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Cultural Considerations in the Diagnosis and Classification of Depression: The Hispanic Perspective

  • Renato D. Alarcón
Chapter
Part of the Issues in Children's and Families' Lives book series (IICL, volume 8)

Personal Journey: Renato D. Alarcón

It was a sunny weekend afternoon in Atlanta. Dressed in a T-shirt and blue-jeans I was cutting the grass and enjoying the exercise. Suddenly, the lawn mower got stuck, and I did the most naïve (or stupid) thing one can imagine: without turning the engine off, I put my hand under the blades attempting to clear the path. A sharp pain only meant that in an instant, two fingernails had been “erased,” and one finger severely fractured. My wife took me to the Emory Hospital ER (I was professor and vice-chair of psychiatry at the time). The radiology technician took a look at the X-rays of my hand. Then he looked at me –brown, sweaty, dusty, with a bloodied hand wrapped in gauze: “Sorry man,” he said “you’ll have to change your line of work, no more cutting the grass, get a safer job. Perhaps you can learn to make hamburgers or tortillas at McDonald’s.”

I had decided to be a psychiatrist early in my high school years. When I was 11, my father gave me, a...

Keywords

Domestic Violence Mental Health Professional Suicide Rate Hispanic Population Cultural Formulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Adler, N.E., Boyce, T., Chesney, M.A., Cohen, S., Folkman, S., Kahn, R. L, & Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49, 15–24.PubMedCrossRefGoogle Scholar
  2. Alarcón, R. D. (1995). Culture and psychiatric diagnoses: Impact on DSM-IV and ICD-10. Psychiatric Clinics of North America, 18, 449–466.PubMedGoogle Scholar
  3. Alarcón, R. D. (2003). Estrés de Aculturación como probable categoría nosológica: El caso hispánico. In R. D. Alarcón (Ed.), Los mosaicos de la esperanza. Reflexiones en torno a la psiquiatría latinoamericana (pp. 215–236), Caracas, Venezuela: Ediciones APAL.Google Scholar
  4. Alarcón, R. D. (2004). Trastorno Esquizoafectivo: Un enigma clínico en la nosología moderna. Lecture presented at the 8th Colombian Congress of Neuropsychopharmacology and International Seminar on Mood and Psychotic Disorders. Bogotá, Colombia, February 26–28, 2004.Google Scholar
  5. Alarcón, R. D., Foulks, E. F., & Vakkur, M. (1998). Personality disorders and culture. Clinical and conceptual interactions. New York: Wiley.Google Scholar
  6. Alarcón, R. D., Westermeyer, J., Foulks, E. F., & Ruiz, P. (1999). Clinical relevance of contemporary cultural psychiatry. Journal of Nervous & Mental Disease, 187, 465–471.CrossRefGoogle Scholar
  7. Alegría, M., Mulvaney-Day, N., Torres, M. Polo, A., Zhun, C., & Canino, G. (2006). Prevalence of psychiatric disorders across Latino sub-groups in the United States. American Journal of Public Health, 97, 68–75.Google Scholar
  8. American Psychiatric Association (APA) (2001). Diagnostic and statistical manual for mental disorders (4th ed., , test revised) (DSM-IV-TR). Washington, DC: Author.Google Scholar
  9. Bauermeister, J. J., Berrios, V., Jiménez, A. L., Acevedo, L., & Gordon, M. (1990). Some issues and instruments for the assessment of Attention-deficit hyperactivity disorder in Puerto Rican children. Journal of Clinical Child Psychology, 19, 9–16.CrossRefGoogle Scholar
  10. Berganza, C. E., & Jorge, M. R. (2002). Latin American guide for psychiatric diagnosis. Psychopathology, 35,185–190.PubMedCrossRefGoogle Scholar
  11. Blue, H. C., & Griffith, E. H. (1995). Sociocultural and therapeutic perspectives on violence. Psychiatric Clinics of North American, 18, 571–588.Google Scholar
  12. Briones, D. F., Heller, P. L., Chalfant, P., Roberts, A. E., Aguirre-Hauchbaum, S. F., & Farr, W. F. Jr. (1990). Socioeconomic status, ethnicity, psychological distress, and readiness to utilize a mental health facility. American Journal of Psychiatry, 147, 1333–1340.PubMedGoogle Scholar
  13. Brislin, R. (1970). Back-translation for cross-cultural research. Journal of Cross Cultural Psychology, 1, 185–216.CrossRefGoogle Scholar
