AMERICAN INDIAN, ALASKA NATIVE, AND NATIVE HAWAIIAN MENTAL HEALTHRESEARCH



NIH GUIDE, Volume 22, Number 6, February 12, 1993



PA NUMBER:  PA-93-53



P.T. 34, FE



Keywords:

  Mental Disorders 

  Epidemiology 

  Disease Prevention+ 



National Institute of Mental Health



PURPOSE



The purpose of this announcement is to encourage research and

research demonstration applications for studies among American

Indian, Alaska Native, and Native Hawaiian populations of the

epidemiology and prevention of mental disorders, co-occurring

substance abuse disorders, and suicide; family and individual coping

styles and resiliency; family violence; and mental health service use

and quality of care.  It is the goal of this initiative to improve

the care and quality of life of American Indians, Alaska Natives, and

Native Hawaiians who suffer from mental illnesses.



HEALTHY PEOPLE 2000



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This PA,

Minority Mental Health Research Centers, is related to the priority

area of mental health.  Potential applicants may obtain a copy of

"Healthy People 2000" (Full Report:  Stock No. 017-001-00474-0) or

"Healthy People 2000" (Summary Report:  Stock No. 017-001-00473-1)

through the Superintendent of Documents, Government Printing Office,

Washington, DC 20402-9325 (telephone 202/783-3238).



ELIGIBILITY REQUIREMENTS



Applications may be submitted by domestic public and private non-

profit organization and by for-profit organizations, including

universities, colleges, hospitals, laboratories, units of State and

local governments, tribal governments and tribal organizations, and

eligible agencies of the Federal government.  Women and minority

investigators are encouraged to apply.  Foreign institutions are not

eligible for First Independent Research Support and Transition

(FIRST) (R29) awards.



MECHANISMS OF SUPPORT



Research support may be requested through applications for a regular

research grant (R01), a small grant (R03), the FIRST award (R29), a

cooperative clinical research grant (R10), and research

demonstrations (R18).



Because the nature and scope of the research proposed in response to

this announcement will vary, it is anticipated that the size of the

awards will also vary.  However, for fiscal year 1993, Congress

directed NIMH to spend $15 million on behavioral research on rural

and Native American mental health issues.



RESEARCH OBJECTIVES



Much about the mental health needs of American Indians, Alaska

Natives, and Native Hawaiians is unknown. Little is known about the

epidemiology and prevention of adult or child mental disorders;

co-occurring substance abuse disorders; family violence and family

dysfunction; cultural, economic, or geographic barriers to care;

appropriateness and effectiveness of treatment; need for services;

and service use patterns.  To begin to address these issues, NIMH, in

conjunction with the National Institute on Alcohol Abuse and

Alcoholism and the National Institute on Drug Abuse, issued a program

announcement in March 1990, "Epidemiologic and Services Research on

Mental Disorders that Co-occur with Drug and/or Alcohol Disorders

Among American Indians, Alaska Natives, and Native Hawaiians."  The

purpose of that announcement was to encourage investigators to test

further the reliability and validity of current psychiatric and

service system measures for native populations and to begin to

estimate the prevalence of disorders and service use.



This announcement is intended to stimulate a broader range of mental

health research related to American Indians, Alaska Natives, and

Native Hawaiians.  By addressing issues relating to epidemiology,

prevention, family and individual coping styles and resiliency,

family violence, and service use, treatment, and quality of care,

progress can be made toward improving the quality of life of American

Indians, Alaska Natives, and Native Hawaiians whose lives are

affected by mental illness, co-occurring substance abuse disorders,

and often-related family dysfunction.



In part, this announcement was developed in coordination with the

Mental Health Programs Branch of the Indian Health Service (IHS).  A

copy of the Native American Mental Health Research Agenda, which was

developed in 1988 by the Mental Health Program Branch of the IHS and

is an Appendix to the National Plan for Native American Mental Health

Services (April 1990), may be obtained by contacting the NIMH program

staff member listed under INQUIRIES.



Listed below are examples from research topic areas in which

knowledge about the mental health needs of and quality of care

provided to American Indians, Alaska Natives, and Native Hawaiians is

lacking.  The list of examples is illustrative, not exhaustive; it is

expected that additional important research topics will be identified

by researchers who respond to this announcement.

