Self-reported psychiatric symptoms among black, Hispanic, and white outpatients

Consideration of Psychosocial Stress in the Treatment of the Latina Immigrant

Psychotherapeutic approaches aimed at the growing population of Latina immigrants are slow to develop. This paper reviews extant literature on the provision of mental health services to Latinas while at the same time proposing that mental health services incorporate a psychosocial component. Latina immigrants are faced with multiple pre-migration stressors including the loss of family and familiar surroundings, as well as post-migration stressors associated with culture change. These psychosocial stressors are addressed within the context of providing mental health services and case studies are used to highlight critical points. Mental health professionals are challenged by the multiple needs and various expectations presented by the Latina immigrant client and this paper hopes to provide baseline information on the psychosocial stressors, needs and expectations most often seen in treating these women.

Hispanic Mental Health Research: A Case for Cultural Psychiatry

Contemporary research involving Hispanic mental health is critically e-xamined. Selected problem areas that span a spectrum covering folk/traditional conceptualizations of mental illness, standardized concepts and methods employed in epidemiology, approaches to psychiatric diagnosis in biomedical settings, and more basic epistemological assumptions involving psychiatric nosology and theory receive systematic attention. The idea is developed that a dominating and exclusive "establishment psychiatry " stipulates concepts and methods of mental health research, thereby setting priorities and legitimating distinctive modes ofpractice and reimbursement for treatment. The need to challenge and broaden establishment psychiatry's paradigms and biases with insights and knowledge drawn from culturally sensitive Hispanic facts in contemporary mental health paradigms pertaining to psychiatric theory and practice is seen to contribute to a truly representative cultural psychiatry. These and related issues are analyzed using a framework that centers on mental health research but includes ideas from social medicine, political economy, and social evolution.

DSM-IV: Implications for Hispanic Children and Adolescents

Hispanic children and adolescents are a rapidly growing segment of the general population. The mental health needs of this group of youth are thought to be at least equal to the needs of nonminority children. Culturally appropriate diagnostic, treatment, and evaluation servicesfor this group of Hispanic youth are much needed so that ethical and appropriate mental health and educational services can be provided. This article provides an overview of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. Highlighted in this article is a discussion of the validity and reliability of the diagnostic categories included in the DSM-IV. An extensive review of the literature reveals few empirical studies related to the validity and reliability of the DSM when used with Hispanic children and adolescents. This review of the existing literature, as well as the clinical experiences of the authors, provide the basis for some general guidelines in the use of the DSM-IV such that diagnostic errors with Hispanic children and adolescents can be minimized.

Children's exposure to violence and distress symptoms: influence of caretakers' psychological functioning

BACKGROUND

Previous studies linking violence exposure to adverse child behavior have typically relied on parental report of child symptoms without accounting for the informant's mental well-being, despite evidence that parental mental health can influence children's mental health and the parent's report of distress symptoms.

PURPOSE

We assess the influence of maternal depression on the violence exposure and child distress association in a subset of the Maternal Infant Smoking Study of East Boston, a prospective birth cohort.

METHODS

Mothers reported on their children's violence exposure using the Survey of Children's Exposure to Community Violence (ETV) and completed the Checklist of Child Distress Symptoms (CCDS). The children also completed the ETV survey and the self-report version of the CCDS. Linear regression was used to assess the influence of violence exposure on distress symptoms adjusting for potential confounders, first using parent's report of exposure and outcome and a second time using the child's self-report. The mediating effect of maternal depression on the violence and distress association was also tested.

RESULTS

Among the 162 children ages 7 to 11, 51% were boys and 43% self-identified as Hispanic. When using child self-report, increased violence exposure was significantly associated with a broader range of distress symptoms (numbness, arousal, intrusion, avoidance subscales) compared to parent reported findings, which were only significantly related to the intrusion and avoidance subscales. Moreover, a significant mediation effect of maternal depression on the violence and distress association was noted only when mother's report of exposure and outcome was used.

