3. ETHNICITY ETHNICITY = SOCIAL GROUPS THAT DISTINGUISH THEMSELVES FROM OTHER GROUPS BASED ON SHARED DESCENT, CULTURE, AND IDENTITY VARIES IN IMPORTANCE BY INDIVIDUALS AND GROUPS

4. RECENT INTEREST IMMIGRATION – 10% of all US residents DIVERSITY OF CULTURES MULTICULTURALISM

5. PROBLEMS IN STUDYING ETHNICITY COMPLEXITY OF ETHNIC GROUPS HOW TO SEPARATE ETHNIC CULTURE FROM OTHER FACTORS SOCIAL CLASS, AGE, ACCULTURATION, ETC. CULTURALLY INSENSITIVE INSTRUMENTS

6. 4 WAYS ETHNICITY AFFECTS MENTAL ILLNESS RATES OF MENTAL ILLNESS EXPRESSION OF MENTAL ILLNESS RESPONSE TO MENTAL ILLNESS COURSE OF MENTAL ILLNESS

8. RATES VARY AROUND THE WORLD SCHIZOPHRENIA AND BIPOLAR FAIRLY CONSTANT DEPRESSION FROM 2.4% IN RURAL SPAIN TO 30% IN AFRICAN CITIES PHOBIAS FROM 2% IN PUERTO RICO TO 20% IN SWITZERLAND ALCOHOLISM FROM 1% IN CHINA TO 23% AMONG NATIVE AMERICANS

10. AFRICAN AMERICANS BLACKS HIGHER MORTALITY AND MORBIDITY BLACKS HAVE SURPRISINGLY LOW RATES OF M.I. EXCEPTION - ANXIETY DISORDERS (PHOBIAS) PERHAPS BETTER COPING ABILITIES - SOCIAL SUPPORT, RELIGION

11. HISPANICS HISPANICS TOTALLY INCONSISTENT - SOMETIMES HIGHER, SOMETIMES LOWER LATINO PARADOX LOW RATES OF M.I. AMONG IMMIGRANTS HIGH RATES IN 2 ND GENERATION

12. Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Women and Mexican-origin Women in U.S. 1 NESARC. 2 from M. Medina-Mora et al., in press. U.S. 1 Mexico 2 ImmigrantsU.S. born Alcohol abuse0.41.08.7 Alcohol dependence0.51.711.0 Drug abuse0.00.65.2 Drug dependence0.10.33.2

13. Lifetime DSM-IV Rates (%) of Substance Disorders in Mexican Men and Mexican-origin Men in U.S. 1 NESARC. 2 from M. Medina-Mora et al., in press. U.S. 1 Mexico 2 ImmigrantsU.S. born Alcohol abuse4.915.425.2 Alcohol dependence8.89.619.4 Drug abuse2.31.812.0 Drug dependence0.70.54.5

14. OTHER GROUPS ASIANS - LOW RATES DIFFERENT EXPRESSIONS? NATIVE AMERICANS - MUCH HIGHER RATES ALCOHOLISM, DEPRESSION, SUICIDE

15. CONCLUSIONS RATES VARY TREMENDOUSLY CROSS-CULTURALLY NOT VERY CONSISTENT FINDINGS WITHIN U.S.

17. GROUPS HAVE DIFFERENT ILLNESS VOCABULARIES “STRUCTURING” - GENERAL SENSATIONS BECOME PARTICULAR ENTITIES E.G. DEPRESSION - SOME: PSYCHOLOGICAL - SADNESS, HOPELESSNESS, LOW SELF ESTEEM OTHERS: PHYSICAL -FATIGUE, ACHES, LOSE APPETITE, NOT PSYCH

18. EXPRESSIONS WESTERN CULTURES = PSYCHOLOGICAL EXPRESSIONS NON-WESTERN CULTURES = PHYSIOLOGICAL EXPRESSIONS

19. IMMIGRANTS COMPARE SYMPTOMS OF NEW AND LONG-TERM IMMIGRANTS STUDY OF CHINESE-AMERICANS NEW IMMIGRANTS SHOW MORE PHYSICAL SYMPTOMS LONG-TERM IMMIGRANTS SHOW MORE PSYCHOLOGICAL SYMPTOMS ASSIMILATION CHANGES SYMPTOMS

20. IMPLICATIONS CLINICIANS SHOULD BE SENSITIVE TO CULTURAL NATURE OF SYMPTOMS OUR MENTAL ILLNESSES - DEPRESSION, EATING DISORDERS, ETC. ARE “CULTURE BOUND” TOO

22. PSYCHOTHERAPY WHITES FAR MORE LIKELY TO BE IN P.T. EVEN MORE LIKELY TO STAY IN P.T. BLACKS ESPECIALLY UNLIKELY

23. REASONS FOR ETHNIC DIFFERENCES DEFINITIONS OF M.I. USE OF INFORMAL OR FORMAL RESOURCES TRUST IN MENTAL HEALTH PROFS RESPONSE OF MENTAL HEALTH SYSTEM USE OF MEDICATION

24. RESPONSE TO SCHIZOPHRENIA IN L.A. MEXICANS DEFINE AS “NERVIOS” KEEP IN FAMILY GAP IN COMMUNICATION WITH M.H.P. ANGLOS DEFINE AS PSYCHOSES BRING TO M.H.P. SHARED DEFINITIONS OF PROBLEM

25. COSTS AND BENEFITS MEXICANS DELAYED TREATMENT MORE SEVERITY LESS COMMUNICATION MORE FAMILY SUPPORT WHITES QUICKER TREATMENT LESS SEVERITY MORE COMMUNICATION LESS FAMILY SUPPORT

26. FAMILY SUPPORT MANY ETHNIC GROUPS GREATER SENSE OF FAMILY OBLIGATION AND LESS INDIVIDUALISM LESS ADEQUATE PROFESSIONAL TREATMENT

28. WHO STUDIES OF SCHIZOPHRENIA NINE COUNTRIES (1970’S) FIVE “DEVELOPED” - DENMARK, ENGLAND, U.S., RUSSIA, CZECHOSLAVAKIA FOUR “DEVELOPING” - COLUMBIA, TAIWAN, INDIA, NIGERIA

29. FINDINGS OF WHO COULD DIAGNOSE SAME SYMPTOMS OF SCHIZ IN ALL SOCIETIES COMPARABLE RATES (1%) OF SCHIZ. IN ALL SOCIETIES TWO YEAR FOLLOW UP SHOWS MUCH BETTER RESULTS IN DEVELOPING SOCIETIES

30. WHO FINDINGS ABOUT HALF OF SCHIZ IMPROVE IN DEVELOPING SOCIETIES, LESS THAN 1/3 IN DEVELOPED SO SURPRISED DID ANOTHER STUDY AND FOUND SAME THING

31. REASONS FEWER EXPECTATIONS FOR ACHIEVEMENT IN DEVELOPING SO LESS DISAPPOINTMENT SOCIAL EXPECTATIONS FOR CHRONICITY IN DEVELOPED LESS STIGMA IN DEVELOPING

32. SUMMARY FEW CONCLUSIONS FOR RATES CULTURE AFFECTS WAY PEOPLE EXPRESS DISORDERS CULTURE AFFECTS DEFINITIONS, FAMILY RESPONSE, AND PROFESSIONAL HELP-SEEKING CULTURE AFFECTS COURSE

33. IMPLICATIONS PROFESSIONALS SHOULD BE CULTURALLY SENSITIVE ETHNIC-SENSITIVE PROGRAMS TEND TO WORK BETTER PARTICULARLY IMPORTANT NOW WITH HIGH RATES OF IMMIGRATION