  14. Canino, G., Lewis-Fernández, R., & Bravo, M. (1997). Methodological challenges in cross-cultural mental health research. Transcultural Psychiatry, 34, 163–184.CrossRefGoogle Scholar
  15. Caraveo-Anduaga, J., Colmenares, B. E., & Saldívar, G. (1999a) Estudio clínico-epidemiológico de los trastornos depresivos. Salud Mental, 22, 7–17.Google Scholar
  16. Caraveo-Anduaga, J. Colmenares, B. E., & Saldívar, G. (1999b).Morbilidad psiquiátrica en la Ciudad de México: Prevalencia y comorbilidad en la vida. Salud Mental, 22, 62–77.Google Scholar
  17. Carrillo, E. (2001). Assessment and treatment of the Latino patient. In A. G. Lopez & E. Carrillo (Eds.), The Latino psychiatric patient. Assessment and treatment (pp. 37–53). Washington, DC: American Psychiatric Publishing.Google Scholar
  18. Castellanos, D., Jacobs-Alvarez, F., & Castellanos, A. (2002). El suicidio en la población hispana de los Estados Unidos. Psychline, 4, 41–43.Google Scholar
  19. Cross, C. L., Bazron, B. J., & Dennis, K. W. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: CASSP Technical Assistance Center at Georgetown University, Child Development Center.Google Scholar
  20. Durie, M.H. (2003). The health of indigenous peoples. British Medical Journal, 3, 510–511.CrossRefGoogle Scholar
  21. Escobar, J. I., Burnam, M. A., Karno, M., Forsythe, A., & Golding, J. M. (1987). Somatization in the community. Archives of General Psychiatry, 44, 713–718.PubMedCrossRefGoogle Scholar
  22. Felix-Ortiz, M., Muñoz, R., & Nurcombe, M. D. (1994). The role of emotional distress in drug use among Latino adolescents. Journal Child Adolescent Substance Abuse, 3, 1–18.CrossRefGoogle Scholar
  23. First, M. B., Bell, C. C., Cuthbert, B., Krystal, J. H., Malison, R., Offord, R. D., et al. (2002). Personality disorders and relational disorders. A research agenda for addressing crucial gaps in DSM. In D. J. Kupfer, M. B. First, & D. A. Regier (Eds.), A research agenda for DSM-V (pp.123–199). Washington, DC: American Psychiatric Association.Google Scholar
  24. Gil, R. M., & Vasquez, C. I. (1996). The Maria paradox: How Latinas can merge old world traditions with new world self-esteem. New York: GP Putnam's Sons.Google Scholar
  25. Golding, J. N., & Lipton, R. I. (1990). Depressed mood and major depressive disorder in two ethnic groups. Journal of Psychiatric Research, 24, 65–82.PubMedCrossRefGoogle Scholar
  26. Group for the Advancement of Psychiatry, Committee on Cultural Psychiatry (2001). Cultural assessment in clinical psychiatry. Washington, DC: American Psychiatric Publishing.Google Scholar
  27. Harman, J. S., Edlund, M. J., & Fortney, J. C. (2004). Disparities in the adequacy of depression treatment in the United States. Psychiatric Services, 55, 1379–1385.PubMedCrossRefGoogle Scholar
  28. Hovey, J. D., & King, C. (1996). Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1183–1192.CrossRefGoogle Scholar
  29. Kessler, R. C., McGonagle, K. A., Zhao, S. Nelson, C. B., Hughes, M., Esheleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.PubMedCrossRefGoogle Scholar
  30. Khouri, P. J., & Akiskal, H. S. (1986). The bipolar spectrum reconsidered. In T. Millon, & G. L. Klerman (Eds.), Contemporary directions in psychopathology (pp. 457–472). New York: Guilford Press.Google Scholar
  31. Kirmayer, L. J. (1989). Cultural evaluations in the response to psychiatric disorders and emotional distress. Social Science Medicine, 29, 327–339.PubMedCrossRefGoogle Scholar
  32. Koss-Chioino, J. D., & Vargas, L. A. (1999). Working with Latino youth: Culture, development and context. San Francisco, CA: Jossey-Bass.Google Scholar
  33. Kupfer, D. J., First, M. B., & Regier, D.A. (2002). A research agenda for DSM-V. Washington, DC: American Psychiatric Association.Google Scholar
  34. Lagomasino, I. T., Dwight-Johnson, M., Miranda, J. Zhang, L., Liao, D., Duan, N., et al. (2005). Disparities in depression treatment for Latinos and site of care. Psychiatric Services, 56, 1517–1523.PubMedCrossRefGoogle Scholar
