Hispanic Women and Mental Health: An Overview of Contemporary Issues in Research and Practice

Psychology Reconstructs The Female: 1968–1988

Recent work on the psychology of gender is pluralistic, stemming from varied specialty areas within psychology, grounded in several intellectual frameworks, and reflecting a spectrum of feminist perspectives. This article is a critical appraisal of diverse approaches to the study of women and gender. It first describes prefeminist or “womanless” psychology, then analyzes four co-existing frameworks that have generated recent research. The four frameworks are: Exceptional Women, in which empirical research focuses on the correlates of high achievement for women, and women's history in the discipline is re-evaluated; Women as Problem (or Anomaly), in which research emphasizes explanations for female “deficiencies” (e.g., fear of success); the Psychology of Gender, in which the focus of inquiry shifts from women to gender, conceived as a principle of social organization that structures relations between women and men; and a (currently relatively undeveloped) Transformation framework that reflexively challenges the values, assumptions, and normative practices of the discipline. Examples of research programs within each approach are described, and the strengths and limitations of each approach are critically examined.

Feminist Theory, Feminist Psychology: A Bibliography of Epistemology, Critical Analysis, and Applications

A selection of recent (post-1980) works on feminist theory and method, this bibliography includes literature from psychology and other social sciences, feminist studies, and philosophy of science. The first of its four sections concerns epistemology and metatheory. The second lists works that offer reformulations or critical analyses of key concepts in gender studies; many of these are grounded in social constructionist and feminist standpoint epistemologies. The third section cites writings that illustrate the potential of new epistemological stances or exemplify new ways of working. The last section lists related bibliographies. (232 entries.)

Ethnic Differences in the Relationship between Job Satisfaction and Sex-Role Conflict among Hispanic and Nonhispanic White Individuals

The study compared sex-role conflict and job satisfaction scores and correlations among a broad sample of 71 Cuban and Central American Hispanic and 120 nonHispanic men and women working in the South Florida area. Analysis showed that the Hispanic respondents had lower satisfaction with pay, supervision, and co-workers, but were similar to nonHispanic white subjects in sex-role conflict and satisfaction with work and promotion. For the Hispanic groups, sex-role conflict was not correlated with any facet of job satisfaction, but for nonHispanic white groups sex-role conflict was correlated with satisfaction with work, pay, promotion, and supervision.

Beyond the Superwoman Syndrome: Work Satisfaction and Family Functioning among Working-Class, Mexican American Women

The "superwoman syndrome" developed as a result of the mistaken belief that women's participation in outside employment was not to come at a cost to their homemaker responsibilities. The purpose of this investigation was to determine whether a "superwoman mentality" existed among working-class, Mexican American women in dualearner families. The present study investigated the interaction of sex-role attitudes, the division of household and child-care responsibilities, role strain, work satisfaction, and family functioning among working-class Mexican American women in dual-earner families. Findings from the present study indicate that Mexican American women do not subscribe to the superwoman myth. Instead, they seem to endorse an expansion of the husbands' roles to include housework and child care. The economic and social changes of the past several decades have influenced patterns of work and family. Married women have entered the labor force en masse. Their employment outside the home has resulted in both financial gains for families and increased opportunities for women. Previously, women's contributions to the family and society came primarily through their homemaker responsibilities. Wives' participation in the labor force has allowed them to contribute economic resources as well. Outside employment permits women to expand their roles to include those of the working and professional woman.

A Conceptual Framework for Understanding Race, Class, Gender, and Sexuality

Since the mid-1980s, scholarship and college courses that address multiple dimensions of inequality under the rubric of race, class, gender, and (recently) sexuality studies have grown rapidly. Most courses now employ a set of readings, many of which are drawn from a growing number of anthologies. A strength of this approach is its presentation of the diversity of human experiences and the multiplicity of critical perspectives. A weakness is its failure to convey the commonalities in race, class, gender, and sexuality analyses of social reality. To aid in teaching and research on race, class, gender, and sexuality, this article presents six common themes that characterize this scholarship. Race, class, gender, and sexuality are historically and globally specific, socially constructed power relations that simultaneously operate at both the macro (societal) and micro (individual) levels of society. Scholarship in this tradition emphasizes the interdependence of knowledge and activism.

