Geriatric Psychiatry: Perceptions, Presentations, and Treatments
11.2 Ethnic and Cultural Infl uence in Mental Health
11.2.1 Ethnic and Cultural Stigma Associated with Mental Health
Stigma , as defi ned by Merriam-Webster, is a set of negative and often unfair beliefs that a society or groups of people have about other individuals or groups. In refer- ence to mental health, Gary [ 8 ] explains stigma as a collection of negative attitudes, beliefs, thoughts, and behaviors that infl uence the individual, or the general public to fear, reject, avoid, be prejudiced and discriminate against people with mental disorders. Gary [ 8 ] also introduces the concept of the double stigma. This occurs when ethnic minorities are confronted with prejudice and discrimination because of their group affi liation are then faced with the additional burden of being diagnosed with a mental illness [ 8 ].
Corrigan [ 9 ] identifi es public stigma as society using stereotypes, prejudices, and discrimination to negatively label the mentally ill. Self or internalized stigma is when someone with mental illness turns negative attitudes toward themselves. This leads to low self-esteem and poor confi dence [ 10 ]. Both types of stigma lead to poor treatment participations and adherence [ 9 ].
Research has shown that ethnic and minority groups experience more shame per- taining to their mental illness diagnosis. Older African Americans are more likely to internalize a mental health stigma and endorse less positive attitudes toward seeking mental health treatment than their White counterparts [ 11 ]. Jimenez [ 12 ] found that both Latinos and Asian-Americans expressed greater shame or embarrassment for hav- ing a mental illness or alcohol abuse problem. In several minority cultures, having mental illness is viewed as bringing shame or disappointment to the family [ 13 , 14 ].
The stigma associated with mental health is often paired with misinformation.
Inaccurate information and stigmatizing attitudes increase the shame associated
with the mental illness, resulting in those affected being socially excluded, discrimi- nated against, blamed, and development of increased levels of recovery pessimism [ 15 ]. Unfortunately, this can result in individuals choosing to live with the detri- ments of the mental illness rather than confront the social pushback associated with seeking help or confi rming the diagnosis.
Jimenez et al. [ 16 ] applied the Cultural Infl uences on Mental Health (CIMH) model to identify cultural attitudes toward the causes of mental illness. In their study, African Americans believed mental illness was caused by loss of family and friends, stress over money, and general stress and worry. Asian-Americans viewed medical illness, cultural differences, and family issues as primary causes of mental illness. Latinos expressed the belief that mental illness is caused by the loss of family and friends, family issues, and moving to a different place [ 16 ]. The stigma of having mental illness in the Latino culture originates in part from a belief that it is a path to going crazy ( volviéndose loco ) or being perceived as witch craft ( brujería ) [ 17 ]. Table 11.1 summarizes Shared Attitudes of Older Ethnic Groups Toward Mental Health .
11.2.2 Acculturation
Factors such as the aging of foreign-born individuals and family unifi cation and refugee admissions have contributed to a growing elderly immigrant population within the United States [ 18 ]. As of 2010, the elderly immigrant population has
Table 11.1 Shared attitudes of older ethnic groups toward mental health Asian Americans, African Americans, and Latino
– Perceived those with mental illness as dangerous – Mental ill lack social skills
– All groups would rather talk to primary care provider versus mental health professional
Older Asian Americans Older Hispanic Americans
Males can shed blood but not tears (old Chinese saying)
– Depression would make family members disappointed – Shorter residence in the US and higher level of
depressive symptoms with associated more negative attitudes toward mental health services – Often present with somatic symptoms – Less willing to speak about mental illness
– Counseling may bring to many bad feelings
– Mental illness is caused by loss of family and friends as well as migration
Older African Americans Common risk factors for suicide – Mental illness is caused by stress and loss – Chronic physical illness – Strong social network is a positive
– distrust of mental health professionals
– Mood disorders and feelings of hopelessness
– Alcohol abuse – Anxiety – Bereavement – Social isolation [ 14 , 16 , 77 , 114 – 116 ]
risen to 4.6 million [ 18 ]. There are both unique and varied characteristics of the elderly immigrant population because of geographical and cultural differences;
however, there are shared challenges due to acculturation into American main- stream culture. Acculturation is an individual’s cultural learning process that occurs while adapting to an alien culture or the gaining of cultural elements of the domi- nant society [ 19 , 20 ]. Acculturative stress refers to tension or strain associated with the acquisition of a second culture that may result in adverse physical or mental health effects [ 20 ].
Researchers have found that the challenges of acculturation affected the preva- lence of certain disorders. Jimenez et al. [ 21 ] found older Latinos had higher 12-month prevalence rates of Major Depression Disorder than non-Latino Whites.
They offer the explanation of intergenerational confl ict [ 22 ]. This is described as when an older generation may feel culturally, socially, or linguistically isolated when the younger generation becomes acculturated. In addition to intergenerational confl ict, the lack of English profi ciency could lead to further social isolation, as well as feelings of depression and anxiety.
11.2.3 Ethnic Identity and Mental Health
Ethnic identity refers to one’s sense of self in broad terms including culture, race, language, or kinship [ 23 ]. Those with a strong sense of pride, belonging, and attach- ment to a racial/ethnic group and participation in ethnic behaviors may be less likely to develop a psychiatric disorder. While those who report as having lost aspects of one’s culture of origin, such a social interaction with other members of one ethnic group may be at increased risk for developing a psychiatric disorder [ 24 ]. Mahoney et al. [ 25 ] reported that the Latino participants worried that their children might forget their cultural traditions of caregiving and adopt what they believed to be the American way of institutionalizing the elderly .
11.2.4 Religious Infl uence in Mental Health
Religion is a powerful cultural force in the lives of older individuals and is related to both mental and physical health [ 26 ]. Older African American and Caribbean Blacks have been shown to have higher levels of religious participation, religious coping, and spirituality than older Whites [ 27 ]. Older African Americans who attended religious services routinely were less likely to have had a lifetime mood disorders [ 28 ]. For Mexican Americans caring for older relatives with long-term or permanent disability, those with higher levels of intrinsic and organizational religi- osity were less likely to perceive their caregiving role as burdensome [ 29 ].
African Americans, as well as several other minority ethnic groups, have devel- oped a resilience that has allowed them to “make it” with the odds stacked against
them (i.e., lower socioeconomic status, lower education, racism, discrimination, etc.). One reason for this is their strong reliance upon religious faith that also serves as a protective factor against suicide [ 30 ]. Unfortunately, this can also affect views toward psychiatric treatment. Religious individuals may refrain from seeking treat- ment options that appear to be disparaging of their religious beliefs [ 31 ].
Individuals who were not previously religious or spiritual prior to diagnosis may turn to religion to cope. Physical and mental illness can force individuals to face mortality. During this time, religion may be used more frequently to cope in order to interpret and explain hardships [ 31 ]. Religion has positive and negative effects on mental health and treatment. Practitioners should examine how these effects may interact to provide the best form of care for patients [ 32 ].