Beyond anxious predisposition: do padecer de nervios and ataque de nervios add incremental validity to predictions of current distress among Mexican mothers?

Ataque de nervios: The impact of sociodemographic, health history, and psychological dimensions on Puerto Rican adults

Introduction

Ataque de nervios (ADN) is a cultural syndrome prevalent in Puerto Ricans characterized as an episode of intense emotional upset due to overwhelming stress.

Methods

The Ataque de Nervios Questionnaire, developed at the Center for the Study and Treatment for Fear and Anxiety (CETMA), served as the diagnostic tool for this retrospective secondary data analysis. We evaluated three models regarding ADN's function as a marker of (1) sociodemographic vulnerability, (2) health history risk, and (3) psychological vulnerability. This last model was subdivided to assess the scores of screening tests regarding anxiety (Anxiety Sensitivity Inventory, Beck Anxiety Inventory, and State-Trait Anxiety Inventory), affect (Beck Depression Inventory, Emotional Dysregulation Scale, Positive and Negative Affective Schedule), personality (NEO Five-Factor Inventory), and trauma (considering the responses to the Childhood Trauma Questionnaire and the Life Event Checklist).

Results

Our study sample had a total of 121 Puerto Rican adult patients from CETMA out of which 75% had ADN. We differentiated subjects according to their ADN status with t-tests and Mann-Whitney U tests and evaluated our models using logistic regressions. People with ADN showed more anxiety, depressive symptoms, emotional dysregulation, and negative affect than those without ADN. They also revealed lower positive affect and agreeableness. Highly extraverted but minimally agreeable personalities related to ADN. Living with a partner and being employed were risk factors for ADN. Having higher educational levels showed the strongest effect size: it greatly reduced the odds of an ataque.

Discussion

These characteristics suggest a distinct profile of ADN seen in employed, educated, adult Puerto Ricans living on the Island experiencing anxiety. Our study provides clinical tools to comprehend our patients' ADN experience, enriching our practice as culturally competent health providers.

Neighborhood characteristics and ataque de nervios: the role of neighborhood violence

Ataque de nervios is a Latina/o idiom of distress that may occur as a culturally sanctioned response to acute stressful experiences, particularly relating to grief, threat, family conflict, and a breakdown in social networks. The contextual factors associated with ataque de nervios have received little attention in research. This study examined the association between neighborhood factors and the experience of ataque de nervios among a sample of Latinas/os participating in the Latino Health and Well-Being Project in the northeastern United States. We examined the association between neighborhood cohesion, safety, trust, and violence and ataque de nervios. In multivariate logistic regression models, neighborhood violence was associated with ataque de nervios (p = .02), with each unit increase in the neighborhood violence scale being associated with 1.36 times greater odds of experiencing ataque de nervios. None of the other neighborhood variables were significantly associated with ataque de nervios. The positive association between neighborhood violence and the experience of ataque de nervios makes a further case for policy efforts and other investments to reduce neighborhood violence.

"We can't carry the weight of the whole world": illness experiences among Peruvian older adults with symptoms of depression and anxiety

BACKGROUND

Despite the high levels of depression and anxiety symptoms in old age, the use of mental health services in this population is low. Help-seeking behaviors are shaped by how an individual perceives and experiences their illness. The objective of this study was to characterize the illness experiences of Peruvian older adults with depression and anxiety symptoms in order to lay the foundation for tailored community-based mental health interventions.

METHODS

In this qualitative study, we conducted in-depth interviews with a purposively selected sample of older adults (≥ 60 years) from peri-urban areas of Lima, Peru. We included individuals with only depressive symptoms (Patient Health Questionnaire-9 ≥ 10), only anxiety symptoms (Beck Anxiety Inventory ≥ 16), with depressive and anxiety symptoms, and older adults who mentioned they had received mental health treatment/care. The interview guide included the following topics: perceptions and experiences about depression and anxiety; perceptions about the relationship between physical chronic diseases and mental health; experiences with mental health professionals and treatments, and coping mechanisms. Data collection was conducted between October 2018 and February 2019.

RESULTS

We interviewed 38 participants (23 women, 15 men) with a mean age of 67.9 years. Participants' ideas and perceptions of depression and anxiety showed considerable overlap. Participants attributed depression and anxiety mainly to familial and financial problems, loneliness, loss of independence and past traumatic experiences. Coping strategies used by older adults included 'self-reflection and adaptation' to circumstances, 'do your part', and seeking 'emotional support' mainly from non-professionals (relatives, friends, acquaintances, and religion).