Contemporary Research on Hispanic Women:A Selected Bibliography of the Social Science Literature

One of the difficulties in developing a new area of research in any field is the lag time between the interest in the area on the part of researchers and the interest in publishing on the part of editors. Initial work may appear in books or publications outside the disciplinary mainstream and be overlooked in literature searches that focus on established journals. Further, work appearing in mainstream journals may be constrained by traditional paradigms and reflect Anglocentric and sexist biases of traditional research. This has been true for work on Hispanic women, which has been hallmarked by Anglocentric and sexist bias (Senour, 1977).

This 134-item bibliography addresses the difficulty of identifying the diverse work on Hispanic women in the U.S. and Puerto Rico by bringing a large part of it together in one place. We have three goals. The first is to facilitate the integration of material on Hispanic women into the curriculum of psychology. The second is to promote and disseminate research on the psychology of Hispanic women. The third is to recognize contributions of early researchers who have pioneered in developing and articulating knowledge about this neglected group.

We want to emphasize that this bibliography is not comprehensive. The focus is on scholarly work in the English language that advances understanding of Hispanic women's uniqueness and diversity as a group. Studies that included Hispanic women in their sample but did not specifically focus on Hispanic women or did not conduct gender or gender/ethnicity analyses were not included.

Where are the Latinas?

The inclusion of scholarship about Latinas into psychology courses is considered by answering two questions: (1) How do we evaluate the scholarship that should be included? (2) What factors should be considered for inclusion? To answer the first question on the evaluation of scholarship, six criteria are presented. The factors to be considered for the inclusion of scholarship about Latinas are illustrated in a discussion of three topics that are often presented in introductory psychology courses: identity, gender role socialization, and educational achievement and aspirations. Our discussion questions the validity of the conceptualization of these three topics when Latinas and other ethno-racial groups are excluded and offers evidence of the possibilities for clarification and expansion of theory and knowledge when they are included.

Linking Femininity, Weight Concern, and Mental Health Among Latina, Black, and White Women

Studies examining women's appearance ideals and weight concern have predominantly relied on samples of White women. This study addresses this oversight, examining the different relations among embodied femininity, weight concern, and depressive symptomatology that exist for different groups of women. Using a nationally representative sample of women between the ages of 18 and 45, bivariate analyses were conducted using three samples of Latina, Black, and White women. When sample size allowed, a multivariate model was tested (i.e., for Black and White respondents). Results confirm, as hypothesized, different patterns of relations between embodied femininity, weight concern, and depressive symptomatology for each of the samples. At the bivariate level, embodied femininity, weight concern, and depressive symptomatology were positively intercorrelated among Latina respondents. Whereas weight concern fully mediated the relation between embodied femininity and depressive symptomatology for the White respondents, the mediational model was not borne out for the Black respondents. For the latter, although embodied femininity and weight concern were related, weight concern was unrelated to depressive symptoms. Both of these patterns are discussed, as well as the need for greater empirical sensitivity to various constructions of femininity among women of different ethnicities.

Addressing Diversity in the Decade of Behavior: Focus on Women of Color

The Decade of Behavior provides an opportunity to reflect on the need for psychologists to develop a “diversity mindfulness” in their education, training, and research activities, a need that has never been more urgent. In this article, we focus on the lives of women of color to illustrate diversity-mindful feminist principles that may inform research and program development related to other aspects of diversity. We discuss perspectives and priorities of women of color in psychology. We consider why implementing feminist psychology's inclusive vision for research is a continuing struggle, particularly with regard to research on poor women, and identify some contributions and priorities of feminist research on women of color that relate to Decade goals of achieving a “safer, better educated, healthier, more democratic and more prosperous nation” (White, Travis, & Russo, 2001, p. 267). Understanding and incorporating perspectives of women of color in Decade activities is essential if researchers are to generate new knowledge “to prepare the world for facing emerging problems in the 21st century” (Decade of Behavior website: http://www.decadeofbehavior.org ).

Research On Women Of Color: From Ignorance to Awareness

Evidence that women of color are dealt with as anomalies in psychological research is discussed in order to: (a) inform researchers about the omissions, (b) stimulate interest in increased inclusion of women of color among research populations, and (c) demonstrate the need for increased diversity in research paradigms. It is noted that research paradigms directed at the study of the “universal woman” have in actuality focused on White middle class populations. This article examines the methodological and theoretical transformations that have occurred in the literature, and evaluates the extent to which researchers have successfully incorporated ethnicity into the study of gender issues. This is a call for an examination of women's experiences relative to ethnicity and a paradigmatic shift in the assumptions about what is worthy or appropriate for investigation.

