Pathways and correlates connecting Latinos' mental health with exposure to the United States

Gender differences in the relationship between discrimination and substance use disorder among Latinos

Using data from the National Latino and Asian American Study collected in 2002-2003 (N = 2,554), we assessed the adjusted odds of lifetime substance use disorder (SUD) associated with report of both unfair treatment and racial/ethnic discrimination. Among men, SUD was increased for those reporting low, moderate, and high levels of unfair treatment compared to those reporting no unfair treatment and patterns were similar for racial/ethnic discrimination. Among women, only those reporting high levels of unfair treatment were at increased risk of lifetime SUD and no associations were observed between racial/ethnic discrimination and lifetime SUD. Future research should examine the role that discrimination plays in the development of substance misuse among Latinos.

Self-reported discrimination and health-related quality of life among Whites, Blacks, Mexicans and Central Americans

This study investigates whether self-reported racial discrimination is related to poor health-related quality of life (HRQoL). Analyses focused on Whites (n = 52,571), Blacks (n = 4,343), Mexicans (n = 12,336), Central Americans (n = 1,504), Multi-ethnic Latinos (n = 1,102), and Other Latinos (n = 1,828) who participated in the 2003 and 2005 California Health Interview survey. Logistic and negative binomial regression was used to examine the association between HRQoL (assessed with the CDC unhealthy days measures) and self-reported racial discrimination. Discrimination was reported by 10% of Whites, 57% of Blacks, and 24-31% of the Latino groups. These reports were associated with increased number of unhealthy days, disability days, and poor self-rated health, even after, controlling for education and other factors. This association did not consistently vary by race/ethnicity. Racial discrimination may be a risk factor for poor HRQoL among diverse groups. Future research should examine the factors that may reduce potential exposure to racial discrimination.

Decomposing associations between acculturation and drinking in Mexican Americans

BACKGROUND

Acculturation to life in the United States is a known predictor of Hispanic drinking behavior. We compare the ability of 2 theoretical models of this effect-sociocultural theory and general stress theory-to account for associations between acculturation and drinking in a sample of Mexican Americans. Limitations of previous evaluations of these theoretical models are addressed using a broader range of hypothesized cognitive mediators and a more direct measure of acculturative stress. In addition, we explore nonlinearities as possible underpinnings of attenuated acculturation effects among men.

METHODS

Respondents (N = 2,595, current drinker N = 1,351) were interviewed as part of 2 recent multistage probability samples in a study of drinking behavior among Mexican Americans in the United States. The ability of norms, drinking motives, alcohol expectancies, and acculturation stress to account for relations between acculturation and drinking outcomes (volume and heavy drinking days) were assessed with a hierarchical linear regression strategy. Nonlinear trends were assessed by modeling quadratic effects of acculturation and acculturation stress on cognitive mediators and drinking outcomes.

RESULTS

Consistent with previous findings, acculturation effects on drinking outcomes were stronger for women than men. Among women, only drinking motives explained acculturation associations with volume or heavy drinking days. Among men, acculturation was linked to increases in norms, and norms were positive predictors of drinking outcomes. However, adjusted effects of acculturation were nonexistent or trending in a negative direction, which counteracted this indirect normative influence. Acculturation stress did not explain the positive associations between acculturation and drinking.

CONCLUSIONS

Stress and alcohol outcome expectancies play little role in the positive linear association between acculturation and drinking outcomes, but drinking motives appear to at least partially account for this effect. Consistent with recent reports, these results challenge stress models of linear acculturation effects on drinking outcomes and provide (partial) support for sociocultural models. Inconsistent mediation patterns-rather than nonlinearities-represented a more plausible statistical description of why acculturation-drinking associations are weakened among men.

Measuring racial/ethnic disparities in health care: methods and practical issues

OBJECTIVE

To review methods of measuring racial/ethnic health care disparities.

STUDY DESIGN

Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. EMPIRICAL APPLICATION: We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004-2008 Medical Expenditure Panel Survey.

CONCLUSION

Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition.

