Documentos de Académico
Documentos de Profesional
Documentos de Cultura
1986
0177.9536
86 53.00+ 0.00
Copyright
1 1956 Pe&mon
Press Ltd
University,
San Diego,
CA 92182,
U.S.A.
Abstract-Correlates
of depressive symptomatology
and caseness are examined for a survey sample of
N = 1825 poor Mexican immigrant
women in San Diego County,
California.
The Center for Epidemiologic Studies-Depression
(CES-D)
checklist is tested against a variety of demographic
variables
as well as health status and service utilization
rates. Statistically
significant
associations
were found
between CES-D
and education, years in the United States, income, marital status and number of adults
in household.
Also significant
were associations
with health status, confidant
support
and recent,
traumatic
life event. Utilization rates point to medical doctors as the major source of formal treatment
and a heavy reliance on family and friends. The implications
of the high disorder rates for diagnosis and
treatment among immigrants
are discussed.
The phenomenon
of world wide immigration in the
twentieth century has been a focal point of research
and a concern of health planners for some time, and
broad speculation has taken place regarding the
relationship of migration to mental disorder. Conclusive evidence on this issue has not been forthcoming,
and studies have appeared that both support and
refute [l-3] the assertion that migrants and imrqigrants are more likely to suffer from mental disorders
and related symptomatology. However, to date, most
of the research concerning levels of psychiatric disorders among immigrants has been based on treatment
data which inherently limits its generalizability. The
data reported herein describes the prevalence of
depressive symptoms in a cohort of Mexican immigrant women residing in a metropolitan community
in the United States, examines the relationship between these symptoms and a number of factors that
have been identified in the epidemiological literature
as salient predictors of psychopathology
[4], and
looks at help-seeking patterns of depressive women.
Mexican immigration to the United States constitutes one of the largest sustained migratory movements in the world. The economic disparity that
distinguishes the United States and Mexico is
reflected in the incessant flow of undocumented aliens
as well as legal migrants and temporary visitors. By
1980, there were 4S43.770 Hispanic heritage people
in California (U.S. Census), not counting illegal
aliens, and this population is characterized by high
fertility rates, low median age and far lower levels of
educational
and economic attainment.
In other
words, the structure of the Hispanic population
resembles that of a developing country, in contrast to
the socioeconomic characteristics of the general population in California. Nowhere else in the world can
such a differential in standards of living be found
distinguishing two nations sharing a common border.
Furthermore, no single area better exemplifies the
The research described in this paper is supported
the Center for Prevention
Research, National
of Mental Health-M.H.
No. 38745-OIAI.
in part by
Institute
645
646
WILLIAM
A.
paper:
the Center
for Epidemiologic
StudiesDepression (see discussion of the depression checklist
in Methods
section).
For example,
Vernon
and
Roberts [6] found a caseness of 28.5% for Mexican
Americans, 18. I % for Blacks and 14.6% for Angles;
and Frerichs er al. [7] reported 27.4% for Hispanics,
21.4% for Blacks and 21.8% for Angles, in two
California studies which did not publish discrete rates
for immigrants.
Vega er al. [S] did find significantly
higher prevalence of depressive symptoms for a small
sample of immigrants, when compared to native born
Mexican Americans or non-hispanic
whites in Santa
Clara County, Calif.; however since a different depression checklist was used to determine rates, the
results are not comparable to the present research, or
the studies cited above.
These epidemiological
studies contradict the earlier
body of research literature [9, 101 which suggested
that Mexican Americans had lower levels of psychopathology due to the cohesive and nurturing qualities
of their social support systems. Indeed, the persistent
underutilization
of mental health servcies by this
ethnic group was seen as verification of this supposed
resistance to psychopathology.
In part this discrepancy in findings may well be due to the use of
disparate theoretical and methodological
designs, including the use of anthropological
observation
and
treatment data in the earlier studies.
The data below represents
the most significant
sample of immigrants
yet reported
in a crosssectional study of depression
in the United States.
This paper will contribute
new information
to the
data base concerning
the prevalence
of depressive
symptoms among Hispanic immigrants, and perhaps
shed some light on associated issues of risk factors
and help-seeking
patterns among depressed women,
and immigrants
more generally.
METHODS
from
the senior
author
VEGA
el
a/
Depressive
Table
among
immigrant
Mexican
women
641
variables
In
category
Mean
SD
I825
100.0
15.71
Il.46
603
558
664
33.0
30.6
36.4
15.56
15.43
16.09
II.16
11.09
12.03
O.j80t
805
5x5
228
184
44.7
32.5
12.1
IO.?
17.13
15.25
I-l.14
12.57
II.56
II.25
Il.73
IO.21
10.68**?
25.69***:
O.Zl$
48.0
39.3
31.1
32.1
32.32
26.7
20.9
IS.1
11.7
251
395
401
379
386
13.9
21.8
22. I
20.9
21.3
17.79
15.74
14.33
16.20
15.03
12.17
II.27
10.66
I I.50
I I .67
1.07**t
6.26.:
3.94J
47.4
42.3
36.9
44.1
37.8
10.33
29. I
21.8
19.2
23.7
21.0
9.72
270
209
81
1229
15.1
I I.7
4.5
68.7
15.61
14.62
17.23
15.84
I I.51
IO.51
Il.75
I I.67
1.17t
41.1
36.1
48.1
42.3
4.06
?1.9
IS.?
