ETHNICITY

• ETHNICITY = SOCIAL GROUPS THAT DISTINGUISH THEMSELVES FROM OTHER GROUPS BASED ON SHARED DESCENT, CULTURE, AND IDENTITY

• VARIES IN IMPORTANCE BY INDIVIDUALS AND GROUPS

RECENT INTEREST

• IMMIGRATION – 10% of all US residents

• DIVERSITY OF CULTURES

• MULTICULTURALISM

PROBLEMS IN STUDYING ETHNICITY

• COMPLEXITY OF ETHNIC GROUPS

• HOW TO SEPARATE ETHNIC CULTURE FROM OTHER FACTORS

• SOCIAL CLASS, AGE, ACCULTURATION, ETC.

• CULTURALLY INSENSITIVE INSTRUMENTS

4 WAYS ETHNICITY AFFECTS MENTAL ILLNESS

• RATES OF MENTAL ILLNESS

• EXPRESSION OF MENTAL ILLNESS

• RESPONSE TO MENTAL ILLNESS

• COURSE OF MENTAL ILLNESS

RATES VARY AROUND THE WORLD

• SCHIZOPHRENIA AND BIPOLAR FAIRLY CONSTANT

• DEPRESSION FROM 2.4% IN RURAL SPAIN TO 30% IN AFRICAN CITIES

• PHOBIAS FROM 2% IN PUERTO RICO TO 20% IN SWITZERLAND

• ALCOHOLISM FROM 1% IN CHINA TO 23% AMONG NATIVE AMERICANS

AFRICAN AMERICANS

• BLACKS HIGHER MORTALITY AND MORBIDITY

• BLACKS HAVE SURPRISINGLY LOW RATES OF M.I.

• EXCEPTION - ANXIETY DISORDERS (PHOBIAS)

• PERHAPS BETTER COPING ABILITIES - SOCIAL SUPPORT, RELIGION

HISPANICS

• HISPANICS TOTALLY INCONSISTENT - SOMETIMES HIGHER, SOMETIMES LOWER

• LATINO PARADOX

• LOW RATES OF M.I. AMONG IMMIGRANTS

• HIGH RATES IN 2ND GENERATION

Lifetime DSM-IV Rates (%) of Substance Disorders Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Women and in Mexican Women and

Mexican-origin Women in U.S.Mexican-origin Women in U.S.

1 NESARC. 2 from M. Medina-Mora et al., in press.

U.S.1

Mexico2 Immigrants U.S. born

Alcohol abuse 0.4 1.0 8.7

Alcohol dependence 0.5 1.7 11.0

Drug abuse 0.0 0.6 5.2

Drug dependence 0.1 0.3 3.2

Lifetime DSM-IV Rates (%) of Substance Disorders Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Men and Mexican-origin Men in U.S.in Mexican Men and Mexican-origin Men in U.S.

1 NESARC. 2 from M. Medina-Mora et al., in press.

U.S.1

Mexico2 Immigrants U.S. born

Alcohol abuse 4.9 15.4 25.2

Alcohol dependence 8.8 9.6 19.4

Drug abuse 2.3 1.8 12.0

Drug dependence 0.7 0.5 4.5

OTHER GROUPS

• ASIANS - LOW RATES

• DIFFERENT EXPRESSIONS?

• NATIVE AMERICANS - MUCH HIGHER RATES

• ALCOHOLISM, DEPRESSION, SUICIDE

CONCLUSIONS

• RATES VARY TREMENDOUSLY CROSS-CULTURALLY

• NOT VERY CONSISTENT FINDINGS WITHIN U.S.