Acculturation, enculturation, and symptoms of depression in Hispanic youth: the roles of gender, Hispanic cultural values, and family functioning

The risk for depression increases as Hispanic youth acculturate to U.S. society. This association is stronger for Hispanic girls than boys. To better understand the influence of culture and family on depressive symptoms, we tested a process-oriented model of acculturation, cultural values, and family functioning. The data came from Project RED, which included 1,922 Hispanic students (53 % girls; 86 % were 14 years old; and 84 % were U.S. born) from Southern California. We used data from 9th to 11th grade to test the influence of acculturation-related experiences on depressive symptoms over time. Multi-group structural equation analysis suggested that both family conflict and cohesion were linked with depressive symptoms. Hispanic cultural values were associated with family cohesion and conflict but the strength and direction of these relationships varied across cultural values and gender. For girls and boys, familismo and respeto were associated with higher family cohesion and lower family conflict. Moreover, gender roles were linked with higher family cohesion in girls but not in boys. These results indicate that improving family functioning will be beneficial for boys' and girls' psychological well-being. This may be achieved by promoting familismo and respeto for boys and girls and by promoting traditional gender roles for girls.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan

OBJECTIVE

This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale.

DESIGN

An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity.

RESULTS

The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity.

CONCLUSIONS

The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

More than culture: structural racism, intersectionality theory, and immigrant health

Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics' main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health.

Change in binge eating and binge eating disorder associated with migration from Mexico to the U.S

Exposure to Western popular culture is hypothesized to increase risk for eating disorders. This study tests this hypothesis with respect to the proposed diagnosis of binge eating disorder (BED) in an epidemiological sample of people of Mexican origin in Mexico and the U.S. Data come from the Mexico National Comorbidity Survey, National Comorbidity Survey Replication, and National Latino and Asian American Survey (N = 2268). Diagnoses were assessed with the WMH-CIDI. Six groups were compared: Mexicans with no migrant family members, Mexicans with at least one migrant family member, Mexican return-migrants, Mexican-born migrants in the U.S., and two successive generations of Mexican-Americans in the U.S. The lifetime prevalence of BED was 1.6% in Mexico and 2.2% among Mexican-Americans. Compared with Mexicans in families with migrants, risk for BED was higher in US-born Mexican-Americans with two U.S.-born parents (aHR = 2.58, 95% CI 1.12-5.93). This effect was attenuated by 24% (aHR = 1.97, 95% CI 0.84-4.62) with adjustment for prior-onset depressive or anxiety disorder. Adjustment for prior-onset conduct disorder increased the magnitude of association (aHR = 2.75, 95% CI 1.22-6.20). A similar pattern was observed for binge eating. Among respondents reporting binge eating, onset in the U.S. (vs. Mexico) was not associated with prevalence of further eating disorder symptoms. Migration from Mexico to the U.S. is associated with an increased risk for BED that may be partially attributable to non-specific influences on internalizing disorders. Among respondents reporting binge eating in either country, similar levels of further symptoms were endorsed, suggesting some cross-cultural generalizability of criteria.

Discrimination, acculturation, acculturative stress, and Latino psychological distress: a moderated mediational model

Prior research has found that perceived discrimination is associated with adverse mental health outcomes among Latinos. However, the process by which this relationship occurs remains an understudied area. The present study investigated the role of acculturative stress in underlying the relationship between perceived discrimination and Latino psychological distress. Also examined was the ability of acculturation to serve as a moderator between perceived discrimination and acculturative stress. Among a sample of Latino adults (N = 669), moderated mediational analyses revealed that acculturative stress mediated the perceived discrimination-psychological distress relationship, and that the link between perceived discrimination and acculturative stress was moderated by Anglo behavioral orientation but not Latino behavioral orientation. The findings are discussed within a stress and coping perspective that identifies the psychological consequences associated with perceived discrimination and acculturative stress.

Migration from Mexico to the United States and conduct disorder: a cross-national study

CONTEXT

Twin studies suggest that conduct disorder (CD) is under substantial genetic influence, which is stronger for aggressive than for nonaggressive symptoms. Studies of migrating populations offer an alternative strategy for separating environmental and genetic influences on psychiatric disorders.