Investigator-initiated projects may focus on:



Basic Psychosocial Processes



o  Individual and family coping styles and their association with the

development of behavior problems and depression in American Indian,

Alaska Native, and Native Hawaiian children and adolescents



o  Child-rearing practices and individual, family, and community

characteristics associated with adaptive individual functioning among

American Indian, Alaska Native, and Native Hawaiians



o  The influence of cultural definitions of normal and abnormal

behavior among American Indian, Alaska Native, and Native Hawaiian

peoples on symptom expression



o  The impact of social networks and supports used by American

Indian, Alaska Native, and Native Hawaiians as buffers against

stressful circumstances and experiences



Basic Prevention and Behavioral Medicine



o  The role of environmental stressors, such as economic strain or

family disruption, in the etiology of physical and mental disorders

among American Indians, Alaska Natives, and Native Hawaiians



o  Psychobiological mechanisms in medical illnesses among American

Indian, Alaska Native, and Native Hawaiians



o  Psychological and behavioral consequences of physical illnesses

and/or substance abuse for individual American Indian, Alaska Native,

and Native Hawaiians and their families



Epidemiology



o  The incidence and prevalence of mental disorders and their risk

factors, including co-occurring substance abuse disorders, among

American Indian, Alaska Native, and Native Hawaiians



o  The incidence and prevalence of mental disorders among American

Indian, Alaska Native, and Native Hawaiians with chronic physical

health problems



Prevention



o  The modification of significant cultural, social, and

psychological factors associated with suicide and suicidal behavior

among American Indians, Alaska Natives, and Native Hawaiians



o  The safety and effectiveness of culturally specific preventive

interventions aimed at suicidal behavior, depression, and alcohol and

other substance abuse



o  The enhancement of individual and family styles of coping with

behavior problems and depression in American Indian, Alaska Native,

and Native Hawaiian children and adolescents



Family and community violence



o  The prevalence of physical and sexual abuse of women, children,

and adolescents



o  The role of physical and sexual abuse in the suicidal behavior

among American Indian, Alaska Native, and Native Hawaiian adolescents



o  The prevalence of serious violent behavior within American Indian,

Alaska Native, and Native Hawaiian communities and the role of

substance abuse in violence Service use and quality of care



o  The effect of social, economic, cultural, and psychological

factors on choice of care-giver for mental health problems and

treatment outcomes



o  Assessment of the reliability, validity, and cost- effectiveness

of various methods used to screen for mental disorders, substance

abuse, and family violence among American Indian, Alaska Native, and

Native Hawaiians



o  Assessment of the reliability and validity of current diagnostic

and assessment instruments and functional assessments for American

Indian, Alaska Native, and Native Hawaiian populations in public

health and mental health settings



o  Availability and use of mental health, substance abuse, and social

services by American Indian, Alaska Native, and Native Hawaiian

persons with mental disorders, particularly with co-occurring

substance abuse disorders



o  The effectiveness of mental health and substance abuse treatments

which combine traditional and Western medicine



STUDY POPULATIONS



SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH

POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL

RESEARCH STUDY POPULATIONS



NIH policy requires inclusion of minorities and females in research

study populations.  Since this announcement requests research

focusing only on minority populations (American Indians, Alaska

Natives, and Native Hawaiians), these instructions apply only to the

inclusion of females.  Applications in response to this announcement

are required to include both genders in study populations so that

research findings can be of benefit to all persons at risk of the

disease, disorder or condition under study.  It is expected that

special emphasis will be placed on the need for inclusion of women in

studies of diseases, disorders, and conditions which

disproportionately affect them.  This policy applies to all research

involving human subjects and human materials, and applies to males

and females of all ages.  If one gender is excluded or is

inadequately represented in this research, particularly in proposed

population-based studies, clear compelling rationale for exclusion or

inadequate representation should be provided.  In addition, gender

issues should be addressed in developing a research design and sample

size appropriate for the scientific objectives of the study.



Applications for support of research must employ a study design with

representation of males and females (by age distribution, risk

factors, incidence/prevalence, etc.) appropriate to the scientific

objectives of the research.  It is not an automatic requirement for

the study design to provide statistical power to answer the questions

posed for men and women separately; however, whenever there are

scientific reasons to anticipate differences between men and women,

with regard to the hypothesis under investigation, applicants should

include an evaluation of these gender group differences in the

proposed study.  If adequate inclusion of one gender is impossible or

inappropriate with respect to the purpose of the research, because of

the health of the subjects, or other reasons, or if in the only study

population available, there is a disproportionate representation of

one gender, the rationale for the study population must be well

explained and justified.  Control group comparisons are encouraged in

all research.