22.2
23.5
3.01
428
678
409
I67
48
24.1
39.2
23.6
9.7
2.8
17.84
16.27
13.70
13.38
il.88
11.76
II.36
II.01
Il.43
9.57
10.53***t
17.06:
0.86:
50.5
43.7
33.5
29.9
27. I
39.8.;
29.4
23.6
15.9
18.0
6.3
31.95***
1318
95
65
I79
IS3
72.8
5.2
3.6
9.9
8.5
14.96
14.71
17.52
18.82
18.61
I I.18
9.29
II.46
13.15
12.04
7.54***+
38.6
41.1
47.7
50.8
54.2
22.19***
20.9
12.6
27.7
33.0
29.4
7: &$*.*
_.
N
Total
A8e
35-39
40-u
45-50
Education
0-j kr
68 kr
9-11 >r
I?+
Years in U.S.
&5 ?r
&IO )r
I I-15 )r
I&?0 yr
II T
Employment status
Full time
Pars lime
Unemployed
Housewife
Income (monthly)
< 5600
60&999
1000-1399
1400-1999
2000 +
Manta1 swtus
Marncd
Never mar.
Widoued
Separated
Divorced
I. CES-D
symptoms
% CES-DB
16
x!
41.5
0.671:
0.4599
10.6
II 1
42.5
C CES-D
5 4
%=
22.6
0.45
~1.6
21.1
24.8
1.96
17.;0***
FIXDINGS
cohort reaches or exceeds this threshold, and approximately 22.63% of the total sample reaches 24 on the
CES-D.
These caseness rates are twice the average
reported in previous community
studies. Furthermore, they also surpass the caseness rates of 28.5%,
reported by Vernon and Roberts in Alameda County,
and 27.4%, reported by Frerichs er al. in Los Angeles
County, for community
samples of adult Mexican
Americans who were interviewed using the CES-D.
DE.MOGRAPHIC
VARIABLES
6-e
WILLl4Sl
Table
Total
Children
None
e: al.
CORRELATES
correlales
,Y
Sb In
category
1825
100.0
15.71
1 I .16
204
I I.2
16.5
20.4
22.2
16.2
13.4
15.70
I5 31
15.53
15.31
16.68
16.00
II.67
Il.63
Il.57
II.17
I I.51
II.37
0.65+
0.77:
0.57%
42.2
39. I
39.5
41.1
45.6
42.9
3.64
22. I
23.5
21.2
20.0
26.0
24.5
4.67
302
372
406
296
245
201
770
417
267
170
Il.0
42.2
28.8
14.6
9.3
18.54
15.29
15.06
15.85
15.68
Il.64
10.92
II.85
II.75
Il.53
3.69**+
4,lSt
4.2Y.P
52.2
39.7
37.4
44 2
42.9
14.34
30.3
21.2
21.3
23.2
22.4
8.23
248
699
626
237
13.7
38.6
34.6
13.1
9.17
12.16
18.77
24.74
7.65
9.04
Il.55
12.65
139,40***t
344.w**:
6.3 I5
15.3
27.8
55.0
73 0
268.12*
5.2
I I.6
30.04
52.3
232.78
1477
321
82. I
Il.9
14.34
22.21
IO.71
12.64
132.90***t
36.4
65.1
88.16***
17.9
44.5
103.90***
512
400
376
I64
II5
229
28.7
22.2
20.9
9.1
6.4
12.7
13.77
13.87
16.04
lb.91
17.83
20.47
10.96
IO.95
II.09
II.17
10.95
12.74
14.72***t
63.56***:
0.99s
34.5
32.5
43. I
48.2
52.2
59.4
62.79
19.2
16.5
22.9
23.5
27.8
35.8
36.88
722
986
42.3
57.1
II.91
18.40
9.15
Il.98
148.42***+
27.6
51.4
96.85***
12.5
29.4
68.22
560
I257
30.8
69.2
10.28
13.69
12.05
IO.56
l38.08***
60.2
33.3
I IJ.53**
36.6
lb.4
89.33
Mean
SD
% CES-D
> 6
%:
41.5
0 CES-D
> 24
1:
22.6
,n home
j+
Adults
2. CES-D
VEGA
in home
Health in
last I2 months
Excellent
Good
Fair
Poor bad
Illness or
disability
NO
Yes
M.D. visits
last I2 months
None
2-3
tj
6-9
lot
Life event
last I? months
No
Yes
Confidant
ruppor1
NO
Yes
***p
F.
<O.OOl.
Depressive
symptoms
among
Family
Friends
Clergy
Hum. ser. prov.
