Systematic Review and Meta-Analysis of Anxiety and Depression Among American Indian and Alaska Native Adolescents in the United States.

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.