For research awards that are covered by these special instructions

for this particular announcement, awardees will report annually on

enrollment of women and men as subjects.



APPLICATION PROCEDURES



Applicants are to use the research grant application form PHS 398

(rev. 9/91).  The number (PA-93-53) and title of this announcement,

"American Indian, Alaska Native, and Native Hawaiian Mental Health

Research," must be typed in item 2a on the face page of the

application form.  Applicants must also specify which support

mechanism they are applying under, e.g., FIRST, small grant, R10.



Application kits containing the necessary forms may be obtained from

IHS Area offices and business offices; offices of sponsored research

at most universities, colleges, medical schools, and other major

research facilities; and from the Grants Management Branch, National

Institute of Mental Health, 5600 Fishers Lane, Room 7C-05, Rockville,

MD 20857, telephone 301/443-4414.



The signed original and five legible copies of the completed

application must be sent to:



Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**



REVIEW PROCEDURES AND CRITERIA



Applications will be reviewed for scientific and technical merit by

an initial review group (IRG) composed primarily of non-Federal

scientific experts.  Final review is by the appropriate National

Advisory Council; review by Council may be based on policy

considerations as well as scientific merit.  By law, only

applications recommended for consideration for funding by the Council

may be supported.  Summaries of IRG recommendations are sent to

applicants as soon as possible following IRG review.



Criteria to be considered in evaluating applications for

scientific/technical merit include:



o  Scientific, technical, or medical significance and originality of

the proposed research



o  Appropriateness and adequacy of the research approach and

methodology proposed to carry out the research



o  Qualifications and research experience of the Principal

Investigators and staff, particularly but not exclusively in the area

of the proposed research



o  Availability of resources necessary to the research



o  Appropriateness of the proposed budget and duration in relation to

the proposed research



o  Adequacy of the proposed means for protecting against or

minimizing adverse effects to human and/or animal subjects



AWARD CRITERIA



As part of the NIMH Public-Academic Liaison (PAL) initiative, special

encouragement is given to applications that involve active

collaborations between academic researchers and public sector

agencies in planning, undertaking, analyzing, and publishing research

pertaining to persons with severe mental illness.  The PAL initiative

is based on the premise that important new advances in understanding

and treatment of severe mental illness can result from improved

linkages between the Nation's scientific resources and the public

sector agencies and programs in which many persons with severe mental

illness receive their care.  The scope of the PAL initiative

encompasses public sector agencies of all types that deal with

children, adolescents, adults, and elderly persons with severe mental

disorders.



In addition, preference in funding will be given to projects that

include, but do not necessarily focus on, American Indian, Alaska

Native, and Native Hawaiians living in urban settings and projects

that include females in study populations.



Factors considered in determining which applications will be funded

include IRG and Council recommendations, PHS program needs and

priorities, and availability of funds.



INQUIRIES



NIMH staff are available for consultation concerning proposal

development in advance of or during the process of preparing an

application.



Applicants with questions about the Indian Health Service and

questions about the feasibility of particular research approaches

with American Indian and Alaska Native peoples, particularly for

research demonstrations, should contact the NIMH staff member listed

below.  She can provide a list that includes the names, addresses,

and phone numbers of the Mental Health Branch Chiefs in the 12 IHS

Service Units and of the Chief of the headquarters IHS Mental Health

Program Branch.



Potential applicants should contact NIMH as early as possible for

information and assistance in initiating the application process and

developing an application.  The NIMH program staff member listed

below may be contacted for further information and assistance:



Ann A. Hohmann, Ph.D., M.P.H.

Division of Epidemiology and Services Research

National Institute of Mental Health

5600 Fishers Lane, Room 10C-06

Rockville, MD  20857

Telephone:  (301) 443-3364



For further information on grants management issues, applicants may

contact:



Diana S. Trunnell

Assistant Chief, Grants Management Branch

National Institute of Mental Health

5600 Fishers Lane, Room 7C-15

Rockville, MD  20857

Telephone:  (301) 443-3065



AUTHORITY AND REGULATIONS



This program is described in the Catalog of Federal Domestic

Assistance 93.242, Mental Health Research Grants.  Awards made under

authorization of the Public Health Service Act, Title IV, Part A

(Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and

285) and administered under PHS grants policies and Federal

Regulations 42 CFR 52 and 45 CFR Part 74.  This announcement is not

subject to the intergovernmental review requirements of Executive

Order 12372, as implemented through DHHS regulations at 45 CFR Part

100, or Health Systems Agency Review.



.

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