As you saw first in Chapter 1 and elsewhere in the text, sociocultural influences are a major and often overlooked factor in understanding people’s behavior and developmental history. Mental health is no exception; in fact, sociocultural influences must be considered in assessing people’s behavior to understand its meaning more adequately and in designing effective ways to treat their problems (Jang, Borenstein, Chiriboga, & Mortimer, 2005). For example, by the time most minorities reach old age in the United States, they have experienced a lifetime of inadequate health care, greater exposure to environmental risks, and the stress of prejudice and discrimination (see Chapters 3 and 4). Many personally experienced discrimination—and, in the case of Japanese Americans, even internment camps—that affect their trust of the health care system (Haley et al., 1998). Let’s look more closely at the key issues.
In neither the general nor the ethnic populations do most people have mental disorders (Qualls & Layton, 2009; Zarit & Zarit, 2006). Still, very little is known about the nature and extent of the difficulties people face in ethnic populations, especially for groups other than African Americans. Neither positive mental health nor psychopathology has been adequately defined in any group, and no current approach takes social context into account in such a way as to be sensitive to contextual differences in ethnic communities. For example, although many explanations of deviant and antisocial behavior are grounded in the oppressive life conditions that characterize many ethnic communities, the conceptualization of positive mental health for older ethnic groups does not take into account the lifetime accumulation of such effects (Jackson et al., 1995) nor the effects of a lifetime of inadequate access to health care (Miranda, McGuire, Williams, & Wang, 2008). However, such sensitivity to conditions does not preclude finding commonalities across ethnic groups; indeed, identifying such commonalities would be an excellent place to start.
What little data we have suggest both similarities and differences in the incidence of specific types of psychopathology across different ethnic groups. Most epidemiological studies of the prevalence and incidence of mental disorders in young adults show little difference across ethnic groups (Jackson et al., 1995). However, a much more complex picture emerges when older adults are studied (Stanford & DuBois, 1992). For example, among Hispanic older adults, men show higher rates than women of alcohol abuse, whereas women have higher rates than men of phobia and panic disorders. Native American men also have high rates of alcohol abuse. Rates of depression are lower among older African Americans than they are for other ethnic groups (Moulton, 1997).
The complicated relations among age, ethnicity, and risk of developing a mental disorder merely emphasize the importance of including age and ethnicity in studies of psychopathology. Clearly, a life-course perspective that includes ethnicity would be the best approach. But even if such a framework were adopted, we would still be faced with another problem: appropriate assessment of functioning.
People have different ways of describing how they feel. Such differences are amplified by ethnic and cultural differences in what one is supposed to reveal to strangers about one’s inner self. Placed in a context of important differences in social stressors, physical health, and age, assessing mental health in older ethnic adults is a daunting task. Currently, there is disagreement in the literature over some key issues. For example, do ethnicity and social class change the relation between chronic stressors and mental health? To what extent do social support, religiosity, and the family support system buffer people against stress differently across ethnic groups? Answers to these questions are difficult, and the few studies that address them provide inconclusive results (Jackson et al., 1995; Yancura & Aldwin, 2010).
What can be done to determine the ways in which ethnicity influences mental health? Jackson
et al. (1995) argue that researchers should adopt an ethnic research matrix that takes as its defining elements ethnicity, national origin, racial group membership, gender, social and economic statuses, age, acculturation, coping reactions, and mental health outcomes (e. g., psychopathology, positive adjustment). Only by adopting this comprehensive approach can we understand what, how, and when aspects of race, ethnicity, age, and the life course influence mental health.
Concept Checks
1. How is psychopathology defined?
2. What biological factors are important to consider in psychopathology?
3. What is known about the role of ethnicity and aging in mental health?