Risk factors found significant for psychiatric outcome in non-Indian adolescents were tested on Child Behavior Checklist Internalizing, Externalizing and Total Behavior scores. Subjects were 211 of 224 (94%) urban American Indian youth, mean age 11 years at initial interview (T1) and 14 years at 36-month follow-up (T4). Males and females were equally represented. Data were from a longitudinal study that used structured annual interviews with a youth and primary caretaker. Biographic Questionnaires, an Alcohol and Drug Use Questionnaire, Harter's People in my Life and What I am Like, Derogatis' Brief Symptom Inventory and Moos Family Relationships Index provided predictor variables. Internal consistency reliability of scales, including three produced by the research project, was evaluated and found adequate for research and clinical applications.

Multiple regression analyses revealed caretaker psychiatric distress, family conflict (anger and aggression) and repeating a grade predicted Total Behavior Problems at T1 and T4 and Internalizing and Externalizing scores at T4. T1 Total Behavior predictors and their standardized Betas were: Caretaker psychiatric distress (.31); Family conflict (.22); Classmate regard ($-$.18); Number of deviant behaviors of peers (.15); and, Repeated a grade (.12). T4 Total Behavior predictors and Betas were: Caretaker psychiatric distress (.17); Family conflict (.19); Number of deviant behaviors of peers (.16); Repeated a grade (.18); Number of major life changes (.14); Proportion of youth's life in the city (.14); Number of Indian ritual activities the youth reported ($-$.14). The proportion of the youth's life in the city predicted Internalizing behavior (Beta =.15). Number of deviant behaviors of peers (Beta =.18) and Indian rituals (Beta = $-$.16) predicted Externalizing behavior. The best predictor of T4 behaviors was T1 Total Behavior Problems with Betas of.41 (Internalizing),.31 (Externalizing) and.46 (Total Behavior Problems).

Results suggest that youth who fail a grade, whose caretaker displays high levels of psychiatric distress and whose family is in conflict need to be recognized and that services be provided the entire family for maximum benefit. Results are discussed from a public health perspective, noting the need to reframe and restructure extant academic, social, family, health and mental health programs to better coordinate prevention and intervention.