CONCLUSION

Considering both parent and child self-report of violence is necessary to obtain a complete picture of violence exposure because parents and children may be offering different, although equally valid information. The influence of maternal depressive symptoms on preadolescent's distress symptoms may be attributed to reporting bias as opposed to more direct effects; thus, the parent's psychological functioning should be taken into consideration when relying on parental report of the child's psychological functioning.

Creation of a community violence exposure scale: accounting for what, who, where, and how often

Previous research has used the Rasch model, a method for obtaining a continuous scale from dichotomous survey items measuring a single latent construct, to create a scale of community violence exposure. The authors build upon previous work and describe the application of a Rasch model using the continuation ratio model to create an exposure to community violence (ETV) scale including event circumstance information previously shown to modify the impact of experienced events. They compare the Rasch ETV scale to a simpler sum ETV score, and estimate the effect of ETV on child posttraumatic stress symptoms. Incorporating detailed event circumstance information that is grounded in traumatic stress theory may reduce measurement error in the assessment of children's community violence exposure.

Witnessing community violence in residential neighborhoods: a mental health hazard for urban women

We examined the prevalence and psychological correlates of witnessing community violence among women of low socioeconomic status living in urban neighborhoods in the northeastern United States. Three hundred eighty-six women receiving their health care at an urban community health center were sampled to assess their violence exposures. Women were asked to report the location and timing of their exposure to witnessing violent neighborhood events in which they were not participants. The Brief Symptoms Inventory was used to assess anxiety and depressive symptoms. Controlling for marital status, educational attainment, age, and intimate partner violence victimization, women who witnessed violent acts in their neighborhoods were twice as likely to experience depressive and anxiety symptoms compared to women who did not witness community violence. Central American-born women had particularly high exposures. We conclude that witnessing neighborhood violence is a pervasive experience in this urban cohort, and is associated with anxiety and depressive symptoms, even among women who are not direct participants in violence to which they are exposed. Community violence interventions must incorporate efforts to protect the mental health of adult women who witness events in their neighborhoods.

Ethnic differences in clinical presentation of depression in adult women

This study examined ethnic differences in self-report and interviewer-rated depressive symptoms and estimated the contributions of sociodemographic and psychosocial factors in predicting severity of depression. One hundred twenty-five clinically depressed African American (n = 46), Caucasian (n = 36), and Latina (n = 43) women were recruited. After controlling for differences in socioeconomic status, African American women reported more symptoms of distress and Latinas were rated as significantly more depressed than the other groups. However, these ethnic differences were not moderated by either education or employment. Finally, hierarchical regression analysis indicated that severity of depression was predicted by low education, being single, being Latina, high perceived stress, and feelings of hopelessness. Additional research is needed to validate these results and to investigate their clinical significance.

Using the brief symptom inventory to profile monolingual Spanish-speaking psychiatric outpatients

As part of a larger study (Acosta, Evans, Hurwicz, & Yamamoto, 1987), a translated version of the Brief Symptom Inventory (BSI) was given to 153 monolingual Spanish-speaking psychiatric outpatients in the Los Angeles area. The raw mean scores on the nine primary symptom dimensions and the Global Severity Index (GSI) of the Spanish-speaking population were compared with the published raw mean scores of a normative sample of English-speaking psychiatric outpatients. Results suggested that the Spanish-speaking population had higher symptom levels on several dimensions and the GSI. It was suggested that the BSI could be a potentially useful instrument for self-reported psychiatric symptomatology among the Spanish-speaking population if an appropriate translation of the BSI were used.

Community mental health and ethnic minority populations

National trends in minority utilization of mental health services are reviewed, and recommendations are made for needed research. In relation to their representation in the population, blacks use services more than expected, and Asian American/Pacific Islanders use services less; Hispanics and Native American/Alaska Islander use varies according to type of service. Hospitalization accounts for part of the increase in minority utilization; this trend is problematic. Disruptions in service continue to plaque minority clients, possibly stemming from inadequacies in the organization and financing of care, and from cultural incongruity. Much more must be learned about these problems in utilization, as well as about other key issues.