OBJECTIVES

To examine variation in the prevalence of CD associated with migration from Mexico to the United States and to determine whether this variation is similar for aggressive and nonaggressive CD symptoms and symptom profiles.

DESIGN

The prevalences of CD, different types of CD symptoms, and CD symptom profiles were compared across 3 generations of people of Mexican origin with increasing levels of exposure to American culture: families of origin of migrants (residing in Mexico), children of Mexican migrants raised in the United States, and Mexican-American children of US-born parents.

SETTING

General population surveys conducted in Mexico and the United States using the same diagnostic interview.

PARTICIPANTS

Adults aged 18 to 44 years in the household population of Mexico and the household population of people of Mexican descent in the United States.

MAIN OUTCOME MEASURES

Conduct disorder criteria, assessed using the World Mental Health version of the Composite International Diagnostic Interview.

RESULTS

Compared with the risk in families of origin of migrants, risk of CD was lower in the general population of Mexico (odds ratio [OR], 0.54; 95% CI, 0.19-1.51), higher in children of Mexican-born immigrants who were raised in the United States (OR, 4.12; 95% CI, 1.47-11.52), and higher still in Mexican-American children of US-born parents (OR, 7.64; 95% CI, 3.20-18.27). The association with migration was markedly weaker for aggressive than for nonaggressive symptoms.

CONCLUSIONS

The prevalence of CD increases dramatically across generations of the Mexican-origin population after migration to the United States. This increase is of larger magnitude for nonaggressive than for aggressive symptoms, consistent with the suggestion that nonaggressive symptoms are more strongly influenced by environmental factors than are aggressive symptoms.

Hopefulness among non-U.S.-born Latino youth and young adults

PROBLEM

U.S. Latino youths experience disproportionately high rates of health and social problems. There is a need to identify protective factors for reducing risky behaviors. Little is known about the protective nature of hope among immigrant Latino adolescents.

METHODS

This descriptive cross-sectional study examined hope and expectations for the future in non-U.S.-born Latino adolescents and young adults (n= 98) in urban and rural areas in the midwestern United States.

FINDINGS

Participants reported feeling hopeful about their future; however, differences were detected among subgroups.

CONCLUSION

Findings affirm the potential of hope as a protective factor for immigrant Latino adolescents and young adults. Nurses should be aware of hopefulness when implementing mental health preventive interventions. Research is needed to identify effective mechanisms for promoting and sustaining hope.

Acculturation, gender, depression, and cigarette smoking among U.S. Hispanic youth: the mediating role of perceived discrimination

Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th-11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth's mental health and substance use behaviors.

The influence of immigrant status and concentration on psychiatric disorder in Canada: a multi-level analysis

BACKGROUND

Many studies have reported an increased incidence of psychiatric disorder (particularly psychotic disorders) among first generation adult immigrants, along with an increasing risk for ethnic minorities living in low-minority concentration neighborhoods. These studies have depended mostly on European case-based databases. In contrast, North American studies have suggested a lower risk for psychiatric disorder in immigrants, although the effect of neighborhood immigrant concentration has not been studied extensively.

METHOD

Using multi-level modeling to disaggregate individual from area-level influences, this study examines the influence of first generation immigrant status at the individual level, immigrant concentration at the neighborhood-level and their combined effect on 12-month prevalence of mood, anxiety and substance-dependence disorders and lifetime prevalence of psychotic disorder, among Canadians.

RESULTS

Individual-level data came from the Canadian Community Health Survey (CCHS) 1.2, a cross-sectional study of psychiatric disorder among Canadians over the age of 15 years; the sample for analysis was n=35,708. The CCHS data were linked with neighborhood-level data from the Canadian Census 2001 for multi-level logistic regression. Immigrant status was associated with a lower prevalence of psychiatric disorder, with an added protective effect for immigrants living in neighborhoods with higher immigrant concentrations. Immigrant concentration was not associated with elevated prevalence of psychiatric disorder among non-immigrants.

CONCLUSIONS

The finding of lower 12-month prevalence of psychiatric disorder in Canadian immigrants, with further lessening as the neighborhood immigrant concentration increases, reflects a model of person-environment fit, highlighting the importance of studying individual risk factors within environmental contexts.

