Peter J. Guarnaccia

The factor structure of the CES-D in the Hispanic health and nutrition examination survey: The influences of ethnicity, gender and language

In this paper, we examine the factor structure of the Center for Epidemiologic Studies-Depression Scale (CES-D) in the Hispanic Health and Nutrition Examination Survey (Hispanic HANES). The Hispanic HANES provides a unique opportunity to examine the patterning of depressive symptoms among the three major Hispanic groups in the U.S. and to compare the factor structures that emerge from the analysis to other studies using this approach. Different factor structures emerged for the Hispanic groups as compared to previous analyses of the CES-D with non-Hispanic populations. We also found significant intra-group differences among Mexican-Americans, Puerto Ricans, and Cuban-Americans which were strongly influenced by the gender of the respondent and the language in which the person was interviewed.

The prevalence of ataques de nervios in the Puerto Rico disaster study. The role of culture in psychiatric epidemiology

This paper presents one of the few epidemiological studies of a popular category of distress, ataques de nervios (attacks of nerves), in the cross-cultural psychiatric literature. As part of a major study of the psychological consequences of the 1985 floods and mudslides which caused considerable damage and death in Puerto Rico, a question was added to the Diagnostic Interview Schedule/Disaster Supplement concerning ataques de nervios. This additional item provided the opportunity to carry out the first study of this important Puerto Rican popular category of distress using a representative, community-based sample. This paper addresses several key questions about ataques de nervios which come from previous psychiatric and anthropological literatures concering the social correlates of who experiences an ataque de nervios and the relationship of ataques to social distress and psychiatric disorder. People who reported an ataque de nervios were more likely to be female, older, less educated, and formerly married. They were also more likely to meet criteria for anxiety and depressive disorders than those who had not experienced an ataque. The picture that emerges from our analyses is that those who suffer from a combination of social disadvantage, psychiatric disorder, and poor perceived health are more likely to experience an ataque de nervios.

Family Cohesion and Its Relationship to Psychological Distress among Latino Groups.

This article presents analyses of a representative sample of U.S. Latinos (N = 2,540) to investigate whether family cohesion moderates the effects of cultural conflict on psychological distress. The results for the aggregated Latino group suggest a significant association between family cohesion and lower psychological distress, and the combination of strong family cohesion with presence of family cultural conflict is associated with higher psychological distress. However, this association differs by Latino groups. In this study, no association for Puerto Ricans is seen; Cuban results are similar to the aggregate group, family cultural conflict in Mexicans is associated with higher psychological distress whereas family cohesion in other Latinos is associated with higher psychological distress. Implications of these findings are discussed to unravel the differences in family dynamics across Latino subethnic groups.

The experiences ofAtaques de nervios: Towards an anthropology of emotions in Puerto Rico

Ataques de nervios are an idiom of distress used by Puerto Ricans and other Latinos to express dislocations in the social world of the family. This paper contributes to the growing study of the “anthropology of the emotions”. Through detailed interviews with 121 people in Puerto Rico, 78 of whom had had anataque de nervios, we are developing a thick description of both the prototypical models forataques de nervios and the varied individual experiences ofataques. The interview used in this study is a version of the Explanatory Model Interview Catalogue specifically adapted for use in a community study ofataques de nervios in Puerto Rico. Responses to questions on the experience ofataque de nervios were analyzed using a team of reviewers who represented differing knowledge and experience with Puerto Rican culture and mental health practice. The experience ofataques de nervios involves a loss of control in several important domains of experience: emotional expressions, bodily sensations, action dimensions and alterations in consciousness. That loss of control is closely linked to important social contexts relating to major life problems and the experience of suffering.

