Transcript October 24, Ethnicity and mental illness

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
in Mexican Women and
Mexican-origin Women in U.S.
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
1
NESARC.
2
from M. Medina-Mora et al., in press.
Lifetime DSM-IV Rates (%) of Substance Disorders
in Mexican Men and Mexican-origin Men in U.S.
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
1
NESARC.
2
from M. Medina-Mora et al., in press.
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
OTHERS
BLACKS
ENTRY
LONG
WHITES
40
35
30
25
20
15
10
5
0
• 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