CONCLUSIONS

Illness experiences of depression and anxiety set the pathway for tailored community-based mental health interventions for older adults. Overlapping narratives and perceptions of depression and anxiety suggest that these conditions should be addressed together. Mental health interventions should incorporate addressing areas related to depression and anxiety such as prevention of loss of independence, trauma, and loneliness. Good acceptability of receiving emotional support for non-professionals might offer an opportunity to incorporate them when delivering mental health care to older adults.

Acculturative stress and mental health among economically disadvantaged Spanish-speaking Latinos in primary care: The role of anxiety sensitivity

The present study examined the role of anxiety sensitivity in the relation between acculturative stress and mood and anxiety symptoms and disorders among Latinos seeking health services at a primary healthcare facility. Participants included 142 adult Latinos (86.6% female, M_age = 39.05 years, SD = 12.46%, and 96.3% reported Spanish as their first language). Results indicated that acculturative stress was indirectly related to the number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through anxiety sensitivity. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between acculturative stress and anxiety sensitivity to better understand and inform interventions to reduce anxiety/depressive vulnerability among Latinos in primary care.

Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology

BACKGROUND

Burgeoning global mental health endeavors have renewed debates about cultural applicability of psychiatric categories. This study's goal is to review strengths and limitations of literature comparing psychiatric categories with cultural concepts of distress (CCD) such as cultural syndromes, culture-bound syndromes, and idioms of distress.

METHODS

The Systematic Assessment of Quality in Observational Research (SAQOR) was adapted based on cultural psychiatry principles to develop a Cultural Psychiatry Epidemiology version (SAQOR-CPE), which was used to rate quality of quantitative studies comparing CCD and psychiatric categories. A meta-analysis was performed for each psychiatric category.

RESULTS

Forty-five studies met inclusion criteria, with 18 782 unique participants. Primary objectives of the studies included comparing CCD and psychiatric disorders (51%), assessing risk factors for CCD (18%) and instrument validation (16%). Only 27% of studies met SAQOR-CPE criteria for medium quality, with the remainder low or very low quality. Only 29% of studies employed representative samples, 53% used validated outcome measures, 44% included function assessments and 44% controlled for confounding. Meta-analyses for anxiety, depression, PTSD and somatization revealed high heterogeneity (I(2) > 75%). Only general psychological distress had low heterogeneity (I(2) = 8%) with a summary effect odds ratio of 5.39 (95% CI 4.71-6.17). Associations between CCD and psychiatric disorders were influenced by methodological issues, such as validation designs (β = 16.27, 95%CI 12.75-19.79) and use of CCD multi-item checklists (β = 6.10, 95%CI 1.89-10.31). Higher quality studies demonstrated weaker associations of CCD and psychiatric disorders.

CONCLUSIONS

Cultural concepts of distress are not inherently unamenable to epidemiological study. However, poor study quality impedes conceptual advancement and service application. With improved study design and reporting using guidelines such as the SAQOR-CPE, CCD research can enhance detection of mental health problems, reduce cultural biases in diagnostic criteria and increase cultural salience of intervention trial outcomes.

Household structure, family ties, and psychological distress among U.S.-born and immigrant Latino women

Latino women endorse the highest rates of past-month depressive symptoms relative to Latino men and non-Latino White men and women. Yet, research into the specific domains of family life that reduce or engender psychological distress among Latinas is sparse. We examine the hypothesis that indicators of household structure and family ties will relate to psychological distress among Latinas in the United States, and that these associations will vary by nativity status. We employed nationally representative data of Latina adults (N = 1,427) from the National Latino and Asian American Study. Nativity-stratified regression analyses revealed that strained family ties (i.e., family burden, family cultural conflict) were associated with greater levels of past-month psychological distress for both U.S.-born and immigrant Latinas. Yet, the effect of household structures on psychological distress differed by nativity status. Adjusting for sociodemographic factors, lower levels of household income were associated with greater psychological distress; and having children in the household was associated with lower levels of psychological distress among U.S.-born Latinas. In contrast, for immigrant Latinas, being out of the labor force was associated with greater levels of psychological distress. Results suggest that dynamics of both the household and family context predict differential as well as similar mental-health outcomes across segments of the Latina population in the United States. These findings underscore the need to understand the pathways by which different facets of family life-structural and social domains-relate to mental-health status among subgroups of Latinas. Our results also have implications for the development of tailored interventions to meet the specific needs of Latinas.