Steven R. López

The Study of Culture, Ethnicity, and Race in American Psychology

The study of culture and related concepts, such as ethnicityand race, in American psychology are examined in thisarticle. First, the conceptual confusion and ways in whichculture, ethnicity, and race are used as explanatory factorsfor intergroup differences in psychological phenomena arediscussed. Second, ways in which to study culture inmainstream psychology and to enhance hypothesis testingand theory in cross-cultural psychology are illustrated. Fi-nally, the importance of examining sociocultural variablesand considering theory in ethnic minority research is ad-dressed. In general, it is proposed that by including theory,conceptualizing, and measuring cultural and related vari-ables, mainstream, cross-cultural, and ethnic research canadvance the understanding of culture in psychology as wellas the generality of principles and the cultural sensitivityof applications.

Priority issues in Latino mental health services research.

This paper identifies issues and trends affecting the quality and comprehensiveness of Latino mental health research and services. These issues include current patterns of need and services use, rapid expansion of the Latino population, extraordinary rates of uninsured, social and language barriers to care, transformation in treatment science and technology, and the sheer complexity and rapid changes in the delivery system. Progress in the field requires coordination and investments from both public and private sectors. Scientific journals should provide assistance for creating a high quality knowledge base and rapidly disseminating this information to students, practitioners, and policy makers. Vigorous activity is needed to (1) augment the supply of people entering the “pipeline” for researcher and practitioner training, and (2) support research in priority areas such as outcome studies for diverse treatments and different sectors of care, cultural competence, treatment models for youth and aging populations, quality of care, and barriers to mental health care.

Patient Variable Biases in Clinical Judgment: Conceptual Overview and Methodological Considerations

Specific conceptual factors are presented as having contributed to the negative findings of past psychotherapy bias research. Among these factors are the restrictive nature of both the definition of bias and the model of the biased clinician. A review of published studies of several patient variable biases (e.g., gender, race/ethnicity, and age) indicated that bias may best be defined in broader terms and that its occurrence may be more circumscribed than originally conceived. In addition, the lack of a theoretical perspective in this area of research is noted and the applicability of some social cognitive processes is discussed. Methodological factors are also considered, and recommendations for future research are offered.

Expressed emotion and schizophrenic outcome among Mexican-American families.

This study has demonstrated that among low-income, relatively unacculturated Mexican- American households, a high level of expressed emotion on the part of key relatives significantly increases the risk of relapse for remitted schizophrenics who return home to live with their families after hospital discharge. This cross-cultural replication of earlier research findings in London and southern California suggests that critical, hostile, or emotionally overinvolved attitudes and behaviors may be general major stressors that adversely influence the fragile adaptation of schizophrenic individuals in diverse cultural settings. The finding of a lower prevalence of high levels of expressed emotion among Mexican-American compared to Anglo-American and British households lends support to the hypothesis that intrafamilial behaviors may account for different schizophrenic outcomes in different cultures.

Ethnicity, Expressed Emotion, Attributions, and Course of Schizophrenia: Family Warmth Matters

The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.

An Attributional Analysis of Expressed Emotion in Mexican-American Families With Schizophrenia

In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients were measured on three dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, we found that high EE families (defined on the basis of critical comments) viewed the illness and associated symptoms as residing within the patients personal control, more so than did low EE families. We also found that attributions held by family members are related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patients personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research.

Contributions to Depression in Latina Mothers with and without Children with Retardation: Implications for Caregiving

Contributions to depression in 148 Latina mothers with and 101 without children with mental retardation were investigated. Depressive symptomatology was assessed using the Center for Epidemiologie Studies-Depression scale (CES-D) (Radloff, 1977). Depression was elevated in both Latina samples relative to a normative group. Furthermore, Latina mothers who had children with mental retardation showed significantly higher levels of depressive symptomatology relative to controls. Depression was predicted by low family cohesion, poor health of the mother, absence of spouse or partner, less use of passive appraisal as a coping strategy, and presence of a child with mental retardation.

Culture, Context, and the Internalizing Distress of Mexican American Youth

Latino youth appear to be at higher risk for depression relative to youth from other ethnic groups. This study assessed the relationship between nativity and several forms of internalizing distress among Mexican American middle school students as well as sociocultural factors that may help explain this relationship. Immigrant Mexican American youth (n = 78) reported significantly higher social anxiety and loneliness than U.S.-born Mexican American youth (n = 83). Acculturation stress and English proficiency were identified as significant mediators of these nativity differences. Although internalizing problems and depression symptoms did not vary across nativity groups, both were related to lower affiliative obedience. The findings point to cultural socialization values and contextual influences as important variables in the mental health of youth in immigrant families.

CULTURAL COMPETENCE AND PSYCHOTHERAPY: APPLYING ANTHROPOLOGICALLY INFORMED CONCEPTIONS OF CULTURE

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinmans (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlors (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

From documenting to eliminating disparities in mental health care for Latinos.

The U.S. Surgeon Generals report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update that report by reviewing five groundbreaking research projects on the mental health of Latinos that were published since 2001. National studies of adults and children, longitudinal designs, and analyses of Latino subgroups characterize these investigations. Despite the increasing sophistication of disparities research, these landmark studies, as well as the research in the supplemental report, can be characterized as documenting disparities in care. We argue that the next wave of research should give greater attention to reducing and eliminating disparities. Accordingly, we apply Rogler and Cortess (1993) framework of pathways to care to the study of Latinos with schizophrenia. Specifically, we draw on research regarding the recognition of illness, social networks (families) and their association with the course of illness, and interventions. We illustrate examples at each pathway that have the potential to reduce disparities. We argue that implementing interventions synchronously across multiple pathways has considerable potential to reduce and eventually eliminate disparities in mental health care.