  35. León, C.A. (1976). Perspectivas de la salud mental comunitaria en Latinoamérica. Boletín de la OPS, 51, 25–36.Google Scholar
  36. León, F. G., Ashton, A. K., D’Mello, D. A., Dantz, B., Hefner, J., Matson, G. A., et al. (2003). Depression and comorbid medical illness: Therapeutic and diagnostic challenges. Journal of Family Practice, Suppl. S, 19–33.Google Scholar
  37. Lewis-Fernandez, R., & Kleinman, A. (1995). Cultural psychiatry. Theoretical, clinical, and research issues. Psychiatric Clinics of North America, 18, 433–448.PubMedGoogle Scholar
  38. Lewis-Fernández, R., Tun, H., Reyes, F., Sánchez-Lacay, A., & Caracci, G. (2000). Los “sindromes dependientes de la cultura”: Un dilema nosológico recurrente en la psiquiatría cultural. Monografia Psiquiatria, 12, 24–29.Google Scholar
  39. Lim, R. F. (2006). Clinical manual of cultural psychiatry. Washington DC: American Psychiatric Publishing.Google Scholar
  40. Lin, K. M., Anderson, D., & Poland, R. E. (1995). Ethnicity and psychopharmacologic: bridging the gap. Psychiatric Clinics of North America, 18, 635–648.PubMedGoogle Scholar
  41. Lopez, A. G., & Katz, I. (2001). An introduction to Latinos in the United States. In A. G. Lopez & E. Carrillo (Eds.), The Latino psychiatric patient. Assessment and treatment (pp. 3–18). Washington, DC: American Psychiatric Publishing.Google Scholar
  42. Lukoff, V., Lu, F. G., & Turner, R. (1995). Cultural considerations in the assessment and treatment of religious and spiritual problems. Psychiatric Clinics of North America, 18, 467–486.PubMedGoogle Scholar
  43. Manson, S. M. (1995). Culture and major depression: Current challenges in the diagnosis of mood disorders. Psychiatric Clinics of North America, 18, 487–502.PubMedGoogle Scholar
  44. Marcos, L. R., Urcuyo, M., Kesselman, M., & Alpert, M. (1973). The language barrier in evaluating Spanish-American patients. Archives of General Psychiatry, 29, 655–659.PubMedCrossRefGoogle Scholar
  45. Medina-Mora, M. E., Borges, G., Lara, M. C., Benjet, C., Blanco, J., Fleiz, D. et al. (2003). Prevalencia de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental, 26, 1–16.Google Scholar
  46. Mendoza, R. (2003). Consideration of CYP2D6 variability across Hispanic samples. Lecture presented at the Course on Psychiatric Genomics: Applications for clinical practice. Mayo School of Continuing Medical Education. Rochester, MN, August 4–8.Google Scholar
  47. Menjívar, C. (2002). Fragmented Ties: Salvadoran Immigrant Networks in America. Berkeley, CA: University of California Press.Google Scholar
  48. Muñoz, R. A., Boddy, P., Prime, R., & Muñoz, L. A. (1990). Depression in the Hispanic community: Preliminary findings in Hispanic general medical patients at a community health center. Annals of Clinical Psychiatry, 2, 115–120.CrossRefGoogle Scholar
  49. Neff, J. A., & Hoppe, S. K. (1993). Race/ethnicity, acculturation, and psychological distress: fatalism and religiosity as cultural resources. Journal of Community Psychology, 21, 3–20.CrossRefGoogle Scholar
  50. Nurcombe, B., & Gallagher, R.N. (1986). The clinical process in psychiatry: Diagnosis and management planning. Cambridge, UK: Cambridge University Press.Google Scholar
  51. Otero, A. A., Rabelo, V., & Echazabal, A. (2001). Tercer Glosario Cubano de Psiquiatria. La Habana, Cuba: Hospital Psiquiatrico, Ministerio de Salud Pública.Google Scholar
  52. Perez-Stable, E. J., & Nápoles-Springer, A. M. (2001). Physical health status of Latinos in the United States. In A. G. Lopez & E. Carrillo (Eds.), The Latino psychiatric patient.Assessment and treatment (pp. 19–36). Washington, DC: American Psychiatric Publishing.Google Scholar
  53. Portes, A., & Rumbaut, R. G. (1997). Immigrant America: A Portrait (2nd ed.). Berkeley, CA: University of California Press.Google Scholar
  54. Pumariega, A., Rothe, E. M., & Pumariega, J. (2005). Mental health of immigrants and refugees. Community Mental Health Journal, 21, 581–597.CrossRefGoogle Scholar