!vledical doctor
bkntal
health
T01al
,v
I32
122
67
16
9j
47
479
27.6
2j.j
11.0
3.3
19.8
9.8
100.0
mean'
17.61
18.47
19.31
?j.?j
2 I .95
?9.Sj
20.39
immigrant
hlexicar,
women
649
AND
During
the course of the interview, and the conclusion of the symptom
checklist. respondents
were
asked some questions about the severity and extent to
which these symptoms had disturbed their normal life
functioning.
In those cases where the respondent
indicated being bothered by their depressive symptoms. they were asked about help-seeking behavior in
terms of the type of provider sought for relief of
symptomatology.
The results are presented in Table
3, and include both informal sources of social support
and direct services.
Mean CES-D
scores were lowest for those immigrant women who sought help from informal sources
such as family, friends, and clergy than for those
seeking more formal help. However,
of the 479
women who reported being bothered by symptoms
and who tried to talk to someone about them. about
67% used informal resources. Those seeking help
from mental health providers had the highest mean
CES-D
scores (29.85), followed by users of human
services
providers
(25.25) and medical
doctors
(21.98). However. medical doctors were the formal
resource most likely to be used (19.9%). Obv-iously,
women who were more depressed were much more
likely to seek services from formal providers.
and
among these, the most depressed were likely to seek
services from a mental health provider (P < 0.000).
In Table 3, x were used to test for the significance
of the differences between the proportions
using any
of the informal or formal resources and the proportions using no resources. The tests were run for
women scoring at or above the two CES-D
cutpoints; the usual I6 caseness threshold, and a higher
threshold of 24. Of those who turned to informal
SD
IO.05
10.67
13.28
12.80
II.60
12.75
II.89
CES-D
49.2
16.7
j3.7
7j.0
69-j
80.9
j7.2
> 16+
CES-D
2j.X
25.7
29.9
50.0
40.0
66.0
34.7
3 14:
650
WILLLM
A.
VEGA
ef
al.
reporting
for some time; that most of the formal
services for treating signs of psychological distress are
being delivered by msdical doctors. ahich obscures
the evaluation of rates-in-treatment
and underscores
the importance
of appropriate
diagnoses and treatment in general medical care settings.
The findings reported in this paper depict a poor.
minimally acculturated
cohort of women who ar2
socially isolated and have levels of sducational
attainment that are far below what is considered normative in the United States, Cert;tinly.
from the
perspective of social psychological
stress theory [34],
these women are at far greater risk for depression
than better integrated members of ths general population. However, there are other socially marginal
groups subjected
to multiple
stressors
in North
America. and studies exist documenting
their correspondingly
high levels of psychopathology
[3j-371.
Indeed. it will be interesting to compare the symptom
levels reported
in this study, indexed for socioeconomic status, with the CES-D
data forthcoming
from the Epidemiological
Catchment Area Program
[38] and the Hispanic Health and Sutrition
Examination which include large multiregional
samples,
including Mexican Americans, encompassing
the major sociodemographic
groups found in the United
States. It is our belief that when the major demographic
variables
are taken
into
account,
differences in symptom counts between immigrants
and native born American citizens will be greatly
attenuated.
although they probably will not disappear altogether.
Further, the cohort of women we
have assessed are in middle age, which appears to be
a special risk group within the Mexican American
population.
It will be interesting
to see whether
diagnostic rates for minor depressive disorders also
accentuate the risk proneness of Me.xican immigrant
women over 40 when such data become available.
We would conjecture
that the reasons for the
extraordinary
levels of depressive symptoms in this
cohort of women has its basis in a combination
of
cultural and socioeconomic
factors which may personify poor immigrants
more broadly, but which
focus with particular
intensity on ths middle aged
woman. Family structure and normative expectations
are unstable and deeply conflicted for women undergoing the transitional
processes implicit in the immigration experience. The effort to maintain traditional
cultural role expectations
within the context of highly
urbanized and affluent social systems could be expected to increase stress, and economic marginality
combined with lessened social support compound the
severity of perceived stress and narrow the range of
coping alternatives. Our measure of depressive symptoms, the CES-D,
is known to be v2ry sensitive to
situational stress. This context of high risk for depression should also be prevalent in populations
with
similar demographic
and cultural diff2rences, such as
the Turkish immigrants
in Germany and Sweden.
Perhaps the most intriguing question suggested by
this research but fundamentally
unansvverable using
cross-sectional
data, is the potential for identifying
factors that distinguish successful copsrs within the
immigrant
cohort.
Given the homogeneity
of the
sample, many types of life stressors encountered
by
poor immigrant
women are expected to be nearly
construct of migration and stress developed by Fabrega [-lo] in order to determine if the factors have
any predictive value for depressive symptoms within
this immigrant
cohort.
Ideally,
the information
gleaned will better explain differences in immigrant
adjustment
and related social processes that affect
health and psychological
well being.
The tindings in this paper forcefully suggest the
importance of intervening with new immigrant populations using broad educational approaches as well as
targeted public health interventions.
The finding that
respondents
are very sensitive to the impact of depressive symptoms on their functioning is important
evidence supporting
the viability of public health
interventions
with this population.
REFEREKCES
14. Roberts
651
651
WIm~h4 A. Vx4
er al.
37. Warhcit