being in the High Symptoms group (O.R. = 3.22, p<.05). Being female tripled the odds of being in the High Symptoms group (O.R. = 3.22, p<.001). Perceived discrimination had the strongest association with membership in the High Symptoms group, increasing the odds by nearly 7 fold (i.e., 669%) versus being in the Low Symptoms group. A one-unit increase in warmth and support decreased the odds of being in the High Symptoms group by 65% (O.R. = 0.35, p<.05).

Table 4.

Multinomial Logistic Regression Predicting CES-D Trajectory Group Membership

Low group versus
Decreasing Increasing High
Constant 1.46** (0.63) 0.34 (0.74) 0.63 (0.66)
Parental BRS History 1.79 (0.32) 2.25* (0.37) 2.05* (0.34)
Parental Family Income 1.02 (0.03) 1.00 (0.04) 0.97 (0.04)
Parental Depression History 1.20 (0.42) 1.26 (0.43) 3.32** (0.37)
Child-reported Parental Warmth & Support 0.38** (0.38) 0.89 (0.42) 0.35** (0.38)
Child Female Sex 1.04 (0.28) 1.84* (0.30) 3.22*** (0.29)
Child Discrimination 4.44*** (0.57) 1.73 (0.63) 7.69*** (0.55)
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Note: Low symptom trajectory is the reference group. Standard errors in parentheses.

*

p<.05

**

p<.01

***

p<.001

We did not propose any hypotheses regarding the other trajectory groups, but several findings warrant attention. Family BRS history increased the odds of being in the Increasing Symptoms group (O.R. = 2.25, p<.05) versus the Low Symptoms group, as did being female (O.R. = 1.84, p<.05). A one-unit increase in warmth and supportiveness decreased the odds of being in the Decreasing Symptoms group by 62% compared to the Low Symptoms group (O.R. = 0.38, p<.01). Perceived discrimination was also the strongest predictor of membership in the Decreasing Symptoms group, increasing the odds by 344%. Additionally, per capita family income was not associated with trajectory group membership.

DISCUSSION

More than three-quarters of the participants in the current analysis had a parent, grandparent, or other family member who attended a boarding or residential school. Despite this high prevalence of intergenerational risk, 22.3% of the target participants (children at baseline; now, young adults) were predicted to have sustained high levels of depression symptoms. Notably, the percentage of Indigenous target participants predicted to have sustained high depression symptoms does not greatly vary from the lifetime prevalence estimates of lifetime Major Depressive Disorder in the general population (22.3% in our sample vs. 20.6% lifetime MDD).50 Family BRS history was a risk factor for being in the high depression symptoms group, even after accounting for more proximal risk factors, such as caregiver depression, female sex, and perceived discrimination. Despite the high prevalence of participants with BRS family history (77.9%), over 50% (i.e., 55.3%) were predicted to have either Low Symptoms or Decreasing Symptoms of depression. Our findings align with, and further contribute to, literature on mental well-being (e.g., relatively low depression symptoms) among Indigenous adolescents despite greater exposure to early life risks,21–23 illustrating Indigenous strengths and resilience.

Our hypotheses regarding high depression symptoms were largely supported. Family BRS history doubled the odds of being in the High Symptoms group compared to the Low Symptoms group. This robust finding indicates that now adult children (children/target participants) of caregivers (parents) who reported any family BRS history at study baseline are more than twice as likely to experience high depression symptoms in survey assessments over 15 years in the study and decades since family BRS experiences began compared to those without a familial BRS history. This finding is consistent with previous qualitative work linking family BRS history with symptoms of depression and loneliness in subsequent generations, as well as quantitative findings demonstrating family BRS history was associated with increased suicide risk.28–30,48 Compared to no caregiver depression, having a caregiver with a history of depression increased the odds of being in the High Symptoms group in the current study. This finding is consistent with previous behavioral trajectory research with Indigenous youth, which found that Indigenous youth with High Chronic mental health symptoms were more likely to have a parent with mental health problems.49 Being female tripled the odds of being in the High Symptoms group in the current study. This finding is consistent with epidemiological research that found higher prevalence rates of Major Depressive Disorder (MDD) among women (compared to men) and among Native American adults (compared to African American, Asian American, and Hispanic adults).50 Collectively, these findings align with broader literature that has identified historical trauma interacting with genetic vulnerabilities as one potential pathway for the transmission of psychiatric disorders. Perceived discrimination had the strongest association with membership in the High Symptoms group, increasing the odds by nearly 7 fold (i.e., 669%) versus being in the Low Symptoms group in the current study. This robust finding is consistent with research that has found discrimination as especially pernicious to Indigenous youth and adults.51,52 Indeed, racism is now widely cited as a public health crisis.53 Notably, anti-racist efforts are increasingly viewed as critical yet incomplete agendas for addressing the systemic oppression of Indigenous Peoples who exist simultaneously as racialized and distinctive sociopolitical groups.53 This point is underscored by the fact that both perceived ethnic/cultural discrimination and familial experiences of historical trauma linked to settler colonialism are associated with depression symptoms in our study.

Current results also indicated that experiencing warm and supportive parenting (with female caregivers) decreased the odds of being in the High Symptoms group by 65% for Indigenous young adults. This finding is consistent with previous research that indicated multidimensional resilient mental health (i.e., pro-social behavioral outcomes, such as school involvement and absence of problematic behaviors) was significantly associated with maternal warmth and support among North American Indigenous youth.52

Researchers have posited that many Indigenous Peoples exposed to historical trauma remain healthy and suggested future research to explore factors related to maintaining health in the face of historically traumatic events.7 These maintaining, or resource, factors in the face of historically traumatic events for Indigenous Peoples may include warm and supportive parenting practices, which is in line with the current findings and previous research.52 It is also possible that other maintaining and/or resource factors not captured in the current study, such as socio-cultural integration,54 and widespread cultural reclamation may be buffering, or even reversing, these negative impacts over time.