Common mental health problems in immigrants and refugees: general approach in primary care

BACKGROUND

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.

METHODS

We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.

RESULTS

The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.

INTERPRETATION

Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

Common mental health problems in immigrants and refugees: general approach in primary care

BACKGROUND

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.

METHODS

We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.

RESULTS

The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.

INTERPRETATION

Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

Functional impairment in adults with past posttraumatic stress disorder: findings from primary care

BACKGROUND

Although many patients with posttraumatic stress disorder (PTSD) experience a reduction in posttraumatic symptoms over time, little is currently known about the extent of their residual functional impairment. This study examines functional impairment in primary care patients with a history of PTSD as compared to patients with current PTSD, and those who never developed PTSD following exposure to trauma.

METHODS

The sample consisted of 321 trauma-exposed low-income, predominantly Hispanic adults attending a large urban primary care practice. PTSD was assessed with the Lifetime Composite International Diagnostic Interview and other psychiatric disorders with the SCID-I. Physical and mental health-related quality of life was assessed with the Medical Outcome Health Survey (SF-12), and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report.

RESULTS

Logistic regression analyses controlling for gender, psychiatric comorbidity, and interpersonal traumas showed that although patients with past PTSD function significantly better than patients with current PTSD, they experience persisting deficits in mental health-related quality of life compared to trauma-exposed patients who never developed PTSD. Overall, results revealed a continuum of severity in psychiatric comorbidity, functioning, and quality of life, with current PTSD associated with the most impairment, never having met criteria for PTSD with the least impairment, and history of PTSD falling in between.

CONCLUSIONS

In this primary care sample, adults with a history of past PTSD but no current PTSD continued to report enduring functional deficits, suggesting a need for ongoing clinical attention.

The role of migration in the development of depressive symptoms among Latino immigrant parents in the USA

Nearly one out of every four children in the US is a child of immigrants. Yet few studies have assessed how factors at various stages of migration contribute to the development of health problems in immigrant populations. Most focus only on post-migration factors influencing health. Using data from the Latino Adolescent Migration, Health, and Adaptation Project, this study assessed the extent to which pre-migration (e.g., major life events, high poverty), migration (e.g., unsafe and stressful migration experiences), post-migration (e.g., discrimination, neighborhood factors, family reunification, linguistic isolation), and social support factors contributed to depressive symptoms among a sample of Latino immigrant parents with children ages 12-18. Results indicated that high poverty levels prior to migration, stressful experiences during migration, as well as racial problems in the neighborhood and racial/ethnic discrimination upon settlement in the US most strongly contribute to the development of depressive symptoms among Latino immigrant parents. Family reunification, social support, and familism reduce the likelihood of depressive symptoms.

A cultural adaptation of motivational interviewing to address heavy drinking among Hispanics

Although the need for cultural adaptations is often noted in addiction research, there are few templates to guide the process. The rationale for a social contextual framework to culturally adapt motivational interviewing for an immigrant heavy drinking Latino population in the U.S. Northeast is presented. The aim of the pilot study was to obtain data on acceptability of this approach. Participant responses to the adaptation were examined qualitatively and quantitatively in a preliminary study. Participants recruited from the community met criteria for risky drinking (men, ≥5 drinks/occasion or ≥14 drinks/week; women, ≥4 drinks/occasion or ≥7 drinks/week). Participants (n = 25) who completed baseline assessments and a culturally adapted brief motivational interview (CAMI) were asked to complete a qualitative exit interview to give feedback on their interview experience. Participants reported being highly engaged with treatment (M = 3.58 on a scale of 1-4, SD = .50), and felt very satisfied with treatment (M = 3.58 on a scale of 1-4, SD = .93). Nearly all (95%) reported that understanding their culture was important to understanding their drinking behavior. Results support the acceptability and relevance of this adaptation from participants' perspectives.

Migration from Mexico to the United States and subsequent risk for depressive and anxiety disorders: a cross-national study

CONTEXT

Migration is suspected to increase risk for depressive and anxiety disorders.

OBJECTIVE

To test the hypothesized increase in risk for depressive and anxiety disorders after arrival in the United States among Mexican migrants.

