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ETHNICITY AND MENTAL ILLNESS

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

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ETHNICITY AND MENTAL ILLNESS

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  1. ETHNICITY AND MENTAL ILLNESS

  2. ETHNICITY • ETHNICITY = SOCIAL GROUPS THAT DISTINGUISH THEMSELVES FROM OTHER GROUPS BASED ON SHARED DESCENT, CULTURE, AND IDENTITY • VARIES IN IMPORTANCE BY INDIVIDUALS AND GROUPS

  3. RECENT INTEREST • IMMIGRATION – 10% of all US residents • DIVERSITY OF CULTURES • MULTICULTURALISM

  4. PROBLEMS IN STUDYING ETHNICITY • COMPLEXITY OF ETHNIC GROUPS • HOW TO SEPARATE ETHNIC CULTURE FROM OTHER FACTORS • SOCIAL CLASS, AGE, ACCULTURATION, ETC. • CULTURALLY INSENSITIVE INSTRUMENTS

  5. 4 WAYS ETHNICITY AFFECTS MENTAL ILLNESS • RATES OF MENTAL ILLNESS • EXPRESSION OF MENTAL ILLNESS • RESPONSE TO MENTAL ILLNESS • COURSE OF MENTAL ILLNESS

  6. RATES OF MENTAL ILLNESS

  7. 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

  8. U.S.

  9. 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

  10. HISPANICS • HISPANICS TOTALLY INCONSISTENT - SOMETIMES HIGHER, SOMETIMES LOWER • LATINO PARADOX • LOW RATES OF M.I. AMONG IMMIGRANTS • HIGH RATES IN 2ND GENERATION

  11. Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Women and Mexican-origin Women in U.S. 1 NESARC. 2 from M. Medina-Mora et al., in press.

  12. Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Men and Mexican-origin Men in U.S. 1 NESARC. 2 from M. Medina-Mora et al., in press.

  13. OTHER GROUPS • ASIANS - LOW RATES • DIFFERENT EXPRESSIONS? • NATIVE AMERICANS - MUCH HIGHER RATES • ALCOHOLISM, DEPRESSION, SUICIDE

  14. CONCLUSIONS • RATES VARY TREMENDOUSLY CROSS-CULTURALLY • NOT VERY CONSISTENT FINDINGS WITHIN U.S.

  15. EXPRESSION OF SYMPTOMS

  16. 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

  17. EXPRESSIONS • WESTERN CULTURES = PSYCHOLOGICAL EXPRESSIONS • NON-WESTERN CULTURES = PHYSIOLOGICAL EXPRESSIONS

  18. 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

  19. IMPLICATIONS • CLINICIANS SHOULD BE SENSITIVE TO CULTURAL NATURE OF SYMPTOMS • OUR MENTAL ILLNESSES - DEPRESSION, EATING DISORDERS, ETC. ARE “CULTURE BOUND” TOO

  20. SOCIAL RESPONSES

  21. PSYCHOTHERAPY • WHITES FAR MORE LIKELY TO BE IN P.T. • EVEN MORE LIKELY TO STAY IN P.T. • BLACKS ESPECIALLY UNLIKELY

  22. 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

  23. 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 RESPONSE TO SCHIZOPHRENIA IN L.A.

  24. MEXICANS DELAYED TREATMENT MORE SEVERITY LESS COMMUNICATION MORE FAMILY SUPPORT WHITES QUICKER TREATMENT LESS SEVERITY MORE COMMUNICATION LESS FAMILY SUPPORT COSTS AND BENEFITS

  25. FAMILY SUPPORT • MANY ETHNIC GROUPS • GREATER SENSE OF FAMILY OBLIGATION AND LESS INDIVIDUALISM • LESS ADEQUATE PROFESSIONAL TREATMENT

  26. COURSE OF MENTAL ILLNESS

  27. WHO STUDIES OF SCHIZOPHRENIA • NINE COUNTRIES (1970’S) • FIVE “DEVELOPED” - DENMARK, ENGLAND, U.S., RUSSIA, CZECHOSLAVAKIA • FOUR “DEVELOPING” - COLUMBIA, TAIWAN, INDIA, NIGERIA

  28. 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 DEVELOPINGSOCIETIES

  29. 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

  30. REASONS • FEWER EXPECTATIONS FOR ACHIEVEMENT IN DEVELOPING SO LESS DISAPPOINTMENT • SOCIAL EXPECTATIONS FOR CHRONICITY IN DEVELOPED • LESS STIGMA IN DEVELOPING

  31. SUMMARY • FEW CONCLUSIONS FOR RATES • CULTURE AFFECTS WAY PEOPLE EXPRESS DISORDERS • CULTURE AFFECTS DEFINITIONS, FAMILY RESPONSE, AND PROFESSIONAL HELP-SEEKING • CULTURE AFFECTS COURSE

  32. IMPLICATIONS • PROFESSIONALS SHOULD BE CULTURALLY SENSITIVE • ETHNIC-SENSITIVE PROGRAMS TEND TO WORK BETTER • PARTICULARLY IMPORTANT NOW WITH HIGH RATES OF IMMIGRATION

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