9 - PsychopathologyASA3Fall2009

9 - PsychopathologyASA3Fall2009 - Asian American Studies 3...

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Unformatted text preview: Asian American Studies 3 Psychosocial Perspectives of Asian Americans Harry Harry Kitano & Stanley Sue Mental Disorders n A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present present distress (e.g., a painful symptom) or disability (i.e., impairment in one disability or more important areas of functioning) or with a significantly increased increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above. Problems functioning in social, occupational, or recreational areas and/or subjective distress n 1 Questions n What is the role of racism (or prejudice and discrimination) on mental disorders? Are prevalence rates of mental disorders different from one ethnic group to another? What factors are associated with mental health for ethnic minority groups? n n Treated and Untreated Methods 1. Treated cases advantages: good records; uniform reporting and diagnosis; extensive data over long time. disadvantages: different agencies, diagnosticians, and practices/policies. Major problem is sampling. Representative of all disordered persons and inclusive of all disordered persons? Most severely disturbed, only those with self insight to know they have problems, criminally insane, come to attention only if caught; only those with money, transportation , motivation. Believe treatment no help or alternative resources or fear stigma. (funnel effect) 2. Field surveys advantages: good control, sampling technique known, common assessment procedures, unbiased or blind study, representativeness, answer specific questions about disorders, can select tools. disadvantages: often one shot, short term assessment; social desirability or response sets; not private interview 3. Observations Advantages: participant observer, close to community Disadvantages: not systematic, biased,, political consideration Racism Racism and Mental Health n “I can conceive of no Negro native to this country who has not, by the age of puberty, been irreparably scarred by the conditions of his life. The wonder is not that so many are ruined but that so many survive.” James Baldwin (1957, p. 71): “Racist practices undoubtedly are key factors— factors— perhaps the most important ones —in producing ones— mental disorders in Blacks and other underprivileged groups….” (Kramer, Rosen, & Willis, 1973, p. 353). n 2 Hypotheses for African Americans n Stress causes mental disorders (diathesis (diathesisstress notion) Prejudice and discrimination are stressors Because of prejudice and discimination, African Americans have higher prevalence of mental disorders. n n Who are Asian/Pacific Americans? l Asian/Pacific Americans are one of the fastest growing ethnic minority groups They are composed of at least 43 distinct subsubgroups The groups are very heterogeneous l l Model Minority Image l Economic, educational and social indicators of success Stereotypes Problems among the Asian/Pacific-American Asian/Pacificpopulation l l 3 Hypotheses for Asian Americans n In view of relatively low rates of crime, delinquency, and divorce; and high socioeconomic standing and educational attainments, Asian Americans are relatively well adjusted Asian Americans have “immunity” against social stressor, because of cultural and family strengths With acculturation and assimilation, prevalence of mental disorders increase n n Findings for African Americans n Epidemiological Catchment Area Study (ECA) National CoMorbidity Study (NCS) National Survey of American Life (NSAL) n n Epidemiological Catchment Area Study (ECA) Lifetime Prevalence of Any Disorders (Robins, (Robins, Locke, & Regier, 1991) Total Baltimore Durham Los Angeles St. Louis New Haven 41 35 33 31 28 Whites 38 34 32 31 28 Blacks 46 38 33 35 31 4 Epidemiological Catchment Area Study (ECA) Lifetime Prevalence of Any Disorders (%) (Adapted from Robins, Locke, & Regier, 1991) 50 45 40 35 30 25 20 15 10 5 0 Whites Blacks Baltimore Durham Los St. Louis Angeles New Haven ECA n Racial differences were few. They are largely attributable to demographic differences (social class) and, in the case of older individuals, to a higher prevalence of cognitive disorders among African Americans (Odds ratios for lifetime prevalence by Kessler et al., 1994) 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Aff Anx Sub ASPD Any 3/+ National Comorbidity Study White Afr. Amer 5 James S. Jackson University of Michigan 20 NCS and NSAL Lifetime Prevalence Rates for Major Depression by Race and Age Afri. Amer = blue (in percentages) (Jackson) carib = purp NCS NSAL white = yellow 20 18.9 16.9 15 15 15.3 12.8 12.6 12.8 10 11.4 FUCK THIS 10 1 0.7 10.6 10.3 5 5 5.3 4.6 1.9 0 18 - 34 * 35 - 54 55 + * 0 18 - 34 * 35 - 54 55 + * African American Source: NSAL, 2001, preliminary estimates; NCS, National Co-Morbidity Study, 1990-92. *NCS does not distinguish between African American respondents and Caribbean respondents. •NCS sample includes respondents aged 15 – 54. Caribbean * White African American Mental Health n Prevalence rates same or lower than nonHispanic Whites Overrepresented in high risk groups General health disparities n n 6 Findings for Asian Americans n Small scale studies with selected populations ECA Chinese American Psychiatric Epidemiological Study (CAPES) n n Chinese American Psychiatric Epidemiological Study (CAPES) Purpose: (1) Ascertain prevalence of selected mental health problems (2) Identify factors associated with mental health Method: Household interviews with 1700 respondents with a 1-year followup Measures: Wave 1--Mental disorders (mood disorders, anxiety disorders,somatic problems, alcohol use), general health, resources, social supports, health seeking, acculturation. Wave 2--loss of face, perceived racism, intergenerational conflict, quality of life, tobacco use, gambling Lifetime Prevalence of Mood Disorders 18 16 14 12 