DESIGN

We combined data from surveys conducted separately in Mexico and the United States that used the same diagnostic interview. Discrete time survival models were specified to estimate the relative odds of first onset of depressive disorders (major depressive episode and dysthymia) and anxiety disorders (generalized anxiety disorder, social phobia, panic disorder, and posttraumatic stress disorder) among migrants after their arrival in the United States compared with nonmigrant Mexicans who have a migrant in their immediate family.

SETTING

Population surveys in the United States and Mexico.

PARTICIPANTS

Two thousand five hundred nineteen nonmigrant family members of migrants in Mexico and 554 Mexican migrants in the United States.

MAIN OUTCOME MEASURES

First onset of any depressive or anxiety disorder.

RESULTS

After arrival in the United States, migrants had a significantly higher risk for first onset of any depressive or anxiety disorder than did nonmigrant family members of migrants in Mexico (odds ratio, 1.42; 95% confidence interval, 1.04-1.94). Associations between migration and disorder varied across birth cohorts. Elevated risk among migrants relative to nonmigrants was restricted to the 2 younger cohorts (those aged 18-25 or 26-35 years at interview). In the most recent birth cohort, the association between migration and first onset of any depressive or anxiety disorder was particularly strong (odds ratio, 3.89; 95% confidence interval, 2.74-5.53).

CONCLUSIONS

This is, to our knowledge, the first study to compare risk for first onset of psychiatric disorder between representative samples of migrants in the United States and nonmigrants in Mexico. The findings are consistent with the hypothesized adverse effect of migration from Mexico to the United States on the mental health of migrants, but only among migrants in recent birth cohorts.

Exposure to American culture is associated with premenstrual dysphoric disorder among ethnic minority women

BACKGROUND

Ethnic minorities in America will achieve majority by 2042, and due to their younger age distribution, will represent the largest proportion of women at risk for premenstrual dysphoric disorder (PMDD). Research has not addressed ethnic minority women's vulnerabilities to PMDD. The objective of this study was to examine the relationship between acculturation and PMDD.

METHODS

An analysis of acculturation and PMDD among 3856 English-speaking, pre-menopausal Asian, Latina, and Black women from the National Latino and Asian American Survey and the National Survey of American Life was performed.

RESULTS

The lifetime prevalence of PMDD was 3.3%. Nativity status, duration of residence, and age at immigration were significantly associated with PMDD. Foreign-born women (OR=0.38; 95% confidence interval (CI)=0.21-0.68) and immigrants arriving to the US after age six (OR=0.33, 95% CI=0.18, 0.62) were less likely to have PMDD, compared to US-born women, and US-born women/immigrants who arrived before age six, respectively. The likelihood of PMDD increased as the duration of residence in the US lengthened.

LIMITATIONS

The diagnosis of PMDD was provisional due to retrospective symptom reporting. Statements of causality could not be made because the study was cross-sectional.

CONCLUSIONS

A substantial percentage of ethnic minority women suffer from PMDD in their lifetimes. Exposure to American culture appeared to elevate ethnic minority women's likelihood for PMDD. The stressors that are associated with ethnic minority life in America-discrimination, poverty, pressures to assimilate, etc.-may contribute to ethnic minority women's vulnerability to PMDD, and clinicians should be sensitive to the special risks in this population.

Trauma, Depression, and Comorbid PTSD/Depression in a Community Sample of Latina Immigrants

Trauma exposure is frequently overlooked as a risk factor for psychiatric morbidity among studies with Latinos. The purpose of this study was to examine the relationships among trauma history, immigration-related factors, and mental health status among Latina immigrants. The current study used baseline data from a randomized clinical trial for the treatment of depression (Miranda et al., 2006) of 64 women with comorbid PTSD and depression, 69 with depression-only, and 61 with no Axis I mental disorder. Sixty-four percent of the sample was Central American and 75% percent reported trauma exposure. Multinomial logit analysis suggested fewer years in the US was associated with worse mental health status. Having a non-married marital status was also associated with worse mental health. Reporting four or more types of traumatic events was associated with an increase in the probability of comorbidity. These findings have important implications for future research and clinical practice.