The Incidence and Outcomes of Sexual Harassment Among Hispanic and Non-Hispanic White Women: A Comparison Across Levels of Cultural Affiliation

An extensive body of literature has documented the widespread and damaging nature of sexual harassment among Anglo women, but little attention has focused on the experiences of women of color. The current paper begins to address this gap by comparing sexual harassment incidence rates and psychological and work-related outcomes of Hispanic and non-Hispanic White women across varying levels of cultural affiliation. Chi-square tests of association suggest that risk of harassment increases with affiliation to the mainstream U.S. culture, and hierarchical regression analyses suggest that cultural affiliation moderates the relation between sexual harassment and occupational functioning. These provocative findings are discussed in the context of social and economic vulnerability, socio-sexual norms, and cultural background.

Success of mental health referral among pregnant and postpartum women with psychiatric distress

OBJECTIVE

This study measured rates of and determined factors associated with mental health service use among a cohort of 465 pregnant and postpartum women receiving care from publicly funded obstetric clinics.

METHODS

Women underwent a diagnostic evaluation, were provided with at least one mental health referral and were encouraged to seek treatment; follow-up with provision of additional referrals occurred at 1, 3 and 6 months after the initial assessment. Logistic regression was used to estimate the relationship between clinical and psychosocial factors and self-reported mental health service use.

RESULTS

Of the referred women, 38.1% attended at least one mental health visit, while only 6% remained in treatment during the entire 6-month follow-up interval. Postpartum women were more likely than pregnant women to attend a mental health treatment visit [odds ratio (OR)=4.17]. Being born in the United States (OR=2.06), being exposed to interpersonal violence (OR=2.52) and being unemployed (OR=2.69) were associated with attending at least one mental health-care visit. Women who received a behavioral health referral to the same site as their prenatal or postpartum care were more likely than those referred offsite to attend a mental health treatment visit (OR=3.23).

CONCLUSIONS

Despite active follow-up, rates of accessing and particularly continuing in mental health treatment were low. More work is needed to support the integration of specialty behavioral health services in primary care settings accessed by perinatal women.

Post-treatment symptoms among ethnic minority breast cancer survivors

PURPOSE/OBJECTIVES

To determine racial and ethnic differences in the range and number of post-treatment symptoms among women who have undergone surgical and postsurgical treatment for breast cancer.

DESIGN

Retrospective study.

SETTING

Community-based social services agency and public health clinic.

METHODS

Face-to-face interview of 116 women who had undergone breast cancer surgery.

SAMPLE

Primarily low-income women in an urban area in northern California. Participants were recruited via posted flyers regarding the study.

MAIN RESEARCH VARIABLES

Outcomes (depression, fatigue, pain, and swelling from lymphedema) and demographics (ethnicity, age, income, insurance, education, and marital status).

FINDINGS

The typical participant was 47 years old, had 12 years of education, and was a parent (74%), unmarried (67%), heterosexual (88%), uninsured (68%), and employed (66%). Thirty percent were Caucasian, 30% African American, 25% Latina, and 15% women of other ethnic backgrounds. African American women and Latinas reported increased rates of pain and an increased number of symptoms. Latinas also reported higher rates of fatigue and depression. In multivariate analyses, an increased number of symptoms were associated with decreased income, with receiving chemotherapy, with having a mastectomy, and with Latina ethnicity.

CONCLUSIONS

These data suggest an increased rate of post-treatment symptoms experienced by low-income and ethnic minority women.

IMPLICATIONS FOR NURSING

A need exists for affordable, culturally appropriate symptom management interventions. Nursing will have a vital role in designing, testing, and offering such interventions.

A structural model of acculturation and mental health status among Chinese Americans

This study examined the role of acculturation and its direct and indirect impact on depressive symptom severity through various correlates, including socioeconomic status (SES), stress, social support, personality negativity, and physical health perception. Using structural equation modeling, the proposed model was tested with 983 employed Chinese Americans from a representative community sample, the majority of whom were immigrants. The results demonstrated that acculturation, correlated with SES, contributed to depressive symptom severity only through indirect pathways. Higher acculturation was found associated with higher stress that in turn contributed to more elevated depressive symptoms. On the other hand, higher acculturation was also found strongly correlated with higher SES, which was associated with lower depressive symptoms directly or indirectly through several mediators. Better support, lower personality negativity, better health perception, and lower stress were found mediating the relationship between higher SES and lower depressive symptom severity. The simultaneous multigroup analysis showed that the final model was comparable for both men and women with very few differences.

