摘要：Objective. We surveyed American Indian/Alaska Native (AIAN) women in New York City to determine the prevalence of 3 types of interpersonal violence among urban AIAN women and the behavioral health and mental health factors associated with this violence. Methods. Using a survey, we questioned 112 adult AIAN women in New York City about their experiences with interpersonal violence, mental health, HIV risk behaviors, and help-seeking. The sampling plan utilized a multiple-wave approach with modified respondent-driven sampling, chain referral, and target sampling. Results. Among respondents, over 65% had experienced some form of interpersonal violence, of which 28% reported childhood physical abuse, 48% reported rape, 40% reported a history of domestic violence, and 40% reported multiple victimization experiences. Overwhelmingly, women experienced high levels of emotional trauma related to these events. A history of interpersonal violence was associated with depression, dysphoria, help-seeking behaviors, and an increase in high–HIV risk sexual behaviors. Conclusions. AIAN women experience high rates of interpersonal violence and trauma that are associated with a host of health problems and have important implications for health and mental health professionals. Violence against women is a significant public health problem. Although a growing body of literature documents the consequences of interpersonal violence for the health and mental health of women, 1 – 3 very few studies have examined the relation between interpersonal violence and health and mental health outcomes among American Indian/Alaska Native (AIAN) women. This discrepancy in the literature exists despite findings from the National Violence Against Women Survey, showing that the highest rates of all forms of violence occur among AIAN women, with 34.1% of AIAN women reporting rape, 61.4% reporting physical assault, and 17.0% reporting stalking during their lifetime. 4 Moreover, other research suggests that AIAN women have a higher rate of victimization through violent crime, 5 physical attack, 6 and being a witness to traumatic events. 6 They may also be disproportionately represented among domestic violence homicides. 7 , 8 Understanding risk profiles for AIAN women has important implications for health and mental health professionals. In addition to physical injury, violent victimization may lead to an increased risk of developing serious health problems, such as self-neglect, sexually transmitted disease, and poor adherence to medical recommendations. 3 Women in abusive relationships may develop stress and anxiety that can lead to long-term health issues and reduced immunity to illness in general, 9 – 11 as well as specifically increasing their exposure to HIV infection. 12 , 13 In addition, a history of interpersonal violence is related to health care utilization. For example, female sexual assault victims use more general health and mental health services than nonvictims. 3 Women’s mental health also suffers as a result of victimization. Among samples of non-Native women, those who have been battered or who have experienced sexual assault have higher rates of severe mental disorders, including depression, anxiety, and posttraumatic stress disorder. 1 , 3 In several categories, the rates of distress for survivors of violence are double, and sometimes triple those of women who have not been abused. 7 Violence itself has been found to be more predictive of depression in battered women than preexisting mental disorders, demographics, or developmental characteristics. 3 Among AIAN women specifically, preliminary evidence indicates that violent victimization is related to depression, posttraumatic stress disorder, suicide attempts, and alcohol use. 14 Previous studies of AIAN women represent an initial investigation of interpersonal violence, but most are limited by their use of tribally specific and/or reservation-based samples. The only nationally representative survey to include AIAN women, the National Violence Against Women Survey, relied on a subsample of 88 AIAN women out of a total sample of 16000 for its results. Reservation-based samples typically report high rates of violence across types of victimization. For instance, in 1 of the few studies to explore multiple experiences of victimization across the lifespan of AIAN women, 15 27% reported childhood physical abuse, 40% reported child sexual abuse, 40% reported experiencing adult sexual assault, and 67% reported physical violence from an adult partner. Yet, although there is ample evidence that interpersonal violence among AIAN women is high, the relation between violence and AIAN women’s health has not been addressed, and research exploring interpersonal violence among urban AIAN women is almost nonexistent. American Indians and Alaska Natives in Urban Areas Contrary to their common stereotype as rural or reservation-based people, more than 60% of AIAN people currently live in urban settings. 16 In the past several decades, AIAN people have experienced rapid urbanization, due in large part to federal policies of tribal termination and relocation. The relocation of many Native people from tribal lands has put urban American Indians and Alaska Natives at risk for a host of biopsychosocial problems, 17 , 18 including vulnerability to HIV infection. 19 Despite these high rates of urbanization, the Indian Health Service, which provides the majority of health care to American Indians and Alaska Natives, has allocated only 1% of its funding to urban areas. 20 It is, therefore, of increasing importance to conduct research with Native people living in urban settings, particularly given the fragmented service delivery systems they encounter. Given the limited empirical evidence about the effects of interpersonal violence on AIAN women, particularly urban AIAN women, we conducted the present study to (1) describe the prevalence of interpersonal violence (domestic violence, lifetime sexual assault, and childhood physical abuse) in a sample of urban AIAN women, and (2) to explore the impact of violence exposure on mental health, HIV risk behaviors, and help-seeking.
