ethnicity ethnicity = social groups that distinguish themselves from other groups based on shared...
Post on 21-Dec-2015
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ETHNICITY
• ETHNICITY = SOCIAL GROUPS THAT DISTINGUISH THEMSELVES FROM OTHER GROUPS BASED ON SHARED DESCENT, CULTURE, AND IDENTITY
• VARIES IN IMPORTANCE BY INDIVIDUALS AND GROUPS
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RECENT INTEREST
• IMMIGRATION – 10% of all US residents
• DIVERSITY OF CULTURES
• MULTICULTURALISM
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PROBLEMS IN STUDYING ETHNICITY
• COMPLEXITY OF ETHNIC GROUPS
• HOW TO SEPARATE ETHNIC CULTURE FROM OTHER FACTORS
• SOCIAL CLASS, AGE, ACCULTURATION, ETC.
• CULTURALLY INSENSITIVE INSTRUMENTS
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4 WAYS ETHNICITY AFFECTS MENTAL ILLNESS
• RATES OF MENTAL ILLNESS
• EXPRESSION OF MENTAL ILLNESS
• RESPONSE TO MENTAL ILLNESS
• COURSE OF MENTAL ILLNESS
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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
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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
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HISPANICS
• HISPANICS TOTALLY INCONSISTENT - SOMETIMES HIGHER, SOMETIMES LOWER
• LATINO PARADOX
• LOW RATES OF M.I. AMONG IMMIGRANTS
• HIGH RATES IN 2ND GENERATION
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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
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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
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OTHER GROUPS
• ASIANS - LOW RATES
• DIFFERENT EXPRESSIONS?
• NATIVE AMERICANS - MUCH HIGHER RATES
• ALCOHOLISM, DEPRESSION, SUICIDE
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CONCLUSIONS
• RATES VARY TREMENDOUSLY CROSS-CULTURALLY
• NOT VERY CONSISTENT FINDINGS WITHIN U.S.
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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
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EXPRESSIONS
• WESTERN CULTURES = PSYCHOLOGICAL EXPRESSIONS
• NON-WESTERN CULTURES = PHYSIOLOGICAL EXPRESSIONS
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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
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IMPLICATIONS
• CLINICIANS SHOULD BE SENSITIVE TO CULTURAL NATURE OF SYMPTOMS
• OUR MENTAL ILLNESSES - DEPRESSION, EATING DISORDERS, ETC. ARE “CULTURE BOUND” TOO
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PSYCHOTHERAPY
05
10
15
20
25
30
35
40
WH
ITE
S
BL
AC
KS
OT
HE
RS
ENTRYLONG
• WHITES FAR MORE LIKELY TO BE IN P.T.
• EVEN MORE LIKELY TO STAY IN P.T.
• BLACKS ESPECIALLY UNLIKELY
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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
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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
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COSTS AND BENEFITS
• MEXICANS• DELAYED
TREATMENT• MORE SEVERITY• LESS
COMMUNICATION• MORE FAMILY
SUPPORT
• WHITES• QUICKER
TREATMENT• LESS SEVERITY• MORE
COMMUNICATION• LESS FAMILY
SUPPORT
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FAMILY SUPPORT
• MANY ETHNIC GROUPS
• GREATER SENSE OF FAMILY OBLIGATION AND LESS INDIVIDUALISM
• LESS ADEQUATE PROFESSIONAL TREATMENT
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WHO STUDIES OF SCHIZOPHRENIA
• NINE COUNTRIES (1970’S)
• FIVE “DEVELOPED” - DENMARK, ENGLAND, U.S., RUSSIA, CZECHOSLAVAKIA
• FOUR “DEVELOPING” - COLUMBIA, TAIWAN, INDIA, NIGERIA
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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
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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
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REASONS
• FEWER EXPECTATIONS FOR ACHIEVEMENT IN DEVELOPING SO LESS DISAPPOINTMENT
• SOCIAL EXPECTATIONS FOR CHRONICITY IN DEVELOPED
• LESS STIGMA IN DEVELOPING
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SUMMARY
• FEW CONCLUSIONS FOR RATES
• CULTURE AFFECTS WAY PEOPLE EXPRESS DISORDERS
• CULTURE AFFECTS DEFINITIONS, FAMILY RESPONSE, AND PROFESSIONAL HELP-SEEKING
• CULTURE AFFECTS COURSE
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IMPLICATIONS
• PROFESSIONALS SHOULD BE CULTURALLY SENSITIVE
• ETHNIC-SENSITIVE PROGRAMS TEND TO WORK BETTER
• PARTICULARLY IMPORTANT NOW WITH HIGH RATES OF IMMIGRATION