GROUPS HAVE DIFFERENT ILLNESS VOCABULARIES

• “STRUCTURING” - GENERAL SENSATIONS BECOME PARTICULAR ENTITIES

• E.G. DEPRESSION -

• SOME: PSYCHOLOGICAL - SADNESS, HOPELESSNESS, LOW SELF ESTEEM

• OTHERS: PHYSICAL -FATIGUE, ACHES, LOSE APPETITE, NOT PSYCH

EXPRESSIONS

• WESTERN CULTURES = PSYCHOLOGICAL EXPRESSIONS

• NON-WESTERN CULTURES = PHYSIOLOGICAL EXPRESSIONS

IMMIGRANTS

• COMPARE SYMPTOMS OF NEW AND LONG-TERM IMMIGRANTS

• STUDY OF CHINESE-AMERICANS

• NEW IMMIGRANTS SHOW MORE PHYSICAL SYMPTOMS

• LONG-TERM IMMIGRANTS SHOW MORE PSYCHOLOGICAL SYMPTOMS

• ASSIMILATION CHANGES SYMPTOMS

IMPLICATIONS

• CLINICIANS SHOULD BE SENSITIVE TO CULTURAL NATURE OF SYMPTOMS

• OUR MENTAL ILLNESSES - DEPRESSION, EATING DISORDERS, ETC. ARE “CULTURE BOUND” TOO

PSYCHOTHERAPY

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• WHITES FAR MORE LIKELY TO BE IN P.T.

• EVEN MORE LIKELY TO STAY IN P.T.

• BLACKS ESPECIALLY UNLIKELY

REASONS FOR ETHNIC DIFFERENCES

• DEFINITIONS OF M.I.

• USE OF INFORMAL OR FORMAL RESOURCES

• TRUST IN MENTAL HEALTH PROFS

• RESPONSE OF MENTAL HEALTH SYSTEM

• USE OF MEDICATION

RESPONSE TO SCHIZOPHRENIA IN L.A.

• MEXICANS• DEFINE AS

“NERVIOS”• KEEP IN FAMILY• GAP IN

COMMUNICATION WITH M.H.P.

• ANGLOS• DEFINE AS

PSYCHOSES• BRING TO M.H.P.• SHARED

DEFINITIONS OF PROBLEM

COSTS AND BENEFITS

• MEXICANS• DELAYED

TREATMENT• MORE SEVERITY• LESS

COMMUNICATION• MORE FAMILY

SUPPORT

• WHITES• QUICKER

TREATMENT• LESS SEVERITY• MORE

COMMUNICATION• LESS FAMILY

SUPPORT

FAMILY SUPPORT

• MANY ETHNIC GROUPS

• GREATER SENSE OF FAMILY OBLIGATION AND LESS INDIVIDUALISM

• LESS ADEQUATE PROFESSIONAL TREATMENT

WHO STUDIES OF SCHIZOPHRENIA

• NINE COUNTRIES (1970’S)

• FIVE “DEVELOPED” - DENMARK, ENGLAND, U.S., RUSSIA, CZECHOSLAVAKIA

• FOUR “DEVELOPING” - COLUMBIA, TAIWAN, INDIA, NIGERIA

FINDINGS OF WHO

• COULD DIAGNOSE SAME SYMPTOMS OF SCHIZ IN ALL SOCIETIES

• COMPARABLE RATES (1%) OF SCHIZ. IN ALL SOCIETIES

• TWO YEAR FOLLOW UP

• SHOWS MUCH BETTER RESULTS IN DEVELOPING SOCIETIES

WHO FINDINGS

• ABOUT HALF OF SCHIZ IMPROVE IN DEVELOPING SOCIETIES, LESS THAN 1/3 IN DEVELOPED

• SO SURPRISED DID ANOTHER STUDY AND FOUND SAME THING

REASONS

• FEWER EXPECTATIONS FOR ACHIEVEMENT IN DEVELOPING SO LESS DISAPPOINTMENT

• SOCIAL EXPECTATIONS FOR CHRONICITY IN DEVELOPED

• LESS STIGMA IN DEVELOPING

SUMMARY

• FEW CONCLUSIONS FOR RATES

• CULTURE AFFECTS WAY PEOPLE EXPRESS DISORDERS

• CULTURE AFFECTS DEFINITIONS, FAMILY RESPONSE, AND PROFESSIONAL HELP-SEEKING

• CULTURE AFFECTS COURSE

IMPLICATIONS

• PROFESSIONALS SHOULD BE CULTURALLY SENSITIVE

• ETHNIC-SENSITIVE PROGRAMS TEND TO WORK BETTER

• PARTICULARLY IMPORTANT NOW WITH HIGH RATES OF IMMIGRATION