  55. Regier, D. A., & Narrow, W.E. (2002). Defining clinically significant psychopathology with epidemiologic data. In J. E Helzer & J. J. Hudziak (Eds.), Defining psychopathology in the 21st century: DSM-V and beyond (pp. 19–30). Washington, DC: American Psychiatric Publishing.Google Scholar
  56. Rodriguez, M. A., Bauer, H. M., & Flores-Ortiz, Y. (2001). Domestic violence in the Latino population. In A. G. Lopez & E. Carrillo (Eds.), The Latino psychiatric patient. Assessment and treatment (pp. 163–179). Washington, DC: American Psychiatric Publishing.Google Scholar
  57. Rogler, L. H. (1993). Culturally sensitive psychiatric diagnosis: A framework for research. Journal of Nervous & Mental Disease, 18, 401–408.Google Scholar
  58. Rogler, L. H., Cortes, C. E., & Malgady, R. G. (1991). Acculturation and mental health status among Hispanics. American Psychologist, 46, 585–597.PubMedCrossRefGoogle Scholar
  59. Rothe, E. M., Lewis, J., Castillo-Matos, H., Martinez, O., Busquets, R., & Martinez, I. (2002). Posttraumatic stress disorder among Cuban children and adolescents after release from a refugee camp. Psychiatric Services, 53, 970–976.PubMedCrossRefGoogle Scholar
  60. Rounsaville, B. J., Alarcón, R. D., Andrews, G., Jackson, J. S., Kendell, R. E., & Kendler, K. Basic nomenclature issues for DSM-V. (2002). In D. J. Kupfer, M. B. First, & D. A. Regier (Eds.), A research agenda for DSM-V (pp. 1–29). Washington, DC: American Psychiatric Association.Google Scholar
  61. Satcher, D. (1999). Eliminating disparities, promoting partnership. Mayo Clinic Proceedings, 74, 838–840.Google Scholar
  62. Smart, J. F., & Smart, D. W. (1995). Acculturative stress. Counseling Psychology, 23, 25–42.CrossRefGoogle Scholar
  63. Smith, M, & Mendoza, R. (1998). Ethnicity and pharmacogenetics. Mt Sinai Journal of Medicine, 63, 285–290.Google Scholar
  64. Stavans, I. (1999). The Hispanic condition. Berkeley, CA: University of California Press.Google Scholar
  65. Suarez-Orozco, C., Todorova, I. L. G., & Louis, J. (2002). Making up for lost time: The experience of separation and reunification among immigrant families. Family Process, 41, 625–643.PubMedCrossRefGoogle Scholar
  66. Schwartz, S. J., Montgomery, M. J., & Briones, E. (2005). The role of identity and acculturation among immigrant people: Theoretical propositions, empirical questions, and applied recommendations. Human Development, 304, 1–30.Google Scholar
  67. Ticho, G. (1971). Cultural aspects of transference and countertransference. Bulletin of the Menninger Clinic, 35, 313–334.PubMedGoogle Scholar
  68. Triandis, H. C., Marin, G., Betancourt, H., Lisansky, J., & Chang, B. H. (1982). Dimensions of familism among Hispanic and mainstream Navy recruits. Chicago, IL: University of Illinois.Google Scholar
  69. U.S. Bureau of Census (2006). Current population series. Washington, DC: U.S. Government Printing Office.Google Scholar
  70. Vega, W. A. (1982). The Hispanic natural healer, a case study: Implications for prevention. In R. Valle & W. A. Vega (Eds.), Hispanic natural support systems: Mental health promotion perspective (pp. 65–74). Sacramento, CA: State of California Department of Mental Health.Google Scholar
  71. Vega, W. A., Kolody, B., Aguilar-Gaxiola, S. A., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771–778.PubMedCrossRefGoogle Scholar
  72. Vidaver, R. M., Lafleur, B., Tong, C., Bradshaw, R., & Marts, S. A. (2000). Women subjects in NIH-funded clinical research literature: lack of progress in both representation and analysis by sex. Journal of Women’s Health Gender-Based Medicine, 9, 495–504.PubMedCrossRefGoogle Scholar
  73. Vigil, D. (1988). Barrio gangs: Street life and identity in Southern California. Austin, TX: University of Texas Press.Google Scholar
  74. Weiss, M. G. (2001). Cultural epidemiology: An introduction and overview. Anthropology in Medicine, 8, 5–30.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Professor of Psychiatry, Mayo Medical School and Medical Director of the Psychiatric Teaching Unit, Mayo Medical Research CenterRochester

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