10 8 6 6 4 2 0 0 18 manic Manic Maj Depress maj. depression Dysthymia dysthymia ECA ECA CAPES NRC NRC CAPES 7 Lifetime Prevalence of Mood Disorders Manic Major Depression Dysthymia ECA 0.8 4.9 3.2 NCS 1.6 17.1 6.4 CAPE 0.1 6.9 3.7 CultureCulture-Bound Syndromes The term culture-bound syndrome denotes recurrent, locality - specific patterns of cultureaberrant behavior and troubling experience that may or may not be linked to a particular DSM- IV diagnostic category. Many of these patterns are indigenously DSMconsidered to be "illnesses," or at least afflictions, and most have local names. Although presentations conforming to the major DSMDSM- IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture- bound syndromes are generally limited to specific societies or cultureculture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations. There is seldom a one - to- one equivalence of any culture- bound syndrome with a DSM toculturediagnostic entity. Aberrant behavior that might be sorted by a diagnostician using DSMDSM- IV into several categories may be included in a single folk category, and presentations that might be considered by a diagnostician using DSM- IV as DSMbelonging to a single category may be sorted into several by an indigenous clinician. Moreover, some conditions and disorders have been conceptualized as cultureculturebound syndromes Specific to industrialized culture (e.g., Anorexia Nervosa, Dissociative Identity Disorder), given their apparent rarity or absence in other cultures. It should also be noted that all industrialized societies include distinctive subcultures and widely diverse immigrant groups who may present with culture-bound culturesyndromes. Koro A term, probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in females, the vulva and nipples) will recede into the body and possibly cause death. The syndrome is reported in south and east Asia, where it is known by a variety of local terms, such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thailand). It is rokoccasionally found in the West. Koro at times occurs in localized epidemic form in east Asian areas. 8 Neurasthenia In China, a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases, the symptoms would meet the criteria for a DSM-IV Mood or Anxiety DSMDisorder. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition (CCMD-2). (CCMD- Hwa Byung A Korean folk syndrome literally translated into English as "anger syndrome" and attributed to the suppression of anger. The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium. Reasons for Differences in Findings l Relatively small population of Asian/Pacific Americans and sampling problems FUCK THIS l Heterogeneity EverEver-changing population l 9 Asian American Mental Health Prevalence rates within range of nonHispanic Whites n Presence of “culture-bound” syndromes “culturen High symptom count n Acculturation and disturbance unclear n Mexican American Mental Health n n n n n n Mexican Americans prevalence rates for mental disorders same as, or lower than, those of nonHispanic Whites Mexican Americans born in Mexico have much lower rates than those born in the U.S.; place of birth more important variable than age, gender, and social class Immigrant Mexican Americans have rates similar to Mexicans in Mexico U.S. born Mexican Americans have rates similar to nonHispanic Whites Rates positively correlated with length of time in the U.S. Differences among Hispanics (Cubans low, Puerto Ricans high) (Odds ratios for lifetime prevalence by Kessler et al., 1994) 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Aff Anx Sub ASPD Any 3/+ White Hispanic National Comorbidity Study 10 Native American Mental Health n No large scale studies available Small scale studies suggest prevalence high Alcohol abuse is a serious problem n n NLAAS Prevalence for Any Depressive, Anxiety, and Substance Abuse Disorders Asian Americans 18 years or older Resided in any of the 50 states and Washington, DC. n Chinese, Filipino, Vietnamese, and other Asian Americans n 2095 Asian American individuals n Weighted response rates were about 70% n Interviews 2.4 mean hours in English or Ethnic languages n n Lifetime Prevalence Gender Men Women Ethnic origins Chinese Filipino Vietnamese Other Asians Nativity status USUS-born ForeignForeign -born EnglishEnglish -language proficiency Excellent/good Fair/poor 17.18 17.43 1212-Month Prevalence 8.44 9.87 18.00 16.74 13.95 18.29 10.00 8.99 6.69 9.55 24.62 15.16 13.22 8.00 17.24 17.47 8.82 9.85 11 2006 National Survey on Drug Use and Health Among persons aged 18 or older, prevalence of past year MDE: 12.1% American Indians or Alaska Natives 7.8% Whites 6.3% African Americans 5.8% Native Hawaiians or Other Pacific Islanders 5.4% Hispanics 3.0% Asians Among persons aged 12 or older, prevalence of past year substance dependence or abuse: 19.0% American Indians or Alaska Natives 12.0% Native Hawaiians or Other Pacific Islanders 10.0% Hispanics 9.2% Whites 9.0% African Americans 4.3% Asians Among persons aged 12 or older, prevalence of past year SPD: 25.9% American Indians or Alaska Natives 11.4% Whites 10.8% Native Hawaiians or Other Pacific Islanders 10.8% Hispanics 10.5% African Americans 7.8% Asians Paradoxes Why are prevalence rates low among African Americans, who are subjected to racism? n Why is acculturation negatively correlated among Mexican Americans? n Why are symptom findings and prevalence rates for mental disorders discrepant? n Recommendations n n n n n n n n Examine each group and individual differences Longitudinal studies Devise measures of nature and type of prejudice and discrimination that groups experience Effects of prejudice and discrimination and moderator/mediator variables Symptoms versus disorders Role of family particularly in bicultural adaptation Begin inductive process Implications for general theory and appreciation of crosscross-cultural samples 12 ...
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