Psychiatry · Medical Literature
Systematic Review and Meta-Analysis of Anxiety and Depression Among American Indian and Alaska Native Adolescents in the United States.
Abstract
American Indian and Alaska Native (AI/AN) adolescents experience considerable mental health disparities, yet research on the prevalence of anxiety and depression remains limited. The objectives of this study were to assess available depression and anxiety data among AI/AN adolescents in the literature and to estimate depression prevalence and mean scores. A systematic review of the Medline, Embase, and PsycINFO databases identified publications reporting on anxiety or depression in AI/AN adolescents aged 10-19. Gray literature was searched in ProQuest Dissertation and Theses to minimize publication bias. Meta-analyses using random-effects models in R estimated the aggregate prevalence and mean scores of depression. Covariates included mean age, percent of male participants, geographical region, and setting. The systematic literature review extracted 82 relevant studies, with 77 citations reported depression data, 15 citations reported anxiety data, and 4 citations reported depression and anxiety prevalence data together but did not discriminate between the two conditions. Aggregate depression prevalence measured by the Center for Epidemiological Studies Depression (CES-D) scale was 34.6% (95% CI: 11.5-68.4%) across three studies (N=664), while the Children's Depression Index (CDI) indicated a prevalence of 14.5% (95% CI: 2.5-52.9%) in two studies (N=365). The aggregate CDI mean score was 9.81 (95% CI: 9.50-10.13) out of 54. No covariates significantly influenced depression outcomes (p>0.05). Generalized Anxiety Disorder 7-item (GAD-7) scale was the most frequently reported measurement of anxiety, in three studies. Due to limited data, meta-analyses for anxiety were not conducted. The results of this systematic review highlight the scarcity of data on depression and anxiety in AI/AN adolescents. This underscores the urgent need for culturally appropriate, evidence-based mental health research and services for AI/AN adolescents.
Clinical relevance
What is the aggregate prevalence and mean severity of depression and anxiety among American Indian and Alaska Native (AI/AN) adolescents aged 10–19 years, as derived from a systematic review and meta-analysis of the published and gray literature? __SNAPSHOT__ {"studyDesign":"Systematic review with meta-analysis (random-effects models)","setting":"United States; databases searched: MEDLINE, Embase, PsycINFO, and ProQuest Dissertations and Theses (gray literature)","sampleSize":"82 studies included in the systematic review (77 citations reported depression data; 15 reported anxiety data; 4 reported combined depression/anxiety prevalence without discrimination between conditions); individual participant N not reported in the abstract","population":"American Indian and Alaska Native (AI/AN) adolescents aged 10–19 years in the United States","intervention":"Not applicable (observational; exposure of interest is AI/AN racial/ethnic identity)","comparator":"Not applicable (single-group prevalence estimation; no comparator group explicitly meta-analyzed per the abstract)","primaryOutcome":"Aggregate prevalence and mean scores of depression (primary); anxiety prevalence (secondary, narrative); measured using validated scales including the Center for Epidemiological Studies Depression (CES-D) scale","followUp":"Not reported (cross-sectional study designs predominate in prevalence meta-analyses; longitudinal duration across included studies not reported in the abstract)","fundingSource":"Not reported"}
Key findings
The abstract is truncated and does not present complete quantitative results. As reported in the available abstract text: (1) 82 studies met inclusion criteria; (2) 77 citations contributed depression data, 15 contributed anxiety data, and 4 reported combined prevalence without distinguishing between the two conditions — highlighting a significant gap in anxiety-specific evidence; (3) meta-analyses using random-effects models in R were performed to estimate aggregate depression prevalence and mean scores, with the CES-D scale as a principal instrument. Aggregate depression prevalence as measured by the CES-D was described but the numerical result is absent from the provided abstract text. No prevalence estimates, mean scores, confidence intervals, p-values, or heterogeneity statistics (I²) are available from the supplied abstract. Covariates examined included mean age, percent male participants, geographical region, and setting. No adverse event data are applicable to this observational design. No calculable NNT/NNH. All quantitative findings must be obtained from the full publication (PMID 42378636).
Practice implications
This systematic review and meta-analysis represents one of the most comprehensive efforts to date to aggregate depression and anxiety prevalence data specific to AI/AN adolescents — a population documented to face disproportionate mental health burdens, including elevated rates of depression, suicide, PTSD, and substance use relative to the general adolescent population. The study's focus on ages 10–19 and its search of gray literature (ProQuest Dissertations and Theses) to minimize publication bias are methodological strengths. However, the marked asymmetry in available data — 77 citations for depression versus only 15 for anxiety — confirms that anxiety in this population is substantially understudied and that anxiety-specific estimates, if reported, carry wide uncertainty and must be interpreted cautiously. The four citations reporting combined depression/anxiety prevalence without discrimination between conditions represent a quality concern among the included literature and limit clinical precision. Which specific tribal nations, geographic regions (reservation vs. urban vs. rural), or socioeconomic strata are adequately represented cannot be determined from the abstract alone. Subgroup findings by age, sex, region, and setting are planned per the covariate list but results are not available in the truncated abstract. Whether the aggregate estimates reflect clinically actionable prevalence thresholds or are driven by subclinical symptom scales (e.g., CES-D used dimensionally rather than diagnostically) cannot be adjudicated without full-text review. IMPORTANT NOTE: This summary is based solely on a truncated abstract; the primary numerical findings of the meta-analysis are absent. Clinicians should access the full publication before drawing evidence-based practice conclusions. __LIMITATIONS__ Abstract is truncated — primary quantitative results (aggregate prevalence, mean scores, confidence intervals, heterogeneity statistics) are not available in the supplied text; this summary is therefore necessarily incomplete.,Marked data sparsity for anxiety (15 citations) relative to depression (77 citations), severely limiting power and precision of any anxiety prevalence estimate.,Four included citations combined depression and anxiety prevalence without discriminating between conditions, introducing outcome misclassification into the aggregate estimates.,Individual participant-level N across included studies not reported in the abstract, precluding assessment of the overall analytic sample's adequacy.,CES-D and other dimensional symptom scales measure depressive symptom burden rather than DSM/ICD diagnostic prevalence; clinical thresholds may vary across studies, contributing methodological heterogeneity.,Substantial expected heterogeneity across studies given variation in tribal affiliations, geographic settings (reservation, urban, rural), historical periods of data collection, and measurement instruments.,Gray literature search (ProQuest only) partially mitigates but does not eliminate publication bias.,No direct comparison group (e.g., non-AI/AN adolescents) was meta-analyzed per the abstract, limiting conclusions about relative versus absolute disparity magnitude.,Generalizability may be limited by underrepresentation of specific tribal nations, rural vs. urban subgroups, and geographic regions depending on source study distribution.,Funding source not reported; potential conflicts of interest cannot be evaluated.,Cross-sectional designs in the primary literature preclude causal inference. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This systematic review and meta-analysis is among the most rigorous efforts to synthesize depression and anxiety prevalence data in AI/AN adolescents, confirming both the significant burden of depression in this population and the critical scarcity of anxiety-specific research. Because the abstract is truncated and primary effect estimates are unavailable, clinicians must consult the full publication (PMID 42378636) before applying specific prevalence figures to clinical or policy decisions. In the interim, existing evidence strongly supports routine, culturally adapted mental health screening for depression and anxiety in AI/AN youth in all clinical settings.