Looking Beyond Nativity: The Relation of Age of Immigration, Length of Residence, and Birth Cohorts to the Risk of Onset of Psychiatric Disorders for Latinos

Past studies have yielded inconsistent results regarding risk of psychopathology for U.S. Latinos by nativity possibly due to differences across immigrants in their age of arrival to the United States, their length of residence in the United States, or birth-cohort differences. In this article, we seek to document the relation of age of arrival, time in the United States, and cohort effects on the risk of onset of psychiatric disorders using a nationally representative sample of 2,554 Latinos in the coterminous United States. We assessed risk of onset of psychiatric disorders using the World Health Organization Composite International Diagnostic Interview (Kessler & Us-tun, 2004). Findings indicate that Latino immigrants have lower risks of onset for some psychiatric disorders in their country of origin, but once in the United States, Latino immigrants appear to experience similar risks of onset as U.S.-born Latinos of the same age. The longer Latino immigrants remain in their country of origin, the less cumulative risk of onset they experience, resulting in lower lifetime rates of disorders. These findings could potentially be due to variation in cultural and social norms and expectations across geographical contexts, differences in family structure and gender roles, as well as artifactual-level explanations.

Concepts of Culture and Their Role in the Development of Culturally Competent Mental Health Services.

The purpose of this article is to review different ways that culture has been used in developing the notion of culturally competent mental health services and to provide an enhanced definition of culture through a critical review of these ideas. We discuss different dimensions of culture that emerge as important issues in the development of bilingual/bicultural psychiatric programs. We provide a multifaceted definition of the influences of culture on the assessment of clients in culturally competent mental health programs. We illustrate the issues raised in this review with case examples from an evaluation of three inpatient bilingual/bicultural psychiatric programs.

Toward a Puerto Rican Popular Nosology: Nervios and Ataque de Nervios

This paper is about naming illnesses—about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come from the responses to a series of open-ended questions which tapped into peoples general conceptions of nervios and ataques de nervios. These questions were incorporated into follow-up interviews to an epidemiological study of the mental health of adults in Puerto Rico. The results suggest ways to incorporate these different categories of nervios into future research and clinical work with different Latino groups in the United States and in their home countries.

Assessing Diversity among Latinos: Results from the NLAAS

This article provides a profile of a range of important variables for assessing diversity among different Latino groups from the National Latino and Asian American Study (NLAAS). The NLAAS is a nationally representative study of the mental health needs and mental health services use of the Latino population of the United States. The NLAAS employs a stratified area probability sampling design. There are 2,554 respondents in the Latino portion of the NLAAS. The article demonstrates through a detailed presentation of a wide range of variables the diverse experiences of Latino groups in their encounters with U.S. culture. Language use and migration experiences show considerable variability within and across Latino groups and are promising areas for analysis of their mental health consequences.

“It’s Like Going through an Earthquake”: Anthropological Perspectives on Depression among Latino Immigrants

Depression is one of the most prevalent mental illnesses in the community and is responsible for a significant amount of disability. According to epidemiological and primary care studies, Latinos suffer from depression at high rates. This paper examines in depth Latinos’ conceptions of depression and their attitudes towards and expectations of mental health treatment. The aim of this paper is to summarize several qualitative studies examining Latinos’ cultural understandings of mental health in general and depression in particular, as well as to obtain information about the barriers to care that this community experienced. The results are a compilation of findings from four different research projects in New Jersey and New York that examined diverse Latinos’ conceptions of mental health, treatment and barriers to care.

Ataques de nervios in the Puerto Rican Diagnostic Interview Schedule: the impact of cultural categories on psychiatric epidemiology.

This paper examines the effect of the cultural category ataques de nervios on responses to the Puerto Rican Diagnostic Interview Schedule (DIS), a Spanish version of structured psychiatric diagnostic interview developed for the NIHM Epidemiologic Catchment Area study. An ataque de nervios scale was created from the Somatization items of the DIS to explore the effect of this culturally meaningful category of distress on responses to a standard psychiatric interview. Analysis of 1,513 cases from a representative sample of the island of Puerto Rico indicated that people reporting ataque symptoms fit the social characteristics described for ataques sufferers in the ethnographic literature. Qualitative data indicated that Puerto Ricans were reporting ataques de nervios in the panic section of the DIS. Questions are raised about the validity of the somatization and panic sections of the DIS in cross-cultural research with Hispanics.