The Critical Role of Cultural Engagement in the Link between Family Conflict, Maternal Depression, and Youth Internalizing Symptoms in American Indian and Alaska Native Families

Abstract

Research has established a significant link between Maternal Depression (MD) and increased emotional and psychological symptoms in children. However, they have largely overlooked the specific impact on AI/AN children who are at higher risk for these internalizing and externalizing symptoms compared to children of other racial/ethnic backgrounds. This study aims to bridge this gap by identifying key risk and protective factors (e.g., family conflict, traditional cultural engagement) that might exacerbate or mitigate the effects of MD on AI/AN children, thereby advancing health equity for this underserved population. This study involved 197 AI/AN children, aged 9–12, whose mothers had a history of MD based on data from the Adolescent Brain Cognitive Development (ABCD) Study. We examined whether MD symptom severity correlates with child internalizing symptoms, including anxiety and depression. Moreover, we investigated the potential moderating roles of traditional cultural engagement and family conflict in this relationship. The findings revealed that higher family conflict significantly amplifies internalizing (d = 0.29) and depressive symptoms (d = 0.29) in children when level of MD is low. Family conflict heightened anxiety symptoms only in children who had low levels of traditional cultural engagement. Furthermore, a three-way interaction indicated that traditional engagement moderated the relationship between family conflict and anxiety symptoms, with higher traditional engagement buffering the negative impact of family conflict, particularly among younger children (d = 0.35). Taken together, these results underscore the heightened vulnerability of AI/AN children to internalizing symptoms in the context of MD and family conflict. However, they also highlight the potential of cultural protective factors to counteract these negative outcomes.