Using eye movement desensitization and reprocessing to treat complex PTSD in a biracial client

A biracial client's recovery from posttraumatic stress disorder (PTSD) through the use of eye movement desensitization and reprocessing (EMDR) is discussed to illustrate the interaction between ethnicity and phenotype as well as diagnosis and treatment considerations. This case explores a woman's experience of discrimination in and out of her home and her vulnerability to complex PTSD, and it documents the importance of the therapy focusing on experiences of discrimination and prejudice as well as abuse. It shows how the client structures her environment in a personally creative fashion to include representative features of various aspects of her identity, by her choice of where and who she teaches as well as how and with whom she spends her free time.

Distressed women's clinic patients: preferences for mental health treatments and perceived obstacles

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women's clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women's clinic patients are discussed.

Women and outpatient mental health services: use by black, Hispanic, and white women in a national insured population

Factors affecting ethnic differences in women's use of outpatient mental health services were analyzed to determine whether lower use by black and Hispanic women occurred when socioeconomic and other factors are controlled. Employing the Andersen and Newman model of health use, insurance claims of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed to identify significant predictors of use. Results revealed that black and Hispanic women had lower probabilities and amounts of use when compared to white women even after controlling for a number of variables. Further research is needed to examine cultural and gender-related factors that may underlie ethnic differences; attitudinal factors and service system barriers are also implicated. Such findings have policy implications in the current climate of health care reform for which efforts are needed to increase access to care for ethnic minority women and other underserved populations.

Improving substance abuse service delivery to Hispanic women through increased cultural competencies: a qualitative study

In 1985, one woman in seventeen in the US was Hispanic-an estimated 8.5 million-and it is predicted that by the end of this century, Hispanics will comprise the largest ethnic group in this country (Amaro & Russo, 1987). Although the term "Hispanic" suggests a homogeneous group, united by similarities, this is not the case. The term refers to an ethnic group, not a racial one, whose chief commonalities are the Spanish language and some broad cultural values. Making substance abuse treatment services accessible to Hispanic women and their families requires that agencies become culturally competent to deal with this population. The authors of this qualitative study interviewed female Hispanic substance-abuse treatment clients and therapists to find what agencies might do to create a receptive atmosphere for Hispanic women.

Coping and social support resources among Latinas with arthritis

OBJECTIVE

To examine the coping strategies and social support resources of Latinas (Hispanic women with arthritis.

METHODS

A sample of 109 Latinas of low socioeconomic status with arthritis were interviewed. Most interviews were conducted in Spanish. In open-ended responses, participants described how they cope with their illness. Respondents also named the two individuals who help them most when they do not feel well because of their illness.

RESULTS

Engaging in activities was the most commonly reported coping strategy, followed by the use of religion or prayer. Respondents relied more on family members (especially daughters) than friends for support.

CONCLUSIONS

Coping responses to arthritis may reflect culture-based notions of "coping," as well as culturally valued norms, such as familism. The extent to which findings illustrate cultural, gender, or socioeconomic status factors requires further study.

Correlates of Drug Use, Sexual Behavior, and Attitudes toward Safer Sex among African-American and Hispanic Women in Methadone Maintenance

Female intravenous drug users are among the fastest growing segments of the population infected with the human immunodeficiency virus. This article, based on interviews with 91 African-American and Latina women in methadone clinics, describes respondents' drug use, sexual risk taking, and attitudes toward condom use and negotiation of safer sex; and examines relationships between sexual risk taking and demographic characteristics, length of time in treatment, current drug use, and attitudes toward negotiating safer sex and condoms. Forty-two percent of the sample reported that they had changed their sexual practices to reduce their risk of AIDS. Recovering IV drug users in long-term monogamous relationships tended to use condoms less frequently during sexual intercourse than those in casual relationships. Various drugs were differentially related to high-risk sexual activity. Frequent drug injectors admitted to having more sexual partners and to having sex more frequently, and used condoms with less frequently than women who used IV drugs less often.

Attitudes toward negotiating safer sex and frequency of condom use varied by ethnicity. In addition, use of condoms appeared to be related more to attitudes toward negotiating safer sex and the degree of comfort with social skills in communicating with sexual partners than to perceptions about the properties of condoms. Findings have implications for developing interventions to reduce AIDS risks.