Positive Mental Health: A Concept Mapping Exploration

Abstract

American Indian (AI) people experience higher rates of depressive symptoms, psychological distress, and poor mental health than non-Native Americans. Despite a 17.1% prevalence of Anishinabe (an indigenous people who live in the Midwest of the United States and Canada) adults living with type 2 diabetes and meeting the PHQ-9 cutoff for depression, half (51.3%) of those surveyed were flourishing according to Keyes' Mental Health Continuum--Short Form (MHC-SF). A unique paradox appears to exist for AI people more so than that documented for other groups: despite historical trauma, various social stressors, ongoing marginalization, and depression and chronic diseases, a disproportionately large number of AI people met criteria for flourishing mental health. In order to better understand Anishinabe concepts of mental wellness and the utility of the MHC in this population, the specific aim of the study was to gain a deeper understanding of indigenous interpretations of positive mental health (PMH) by engaging in a group concept mapping session with Anishinabe community members from two communities. The resulting concept map varied somewhat from the three aspects of PMH presented in Keyes' MHC-SF (emotional, psychological, and social wellbeing). According to the map, PMH included the following clusters: 1) Values Gained with Maturity, 2) Motivated, 3) Traditional Spirituality/Culture, 4) Culturally Competent/Accept Others, 5) Take Care of Self, 6) Financial Health/Organized, 7) Ethical/Moral Leadership, 8) Community, and 9) Family/Relationships. Many of the clusters were related at least in part to the MHC-SF, but some differences were evident. Additionally, themes of harmony and balance, resilience and coping, and connection and interconnectedness, while not found in the MHC-SF, were prominent aspects in this concept map, lending support to their importance in indigenous PMH. Overall, the theme of interconnection is key to understanding the results of the concept map. The focus of this study fulfilled calls for strengths-based (as opposed to deficit-based) research for indigenous people. This was significant not only for better understanding Anishinabe perspectives of PMH, but also for understanding the ways in which all groups of people can learn lessons about PMH through cross-cultural research.