To our knowledge, this is the first study to longitudinally examine intergenerational associations between historical trauma and depression symptoms in a sample of Indigenous young adults. Furthermore, the HP project is one of the longest (currently in Wave 12 of data collection, spanning over 20 years) and largest (with 3 generations of family participants) multi-method data collections with Indigenous families over the life course in the U.S. and Canada. An additional strength is the community-based participatory research (CBPR) design of the HP project, which includes community research councils (CRCs) and community member interviewers as co-authors. Each involved community and research partner have input, oversight, and relationships with community participants, which are crucial for the continuation and successes of this project.

The current findings should be interpreted with important limitations in mind. Given this study focused on a single cultural group located in the Midwest of the U.S. and Canada, findings may not generalize to diverse, heterogeneous Indigenous communities, each with their own unique culture and rich traditions.55 For example, there are currently 574 federally recognized tribes in the U.S., other tribes who are state-recognized, and additional tribes without federal and state recognition who continue to exist as unique cultural groups.56,57 All participating families in this study resided either on or near rural or remote reservations and reserves; thus, findings may not generalize to Indigenous communities in urban and other settings. Moreover, our sample did not allow for examining impacts of relocation on families who remained in urban areas nor those who migrated back and forth; therefore, we cannot draw conclusions about relative outcomes between families relocated on and off-reservation lands. Additionally, the information regarding the parents’ grandparents’ generation was limited by children’s caregiver reports, and retrospective reports are not always accurate. The dichotomous questions asked to parents about BRS family history involvement (if they, a grandparent, or another member of their family, had attended boarding/residential school) did not specifically consider parental BRS attendance nor account for multiple familial BRS involvement. Because the analysis was restricted to only female caregiver reports, our estimates of BRS history are conservative given they do not reflect two sides of a family of origin. Lastly, seven waves of depression symptom data measured via the CES-D-937 were collected in the current study and demonstrated acceptable to excellent reliability over time. A meta-analysis on the original CES-D replicated the four-factor structure in American Indian samples,58 and it has previously demonstrated excellent reliability in samples of American Indian young adults.59,60 Future research should collect diagnostic and qualitative interview data to better understand shared and unique experiences of depression among Indigenous individuals and communities. Such efforts may reveal unique factors (e.g., collective grief and loss) related to experiencing depression among Indigenous communities to improve culturally relevant interventions, as has been found in other Indigenous samples.61,62

To address intergenerational trauma and depression, as well as prevent future sociocultural harms toward Indigenous communities, researchers and mental/health service providers should partner with Indigenous communities to develop population health-based interventions based on traditional knowledge and cultural practices, from a “culture as treatment” approach.63–66 Similarly, Indigenous scholars have argued for promoting “practice-based evidence” (e.g., traditional Indigenous practices) in contrast to evidence-based practice (e.g., Westernized scientific practices).67 While we did not specifically examine substance use or utilization of mental health services in the current analyses, substance use is commonly associated with historical trauma among some Indigenous communities as a way to cope with the devastating impacts that result from these experiences.24,28,29 As such, prior literature has suggested that culturally relevant methods and Tribal Best Practices (TBPs) may be the most efficacious for preventing alcohol and drug use among Indigenous communities, which we mention here to inform future prevention efforts.68

Acknowledgments

The preparation of this work was supported by the National Institute on Drug Abuse (R01DA039912: Drs. Kelley J. Sittner and Melissa Walls; P50DA058619: Dr. Melissa Walls); the National Institute of Mental Health (R01MH126586: Dr. Ashley B. Cole); the National Cancer Institute (P20CA253255; Dr. Ashley B. Cole); and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK091250: Dr. Melissa Walls).

This article is part of a special series devoted to addressing bias, bigotry, racism, and mental health disparities through research, practice, and policy. The 2024 Race & Disparities Team includes Deputy Editor Lisa R. Fortuna, MD, MPH, MDiv, Consulting Editor Andres J. Pumariega, MD, PhD, Diversity, Equity, and Inclusion Emerging Leaders Fellows Tara Thompson-Felix, MD, and Nina Bihani, MD, Assistant Editor Eraka Bath, MD, Deputy Editor Wanjikũ F.M. Njoroge, Associate Editor Robert R. Althoff, MD, PhD, and Editor-in-Chief Douglas K. Novins, MD.

The research was performed with permission from the Johns Hopkins University Institutional Review Board.

Consent has been provided for descriptions of specific patient information.

Footnotes

Disclosure: Drs. Cole, Sittner, and Walls and Mrs. Bruyere have reported no biomedical financial interests or potential conflicts of interest.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Ashley B. Cole, Oklahoma State University, Stillwater, Oklahoma..

Kelley J. Sittner, Oklahoma State University, Stillwater, Oklahoma..

Trisha Bruyere, Johns Hopkins University, Duluth, Minnesota..

Melissa L. Walls, Johns Hopkins University, Duluth, Minnesota..

Data Sharing:

Data collected for the study will not be made available to others. Data is anonymized to protect Tribal sovereignty.

Dr. Sittner served as the statistical expert for this research.

The authors would like to thank and acknowledge past and present Healing Pathways Community Research Council members and interviewers. Details can be found at the following link: https://cih.jhu.edu/programs/healing-pathways/.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data collected for the study will not be made available to others. Data is anonymized to protect Tribal sovereignty.

Dr. Sittner served as the statistical expert for this research.

The authors would like to thank and acknowledge past and present Healing Pathways Community Research Council members and interviewers. Details can be found at the following link: https://cih.jhu.edu/programs/healing-pathways/.

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